Thousands of young people in the state of Manipur in Northeast India are driven to drug addiction and are suffering from viral Hepatitis infections. With an increasing number of young people falling prey to drug addiction, the highest number of people being treated for Hepatitis B Virus (HBV) in the state under the National Viral Hepatitis Control Programme is found to be in the age group of 20-30 years.
In view of the worrying situation, Manipur started the implementation of Hepatitis B control programme on July 28, 2021 though the “National Action Plan-Viral Hepatitis” was launched on February 24, 2019, in the effort to eliminate the infection. The National Action Plan provides a strategic framework based on which the National Viral Hepatitis Control Programme (NVHCP) was framed and launched in July 2018 under the National Health Mission by the Health and Family Welfare Ministry.
HBV started to spread in Manipur as the problem of drug menace worsened. The state has been facing the problem of drug menace for more than three decades now. In a bid to address the issue, the state government launched the war on drugs. Despite such anti-drugs campaigns and other concerted efforts to check the spread, the situation is getting worse by the years.
The uncontrolled drug menace pushed up the prevalence of HIV and AIDS in the state. Viral Hepatitis B and C are some of the common co-infectious diseases of HIV and AIDS. But there is no specific data to ascertain the prevalence rate of HBV and Hepatitis C Virus (HCV) infection in the state.
However, according to data received from the Directorate of Health Services, Government of Manipur, the highest number of Hepatitis B treatment under NVHCP is received by youth between the age group of 20-30 years so far.
Speaking exclusively to the Imphal Free Press, state nodal officer of NVHCP, Dr RK Rosie said, “Like in other parts of India, Manipur also launched NVHCP on World Hepatitis Day in 2018 i.e. July 28, 2018 and the National Action Plan was rolled out in 2019. However the treatment of HBV was started only from July 28, 2021 at the Jawaharlal Nehru Institute of Medical Sciences (JNIMS) and the Regional Institute of Medical Sciences (RIMS). Then, COVID-19 pandemic hindered the programme in reaching every nook and corner of the state.
Now, two more Hepatitis B treatment centres have been opened in the state, one at the District Hospital Churachandpur and the other at District Hospital Chandel.
With the normalisation of COVID-19 pandemic, they expanded the viral hepatitis control programme. They had started providing training in connection with Hepatitis B treatment to healthcare workers of five district hospitals such as Churachandpur, Chandel, Ukhrul, Thoubal and Tamenglong, she added.
The nodal officer said that HBV and HCV is considered to be a silent killer as the majority of the infected persons do not know their hepatitis status until it becomes chronic. It is estimated that the prevalence rate of HBV in India is approximately 4 per cent of total population while HCV is one per cent of the total population.
Dr Rosie further said that there is no specific data for prevalence rate of HBV and HCV in Manipur at present. However, a survey was carried out for prevalence rate of HBV and HCV as a part of HIV Sentinel Survey carried out by the Manipur State AIDS Control Society under the National AIDS Control Organisation (NACO). The survey is almost completed and the report would be published soon, she said.
“Once the survey report is published, we would be able to implement the NVHCP in a more efficient manner,” she added.
According to Dr Rosie, since July 28, 2021, as many as 280 people are under treatment for HBV in the state. Of the total, 202 are male while the remaining 78 are female, she said.
The number of people treated in the age group between 18 to 20 years (The HBV treatment can be availed from 18 years and above) is 17; 20 to 30 years age group is 73, range of 30 to 40 is 64; age between 40 to 50 is 58, age between 50 to 60 is 39 and 60 above is 29, she informed.
The World Health Organisation aims to eliminate viral hepatitis by 2030. To accomplish it, the Government of India had launched the NVHCP, providing free screening and treatment. Under the programme, free vaccination for Hepatitis B was started for healthcare workers as a priority group, she said.
As the route of transmission of HBV and HCV is through contaminated blood or by product of blood, HBV vaccination will start soon for high risk group such as injecting drug users, same sex partners, female sex workers, migrants, dialysis patients and persons who frequently transfuse blood.
Dr Rosie said as HBV is one of the silent killers, early detection, vaccination and treatment (if tested positive) are the best ways to stop spreading of HBV. As such screening of high risk groups is still going on in full swing in every primary health centres, community health centres and district hospitals. Anybody, including the general population, can avail this HBV screening facility.
Vertical transmission (mother to child transmission) is also the most common route of transmission. So Hepatitis B Immunoglobulin is provided in every maternity centre to prevent transmission of HBV from mother to child. As such every expecting mother should do screening of Hepatitis B during their pregnancy period and do institutional delivery for sure, she added.
Pointing out that both HBV and HCV are liver infections, she said the probability of causing severe liver cirrhosis is higher among HBV patients than to that of HCV. Also, treatment of HBV is life-long while HCV can be treated during a certain period of time.
Although Hepatitis B Virus is more dangerous, it has vaccines to prevent. Therefore, people who are doubtful of their status should screen as early as possible, she added.
As HBV and HCV are co-infectious diseases of people living with HIV and AIDS (PLHIV), she explained that the Anti-Retroviral Therapy (ART), treatment for PLHIV is not effective if the PLHIV has co-infection of HBV or HCV. As such many PLHIV have died of HBV or HCV and not because of HIV or AIDS due to late detection.
Appealing to people of the state to “test and treat”, she said it is the only option to wipe out viral hepatitis. Test and treat not only keep the infected patient safe but also halts the spreading of virus to others. People should come out for screening, particularly the high risk group at least once or twice in a year, Dr Rosie added.
It may be mentioned that India is one of the few countries in the world to roll out public health management of Hepatitis B and Hepatitis C and offer free diagnostics and treatment drugs lifelong to its beneficiaries.
According to WHO estimates, viral hepatitis caused 1.34 million deaths globally in 2015, a number comparable to deaths due to tuberculosis, worldwide. In India, it is estimated that there are 4 crore people suffering from Hepatitis B and 0.6-1.2 crore people suffering from Hepatitis C.