The vaccine for Hepatitis B Virus (HBV) was launched in India in 2002. Despite the availability of the Hepatitis B Virus (HBV) vaccine in the country, disease burden of HBV in India is rated as “intermediate to high endemicity”. And, the lack of adequate knowledge has deferred detection, treatment and diagnosis of HBV resulting in a potential life-threatening disease.
Viral Hepatitis, an infection that damages the liver, has been regarded as one of the serious global public health problems, according to the World Health Organisation. In view of it and to raise global awareness of the global burden of Viral Hepatitis, Dr Baruch Blumberg developed the vaccine for Hepatitis B virus in 1969. In 1976, he won the Nobel Prize in Medicine for his discovery of the hepatitis B virus.
It may be mentioned that there are five types of viral hepatitis namely Hepatitis A, B, C, D and E. Out of it, Hepatitis B and C tends to be more dangerous and can become chronic if proper and timely treatment is not provided to the person with the infection.
HBV and Hepatitis C Virus are transmittable from an infected person to uninfected person through blood, fluids, unsafe sex, mother to child, etc. Both HBV and HCV are considered equally serious and dangerous. But there is a lack of awareness about it among the people. It seems people are more concerned and aware about HCV than about HBV. And while there is a vaccine to prevent HBV, there isn’t any for HCV. But surprisingly, the number of HBV cases is much higher than that of HCV both in the global context and national level.
In an exclusive interview to the Imphal Free Press, Dr Khumukcham Lokeshwar Singh, medical superintendent at Jawaharlal Nehru Institute of Medical Sciences, Imphal, said that Hepatitis B is an infection that can be easily preventable by vaccination. Yet, the infection is life threatening if it becomes chronic and the liver is severely damaged, he said.
Dr Lokeshwar was former nodal officer of Model Treatment Centre for Hepatitis, JNIMS.
According to the WHO, 2019 report, 354 million people are infected by Hepatitis. Of which, 269 million are infected by Hepatitis B Virus and 58 million by Hepatitis C virus. The most unfortunate part is that 67 per cent to 70 per cent of the population does not know about hepatitis status in the world.
The WHO states that about 30 per cent of the disease burden due to viral hepatitis is located in the South-East Asia Region. It is estimated that 100 million people are infected by HBV and 30 million people by HCV, Dr Lokeshwar Singh said.
The medical superintendent further said that as per a report of the National Centre for Disease Control under the directorate general of Health Services, the Health and Family Welfare Ministry has stated that India has “intermediate to high endemicity” for Hepatitis B surface antigen. It is estimated that 40 million people in the country are infected by chronic HBV constituting approximately 11 per cent of the estimated global burden whereas six million are infected by HCV.
The MS pointed out that because of lack of proper knowledge and fear of stigma and discrimination regarding the infection, only a few people come forward for vaccination and screening of HBV. It is high time to scale up the awareness on significance of vaccination for HBV and early screening followed by proper and timely treatment, he said.
Regarding transmission of HBV, he said that Hepatitis B is most commonly spread from mother to child at birth (prenatal transmission), exposure to infected blood, sharing of contaminated syringe. As such, tattooing, piercing, drug injection, sex work, dental treatment, blood transfusion are some of the possibility of HBV transmission.
Chances of the HBV infection becoming chronic are higher among children than in adults. On an average, the HBV infection in 90 per cent of children becomes chronic. But in the case of adults, less than five per cent of cases lead to chronic hepatitis. Therefore, every mother should do hepatitis screening mandatorily during the pregnancy period and give hepatitis B vaccine to the baby within 24 hours of delivery, he added while highlighting the essence of prioritising infant and childhood vaccination.
Dr Lokeshwar also said that HBV is a silent killer as people hardly experience symptoms during the early stage of infection. People have acute illness like vomiting, passing of dark urine, extreme fatigue, skin and eye turning yellowish in colour, fever, back pain, abdominal pain etc when they become chronic to infection. Not showing any symptoms in the early period is one of the main reasons people are least bothered about getting screened and updating Hepatitis status.
The MS further said that early detection of HBV not only prevents the infection from becoming chronic but also stops further transmission to uninfected persons. Anybody who has doubts of being infected with HBV infection should get their status confirmed at the earliest.
There is no need to worry even if the person is being infected because through proper treatment the virus can be kept under control. Treatment would help to slow down the infection rate of the liver thereby reducing the progression of cirrhosis and liver cancer, he added.
Screening and treatment of hepatitis is provided free of cost under the National Viral Hepatitis Control Programme, he stated.
Dr Lokeshwar further informed that there are two model treatment centres in Manipur. One is located at RIMS and another at JNIMS. In JNIMS, as many as 600 people were treated for HCV and around 200 for HBV. People should avail the facilities maintaining strict norms of treatment to overcome this public health issue and achieve the goal of elimination of viral Hepatitis by 2030.
Stating about the state's context, the MS said that no particular survey has been carried out to figure out the prevalence rate of the state. However, some private entities expressed concern in view of the presence of a high number of injecting drug users.
Manipur being one of the states having a serious issue of drug menace, there is a need to scale up screening of viral hepatitis. For this, collective effort from every corner is much needed, he said, stressing upon making the observance of World Hepatitis Day meaningful.
The WHO observes World Hepatitis Day every year as one of its nine annual health campaigns with an objective to enhance awareness on hepatitis. This year too, it was observed under the theme “Bringing hepatitis care closer to you” which defines the easy accessibility of hepatitis care to eliminate it.
Even in the state of Manipur, service for hepatitis care is available at free of cost. The Manipur government has also opened two Model Hepatitis B Treatment Centres at JNIMS and the Regional Institute of Medical Sciences (RIMS). The centres were launched by Chief Minister N Biren Singh on the occasion of World Hepatitis Day 2021. The CM then informed that as per the National Viral Hepatitis Control Programme, a total of 29,414 people had been screened for Hepatitis B and 35,036 for Hepatitis C so far. Of the total screened, 1,519 were found positive and 1,225 were undergoing treatment, while 861 had undergone complete treatment.
To make the service more successful, great support and cooperation from society is also a must, Dr Lokeshwar said, while appealing to people of the state to motivate and counsel high risk groups to get tested for HBV. People should get vaccinated for prevention of the life-threatening disease instead discriminating or sidelining people with the infection, he added.