Start the Hepatitis Fight Now
Amar was four and Anand six (names changed) in 1990 when I was treating their father, a bureaucrat, for hepatitis B. He had been in a road accident in the 1970s and had got blood transfused from a professional donor, which possibly infected him with the hepatitis B virus (HBV). He was too sick and we lost him. Both kids, on screening, also tested positive for HBV. Interferon was given to both, but it failed in Amar. Five years later, Amar came to me saying, “Uncle, I have a pain in my tummy.” His ultrasound showed a large cancer in the liver to which he succumbed soon after. It wasn’t his fault. He was born to a mother who had got hepatitis B from her husband (transmission is by blood and body fluids). Amar could not choose his mother. The story is the same for children born to some 257 million people. Completely unaware, 1-2 per cent of them die every year; there were 887,000 deaths in 2015, mostly of liver cirrhosis and cancer. Nearly 40 million, four per cent of Indians, are infected with HBV; second only to China. Another blood-borne virus is the hepatitis C virus (HCV), afflicting 170 million globally and nearly one per cent [12 million] Indians. Again, cirrhosis and cancer lead to deaths.
How do we eliminate these deadly viruses and diseases? Well, start with preventing new infections and treating the infected. The hepatitis B vaccine is safe, and given at birth, and at six and 14 weeks, could protect every newborn. Taiwan started it in 1984 and brought hepatitis B prevalence down from 14 per cent to less than one per cent in 20 years. India woke up in 2011, but it needs to improve compliance of its birth dose from the 47 per cent now to 90 per cent. Society has to pitch in and partner the ‘No nursery admissions without hepatitis B immunisation certificate’ campaign. For doctors and paramedics, too, repeated exposure to HBV patients is an occupational hazard. Still, some 40 per cent never take full vaccination or care to check their immunisation status (antibody level greater than 10). This should be mandated. There is no vaccine against HCV.
India also needs to make its blood safer by upgrading to nucleic acid testing (NAT) to detect viruses during their incubation period. Treating the pool of infected can eliminate the source of hepatitis B and C spread. The challenge is to find the carriers, as both viruses are stealthy invaders. As HBV is mostly transmitted from mother to baby, screening family members increases the chances of yielding another positive by five times. For HCV, the best approach is to invite and test everyone who has undergone surgery (cost: Rs 30), intervention (angiography, dialysis, etc.), or received blood before 2001 (when HCV testing was made mandatory in blood banks). Of course, reuse of needles and syringes should be banned.
The social stigma of hepatitis B is still terrible. Marriages are broken, babies aborted—all this scares off the ‘potential positive’ from opting for treatment. Worse is the loss of jobs. While courts shower rights on the HIV positive, there is no sympathy for hepatitis patients. This stigmatising of 50 million of Indian citizens must stop. What India needs now is a national viral hepatitis elimination programme with clear end-points. Full vaccination coverage and treating of all infected should be ingrained in our national health policy. WHO has set 2030 as the target year for elimination of HCV, for which drugs are nearly 100 per cent effective and the cheapest in India. It must be strictly adhered to (a three-month treatment costs Rs 7,500). The Indian government is providing HIV and TB diagnosis and treatment free. HIV prevalence is only 0.3 per cent, but it had a budget of nearly Rs 13,000 crore for 2012-17. HBV and HCV together infect five per cent of Indians, with the death rate several hundred times higher. With a commitment of Rs 8,000 crore, India can eliminate HCV before 2030. Industry, with its CSR initiatives, could do a lot for this cause. We shouldn’t let another World Hepatitis Day (observed on July 28) pass without a concerted effort to eradicate the deadly disease.