Start the Hep­ati­tis Fight Now

India Today - - UPFRONT - DR S.K. SARIN Dr S.K. Sarin is di­rec­tor, In­sti­tute of Liver and Bil­iary Sci­ences, Delhi

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.

Il­lus­tra­tion by ANIR­BAN GHOSH

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