Unveiling the Silent Epidemic and the Urgent Need for Awareness this World Hepatitis Day

In India, this silent epidemic continues to claim lives, largely due to a lack of awareness, persistent myths, and inadequate access to timely diagnosis and treatment. This year, as we mark World Hepatitis Day, it's imperative that we confront these challenges head-on and foster a more informed and proactive approach to liver health.

 

Hepatitis, an inflammation of the liver, is caused by various viruses (A, B, C, D, E). While Hepatitis A and E are typically acute and self-limiting, Hepatitis B and C can lead to chronic infections, progressing to severe liver diseases like cirrhosis and liver cancer if left untreated. India carries a significant burden of this global crisis, ranking second only to China in the number of hepatitis B and C cases worldwide.

 

Lesser-Known Facts and Startling Statistics in India

 

Despite the alarming numbers, many facts about hepatitis in India remain largely unknown to the general public:

 

A Hidden Epidemic: The World Health Organization (WHO) estimates that over 52 million Indians are infected with hepatitis, with a staggering 95% of those with chronic hepatitis unaware of their condition. This "silent" nature of the disease means many are diagnosed only when liver damage is advanced.

 

Significant Burden: India accounts for approximately 11% of the estimated global burden of chronic Hepatitis B and between 6-12 million people are chronically infected with Hepatitis C. In 2022 alone, India registered 2.98 crore Hepatitis B cases and 55 lakh Hepatitis C infections.

 

Geographical Disparities: While the national prevalence of chronic HBV is around 3-4%, certain regions like the Andaman and Nicobar Islands and Arunachal Pradesh show significantly higher prevalence rates. Pockets in Punjab, Haryana, and Mizoram also report higher rates of Hepatitis C. Tribal populations are particularly vulnerable, with prevalence rates for HBV as high as 15.9%.

 

Unsafe Practices are Key Drivers: Despite blood screening being mandatory since 1992, unsafe injections remain a major cause of transmission. India contributes to 25-30% of the global load of unsafe injections, with a frequency of 2.9 injections per person. Outbreaks of acute hepatitis B due to inadequately sterilized needles and syringes are still reported, as seen in Modasa, Gujarat. Unsafe practices like tattooing, traditional medicine involving bloodletting, and body piercing in some regions also contribute to HCV transmission.

 

Mother-to-Child Transmission: While vertical transmission of Hepatitis B from mother to child is a significant concern, its role is often underestimated. Prevention of mother-to-child transmission (PMTCT) through neonatal vaccination and peripartum antivirals for HBeAg-positive mothers is crucial but often lacks adequate coverage.

 

High Mortality: The WHO's 2024 Global Hepatitis Report indicates that deaths due to viral hepatitis are increasing, with 1.3 million deaths globally in 2022. In India, chronic HBV infection accounts for 40-50% of hepatocellular carcinoma (liver cancer) and 10-20% of cirrhosis cases. Hepatitis E is a significant cause of acute liver failure, with an inordinately high mortality rate of 15-25% in pregnant women in their third trimester.

 

Persistent Myths and Misconceptions

 

Despite scientific advancements, several deeply ingrained myths continue to hinder effective prevention and treatment efforts in India:

 

Myth: All Hepatitis infections are fatal.

Fact: While some forms can be severe, many people with hepatitis, especially A and E, recover fully. Even with chronic hepatitis B and C, timely diagnosis and treatment can prevent progression to severe liver disease and enable individuals to live healthy lives.

 

Myth: Hepatitis is a hereditary/genetic disease. 

Fact: Hepatitis is not inherited. Viral hepatitis is caused by viruses. While Hepatitis B can be transmitted from mother to child during childbirth, this is not a genetic inheritance but rather a perinatal transmission that can be prevented with proper medical intervention.

 

Myth: Hepatitis is untreatable, and only herbal medicines or Ayurveda are effective. 

Fact: This is a dangerous myth. Effective antiviral therapies are available for Hepatitis B and C, which can suppress the virus and even cure Hepatitis C. Relying solely on unproven remedies delays crucial medical intervention and can worsen the disease.

 

Myth: Hepatitis B spreads by casual contact like touching, coughing, or sharing utensils. 

Fact: Hepatitis B is primarily transmitted through contact with infected blood or other bodily fluids (e.g., unprotected sexual contact, sharing needles, from mother to child during birth, or through contaminated medical equipment). Casual contact does not transmit the virus.

 

Myth: Hepatitis C goes away without treatment. 

Fact: Approximately 80% of individuals exposed to Hepatitis C develop chronic infection. While a small percentage might clear the infection spontaneously, for most, it becomes a long-term disease requiring treatment to prevent severe complications like cirrhosis and liver cancer.

 

Myth: Hepatitis and jaundice are synonymous, and all hepatitis patients have jaundice. 

Fact: Jaundice is a symptom of hepatitis, not the cause. It occurs due to bilirubin buildup. Many people with hepatitis, especially chronic cases, may not experience jaundice or any noticeable symptoms for years.

 

Myth: There are vaccines for all types of hepatitis. 

Fact: Currently, effective vaccines are available for Hepatitis A and B. There is no vaccine for Hepatitis C, though it is curable with antiviral medications.

 

The Imperative of Awareness on World Hepatitis Day

 

World Hepatitis Day on July 28th, commemorating the birthday of Nobel Laureate Dr. Baruch Samuel Blumberg who discovered the Hepatitis B virus, provides a unique platform to:

 

Break the Silence: Encourage open conversations about hepatitis to dismantle the stigma associated with the disease. Stigma often prevents individuals from seeking testing and treatment, leading to delayed diagnosis and worse outcomes.

 

Promote Testing and Early Diagnosis: Emphasize that a simple blood test can detect HBV or HCV even before symptoms appear. Early detection is critical for initiating timely treatment and preventing progression to severe liver disease.

 

Advocate for Vaccination: Highlight the importance of Hepatitis B vaccination, especially for infants and high-risk adults. India's Universal Immunization Programme includes Hepatitis B vaccination, but continued efforts are needed to ensure high coverage and address vaccine hesitancy.

 

Stress the Importance of Safe Practices: Reinforce the significance of safe injection practices, screened blood transfusions, and safe sexual practices to prevent transmission.

 

Educate Against Myths: Actively debunk common misconceptions that lead to fear, discrimination, and a reliance on unproven remedies. Accurate information empowers individuals to make informed health decisions.

 

Improve Access to Care: Advocate for strengthening healthcare systems to provide comprehensive hepatitis services, including affordable testing, treatment, and ongoing care, especially in primary care settings and remote areas.

 

This World Hepatitis Day, let us remember that "Hepatitis Can't Wait." It's time for collective action – from individuals taking responsibility for their liver health to policymakers ensuring equitable access to prevention, diagnosis, and treatment. By dispelling myths, spreading awareness, and promoting proactive healthcare, we can collectively work towards a hepatitis-free future for India

 

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