India needs to strengthen its effort to tackle spread of Hepatitis B: WHO report

Hepatitis B poses a major threat to Indians. World Health Organization (WHO) estimates that approximately 40-60 million people in India are carriers of the Hepatitis B virus and the virus may affect two to five percent of India's population. Each year, 100,000 patients die of viral Hepatitis (including Hepatitis B and C).

A WHO report, which analyzed country-level performance in tackling the virus points out that the Union government is not doing enough to curb the spread of the disease.

The WHO report has severely criticized India's approach to tackling Hepatitis B, after conducting a global survey of nations and their policies on awareness-raising and partnerships, steps to prevent transmission, as well as taking adequate care for screening and treatment.

This means that we in India do not know for sure, as to how many persons are infected with Hepatitis or are dying because of it. Rough estimates are drawn by WHO at a regional level, but the Union Health Ministry in India has no specific data to compare.

A large number of general practitioners diagnose jaundice, which is the initial symptom of Hepatitis A, E (non-infectious) and B, C (infectious), but do not recommend specialized blood tests.

They treat jaundice based on suspicion with basic medications, but may not test the blood for viral or non-viral Hepatitis. These cases are missed. The government has not made it mandatory for Hepatitis to be reported. How can it maintain data then?

Thus every patient who acquires jaundice is a high risk patient of viral Hepatitis (B or C) and to eliminate any long-term risk to health, like near-lethal deterioration of the liver, must mandatorily get the screening tests done for viral Hepatitis.

The WHO report also notes that there are not enough laboratories in the country to diagnose viral Hepatitis. The Indian labs are equipped with antibody tests to screen blood for Hepatitis virus. But the precision of these tests is merely 80%. Twenty percent of the time, the virus may get missed. Blood transfusions to patients under such risky circumstances are a reality. Also, Hepatitis virus of the B and C type may not get picked up during the window period of 4-6 weeks after a person is infected.

The high quality NAT testing mechanism for blood rarely found in pathology laboratories around the country. Testing the blood through NAT will increase the cost per transfusion by Rs1000. It is still a long road. With NAT though, one can be 100% sure that the blood is free of any virus including Hepatitis. One must always insist on getting the blood tested by NAT mechanism before it is being transfused to patients who are our friends or relatives.

India has not definitively established a goal to eliminate Hepatitis B. The WHO report points out that that there is no national public health research agenda for viral Hepatitis, neither is any routine screening done amongst the general population.

The government should step up its act and intervene by framing policies to tackle Hepatitis B and C. Every patient who comes to a public hospital should be screened for Hepatitis and treatment should be made available for free. Also, screening of all high-risk groups like sex workers and drug users should be made mandatory. Vaccination against the disease amongst adults should be promoted. Any adult can and should get vaccinated against the virus to be on the safer side.

Hepatitis B is new health threat in Nigeria

The absence of funding (local and foreign donor agencies) and lack of awareness for Hepatitis B virus (HBV) are fuelling the disease burden in Nigeria, which has led to millions of Nigerians developing liver cancer/liver cirrhosis, leading to high medical expenses and loss of income.

While local and foreign agencies spent about $400 million to combat HIV and AIDS in Nigeria, according to the National Agency for the Control of AIDS (NACA), Hepatitis B virus has received no foreign support. Medical experts say it is the responsibility of the Federal Government to design a local model to address the ailment, as it is not a priority to foreign donor agencies.

This advice is coming as the World Health Organisation (WHO) estimates that about 19 million Nigerians have HBV virus, of which about 20 percent are chronic carriers and 40 percent of HBV carriers, likely to die from liver cancer or cirrhosis. Many experts consider hepatitis as an orphan disease in Nigeria, as it has not attracted the attention it deserves, especially as it is several times more infectious than HIV. The government should consider declaring hepatitis a national emergency similar to HIV.

The complexity of hepatitis disease lies in the existence of different types of the virus. Hepatitis B, C, and D are spread by infected body fluids including blood, by sexual contact, mother-to-child transmission during birth, or by contaminated medical equipment. Hepatitis B and C have a greater health burden in terms of death, as they can cause life-long infection which can lead to liver cirrhosis and cancer. In fact, chronic hepatitis is the leading cause of liver cirrhosis and cancer.

Hepatitis B can be prevented by reaching every child with immunisation programmes. The fact that many hepatitis B and C infections are silent, causing no symptoms until there is severe damage to the liver, points to the urgent need for universal access to immunisation, screening, diagnosis and antiviral therapy.

Meanwhile, the WHO has urged governments to act against the five hepatitis viruses (Hepatitis A, B, C, D and E) that can cause severe liver infections and lead to 1.4 million deaths annually.

The WHO findings show that 37 percent of countries have national strategies for viral hepatitis, and more work is needed in treating hepatitis. While most of the countries (82 percent) have established hepatitis surveillance programmes, only half of them include the monitoring of chronic hepatitis B and C, which are responsible for most severe illnesses and deaths

Hepatitis B leading to high rate of liver cancer among Asian Americans

Cancer is the leading cause of death for Asian Americans. The most common types of cancer for Asian Americans are liver cancer, stomach cancer and cervical cancer. Breast cancer has also been increasing among Asian Americans. 

Approximately 1 in 12 Asian Americans live with a chronic hepatitis B infection, but too few Asian Americans know that chronic hepatitis B infection is a risk factor for liver cancer.

Hepatitis B is most commonly transmitted from mother to child, which is why vaccination of infants is most important. Hepatitis B can also be transmitted through sexual intercourse with someone who is infected.

Centers for Disease Control and Prevention (CDCP) has launched a campaign to educate the Asian American and Pacific Islander (AAPI) community on the risks of hepatitis B infection. The Know Hepatitis B campaign is the first national multilingual, multi-year communications campaign to increase hepatitis B testing among AAPIs. The campaign aims to improve awareness, advocate for improved testing, improve care and treatment and improve health outcomes for AAPIs. 

Hepatitis B affects ones livelihood and mental health. Many individuals who have hepatitis B perceive the effects of stigma from the disease, which affects their contributions and impact in one’s family and community. Not addressing hepatitis B could have grave societal and cost implications and further isolate the AAPI community. It is important to implement culturally appropriate programs and outreach so that more AAPIs will be aware of the disease and get screened. Many nonprofit organizations works directly with community members to hold screenings, public events and educational receptions. After the free screenings, the organizations pass on the results of the blood tests and if any are found positive, the organization connects patients to care or treatment. It is important for the outreach organizations to use the native language, especially among older generations. 

One of the obstacles some AAPIs, including Vietnamese, face is that they either do not have health insurance or they do not have access to primary care doctors. They want to come but they don’t have the means to come. The organizations have to ask support from local agencies and also private donors to help them out with that.

Hepatitis b affects many Asian communities and it’s known to be a silent killer. As many of the people that are part of these communities come from countries where there’s a high prevalence rate for hepatitis and so that’s why the awareness program is so important. 

The National Cancer Institute advises everyone to get a blood test from their health care provider to see if   they are infected. If the blood test comes back positive, the health care provider will conduct further tests and recommend treatment.

Treatment for those with hepatitis B is available to slow liver damage. The hepatitis B infection is also preventable with a vaccine that involves three shots given over six months.