India is known to have a wide range of infectious diseases such as malaria, dengue, Kala-azar, and tuberculosis. Another challenge that poses a major public health threat that needs to be controlled and eliminated is Viral Hepatitis, which is one of the most infectious diseases caused by several virus including Hepatitis virus.
Globally, India is known to have one of the largest burdens of Viral Hepatitis. According to the National Disease Control Programme (NDCP), an estimated 40 million people suffer from chronic HBV (Hepatitis B Virus) infections in the country.
There are five Hepatitis viruses, referred to as types A, B, C, D and E. These five types are of greatest concern not only because of the illness and death they cause but also they increase the risk of outbreaks and spreads the epidemic.
For instance, Type B and C are the most common cause of chronic Hepatitis, which causes severe liver disease such as liver Cirrhosis, liver failure as well as liver cancer.
Hepatitis A Virus and Hepatitis E Virus are also important causes of acute viral hepatitis and acute liver failure. Hepatitis A and E are caused by ingestion of contaminated food products or water as well as open defecation, which transmits Hepatitis C, causing inflammation of the liver. Since the intestines absorb vitamins, minerals, and nutrients from the food consumed, it makes it difficult for the liver to produce albumin due to which fluids build up in the stomach, causing pain and discomfort. It also causes severe damage to the liver, affecting its functions. It is known that a liver that is functioning poorly cannot remove toxins from the bloodstream, which causes multiple complications.
However, there is limited information about the overall extent of the disease burden. In many States, there is no information related to Hepatitis. Currently, in 2016, according to Integrated Disease Surveillance Programme (IDSP) Hepatitis was reported in four states.
1) Karnataka’s Dakshin Kannada district reported 47 Hepatitis A cases. The situation according to IDSP is under control.
2) Odisha’s Khordha district has reported 84 Hepatitis E cases. Even though no deaths have been reported, the state is under surveillance.
3) Punjab’s Mohali district has reported 123 Hepatitis E cases and is also under surveillance.
4) Himachal Pradesh Solan district reported 586 cases of Hepatitis E. The area is also under surveillance.
5) In Kerala, three districts reported Hepatitis A. While Ernakulam reported 12 cases of Hepatitis A, Malappuram reported 65 cases of Hepatitis A, Thrissur reported 27 cases of Hepatitis A. All three districts are under surveillance.
In each of these villages, Hepatitis outbreaks were investigated and those infected were treated. People were also provided with health education to make them aware of the risk factors and the steps that need to be taken to prevent getting the disease.
However, there is no data about the disease burden in other states like Haryana, Andhra Pradesh, Pondicherry, Arunachal Pradesh and Mizoram, where the prevalence of hepatitis C is much higher compared to other States.
Besides, in states like Jharkhand, especially in unreachable areas and villages away from the mainstream, where water resources and quality of sanitation is extremely poor in households, consumption of contaminated water and food products are important causes of acute viral hepatitis and acute liver failure.
Among the most vulnerable are pregnant women. In these areas, a large number of those who are chronic hepatitis patients do not have provision for free testing or access to timely diagnosis or treatment. Many are not aware of how to prevent themselves from getting infected by Hepatitis.
Currently, few steps have been taken to prevent control and treat Viral Hepatitis.
In order to improve health outcomes for those affected by this infectious disease, multiple steps need to be taken. The government must focus on prevention of Hepatitis. Besides, people across all categories must be provided adequate and timely diagnosis and free treatment of Viral Hepatitis since many cannot afford to pay the cost of treatment, especially in the private sector. It has been found that the cost of treatment is often prohibitive for a lot of patients, both in rural and urban settings. The government must ensure that patients who cannot afford to pay such high prices are provided free treatment and drugs across all states.
It should also be the government’s priority to create awareness in the public about how to control these infectious diseases so that they can prevent themselves and their families from getting infected by Hepatitis.
For instance, across all regions, people should be told how it is important to use safe drinking water and consume food products that are hygienic and ensure clean sanitation in their households and the vicinity where they reside in order to prevent getting exposed to the infectious disease. Open defecation should also be discouraged so that they are not vulnerable to a number of ailments.
Health care profession and health workers like ASHA in rural areas need to be trained as well so that they can identify those who are at risk of viral hepatitis. This would also enable them to provide early diagnosis, and treatment to patients.
If National Viral Hepatitis is to be prevented, controlled and eliminated, it is imperative that public health measures need to be implemented across all states, especially in regions, which are neglected and have limited access to healthcare. Unless the transmission of Hepatitis is eliminated, it will remain endemic across the country, making people susceptible to the severe disease. For that there is a need to undertake surveillance in unreached and ignored areas in order to identify the disease incidence, the mortality and morbidity rates, across all ages.
Overall, to ensure that every person, especially children and pregnant women gets appropriate care and protection from Hepatitis, apart from spreading awareness in the public and health care system, especially health professionals, it is important that there is strict implementation and monitoring of health practices, only then can Hepatitis be prevented and eradicated in India.
(Mohuya Chaudhuri is a journalist and researcher)