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India not doing enough to tackle spread of Hepatitis B: WHO report

New Delhi: Hepatitis B poses a huge threat to Indians. Approximately four crore to six crore people in India are carriers of the Hepatitis B virus. This is according to an estimate by the World Health Organization (WHO), which says that two to five percent of India’s population may be affected by the virus. Each year, one lakh patients die of viral Hepatitis (including Hepatitis B and C) in India.

In spite of this, the Union government is not doing enough to curb the spread of the disease, points out a WHO report, which analyses country-level performance in tackling the virus. 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.

The scathing report starts off by stating that in India Hepatitis-related deaths are not reported to the central registry.

“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,” said Dr Rakesh Rai, liver transplant surgeon at Fortis Hospital in Mulund.

Another folly, as city-based liver transplant surgeon Dr Ravi Mohanka says, is that 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?” said Dr Mohanka.

Dr Rai said, “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 which can diagnose viral Hepatitis. Dr Mohanka agrees, “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,” said Dr Mohanka.

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.
India has not definitively established a goal to eliminate Hepatitis B.

“Even though children are being immunized lately, what about the treatment and care of an estimated four crore or more persons who are currently affected by the disease? Also, what about the hidden population that goes undetected and may suffer all their lives or die without knowing what happened to them?” said Dr Bhavna Dhingra Bhan, faculty member, department of paediatrics, All India Institute of Medical Sciences, Bhopal.

Dr Mohanka said, “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.”

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