Hepatitis: India's silent killer

The silent epidemic is playing havoc with the lives of millions of Indians. But those suffering from this chronic disease remain in the dark about their infection, reports Rashme Sehgal.

50 million Indians are suspected to be suffering from inflammation of the liver due to hepatitis, but the majority remain unaware of it.

This silent epidemic is playing havoc with the lives of millions of Indians, but those suffering from this chronic disease remain in the dark about their infection.

The virus can enter the body from very common sources including body fluids.

A son can get Hepatitis B by using the toothbrush of his father who is not aware that he has the infection.

Sharing a razor with an infected person can cause it as can infected saliva.

It can be passed on from infected blood or from an infected needle as also from sexual contact. Like AIDS, the disease can spread from a pregnant mother to her unborn child.

But this disease, unlike most others, will remain dormant in the individual for several years, before it gets manifest and when it does, it will show up as liver cirrhosis and cancer of the liver.

"Hepatitis B (HBV) and C (HCV) are taking a huge toll in the lives of Indians because of this lack of knowledge," says Dr Rakhi Maiwall, a heptalogist at the Institute of Liver and Biliary Sciences in New Delhi.

"The lack of symptoms only makes the situation worse. Acute infections can occur with limited or no symptoms. Sometimes patients come to us complaining of nausea and extreme fatigue," she says.

"The disease can also be manifest in jaundice or when they have fluid in a patient's legs," Dr Maiwall adds.

"Following the diagnosis," she explains, "the situation is worsened when relatives come to know their family member is suffering from hepatitis. The patient will be ostracised and no attempt is made to provide her/him any kind of emotional support."

"That is why it was important that someone with the stature of Amitabh Bachchan to come forward to help create an awareness about how he picked up this disease. He highlighted, how following an accident on the sets of the movie Coolie, he was given 60 bottles of blood and obviously one of those bottles contained infected blood," says Dr Maiwall who spends a lot of time counselling patients and their relatives so that they can empathise with the patient.

When doctors first inform a patient that HBV has entered her/his body several years ago, s/he goed into a state of shock.

"Patients begin to suffer from a feeling of inferiority. How did they get infected? Why were they singled out? Other members treat them with suspicion and ostracise them. I find that if one member of a family is infected, it is better to screen all the other members because my experience is that multiple members in a family can be similarly infected," she adds.

"A horizontal transfusion is taking place from needles as also a vertical transfusion from mother to child. Of course, I need to add that from the 20 individuals who may be infected with this virus, 19 will steer clear of it, but one individual will develop the disease," Dr Maiwall explains.

"An epidemiological study was conducted across 5,500 randomly selected population around Ludhiana one year ago," says Dr Ajit Sood who heads the haematology department at the Dayanand Medical College in Ludhiana. "While HBV was found prevalent in 1.5 per cent, the rate of infection for HCV has gone up to 5 per cent of the population."

A survey conducted in Srinagar also found the rate of infection of HCV to be 5 per cent of the population.

"The last ten years have seen an increase in the use of intravenous drugs and this has been found to be one of the contributory factors," says Dr Sood. "HCV is also transmitted through exposure to infected blood as also through injection drug use. Sexual transmission is also possible, but is much less common."

Such a high rate of infection in the population is a major source of concern because these diseases are silent killers.

India has no figure about the number of deaths from HBV and HCV, but globally the World Health Organisation attributes over one million deaths annually to viral hepatitis infections.

Globally, around one out of every three people in the world (around two billion people) are infected by HBV and one in 12 live with chronic HBV or HCV infection.

The frightening aspect is that people suffering from this debilitating or fatal liver disease are unknowingly transmitting this infection to others.

"The good news is that even though the disease cannot be cured, it can be controlled by oral drugs including interferon," points out Dr Maiwall.

It is keeping this in mind that UNICEF has launched an important initiative to include the HBV vaccine in its Indradhanush vaccination programme for infants. This, they believe, is one of the most important steps required to combat the disease.

"We do not know the exact number of infants born with this disease because we would need to know just how many mothers have it," says Dr Gagan Gupta, officiating chief of health, UNICEF.

"Most data comes from blood donors which can have a variation of between two to eight per cent," he says. "Going by present statistics we believe around 1 million kids born every year are at risk."

"Adding this antigen will play an important role in controlling this disease with infants," says Dr Gupta adding that the full immunisation coverage for the 26 million children born in India every year is around 65 per cent.

"From this," he says, "nine million kids are not getting full immunisation and the government needs to reach out to them on a priority basis."

The way out is to treat those already infected with timely access to testing, care and effective treatment. Early diagnosis allows for the adoption of safe sex practices and also allow for introduction of lifestyle precautions like eliminating alcohol and certain drugs which are toxic for the liver. These interventions will go a long way in protecting the liver from further harm.