Background

Viral hepatitis is a global public health problem of epidemic proportions that caused 1.34 million deaths in 2015 a number comparable to deaths caused by tuberculosis and higher than those caused by HIV. Infection can be caused by the five known hepatitis viruses – A, B, C, D and E (HAV, HBV, HCV, HDV and HEV). Many of these infections are preventable. Hepatitis B and C are responsible for 96% of overall hepatitis mortality.

Indian Scenario

Viral hepatitis is increasingly being recognized as a public health problem in India.
HAV and HEV are important causes of acute viral hepatitis and acute liver failure (ALF). Due to paucity of data, the exact burden of disease for the country is not established. However, available literature indicates a wide range and suggests that HAV is responsible for 10-30% of acute hepatitis and 5-15% of acute liver failure cases in India. It is further reported that HEV 10-40% of acute hepatitis and 15-45% of acute liver failure.

Based on the prevalence of Hepatitis B surface antigen, different areas of the world are classified as high (?8%), intermediate (2-7%) or low HBV endemicity. India falls under the category of intermediate endemicity zone (average of 4%). Hepatitis B surface antigen (HBsAg) positivity in the general population ranges from 1.1% to12.2%, with an average prevalence of 3-4%. Anti-Hepatitis C virus (HCV) antibody prevalence in the generalpopulation is estimated to be between 0.09-15%. Since India has one-fifth of the world’s population, it accounts for a large proportion of the worldwide HBV burden. India harbours 10-15% of the entire pool of HBV carriers of the world. It has been estimated that India has around 40 million HBV carriers. About 15-25% of HBsAg carriers are likely to suffer from cirrhosis and liver cancer and may die prematurely.

Anti-Hepatitis C virus (HCV) antibody prevalence in the general population is estimated to be between 0.09-15%. Based on some regional level studies, it is estimated that there are 6-12 million people with Hepatitis C in India.

Chronic HBV infection accounts for 40-50% of hepatocellular carcinoma (HCC) and 20-30% cases of cirrhosis and chronic HCV infection accounts for 12-32% of HCC and 12-20% of cirrhosis in the country.

The Viral Hepatitis Program– Points to Remember

Prevalence: 9 times more than HIV

Mortality: Next to TB

Aims

  • Elimination of Hepatitis C by 2030
  • Achieve significant reduction in the infected population, morbidity and mortality associated with Hepatitis B and C viz. Cirrhosis and Hepato-cellular carcinoma (liver cancer)
  • Reduce the risk, morbidity and mortality due to Hepatitis A and E.

Program Components

  • Prevention
  • Awareness
  • Immunization: Birth dose / HCW / HRGs
  • Injection Safety
  • Diagnosis & Treatment
  • Screening of Pregnant Women
  • Free Diagnosis &Treatment with DAAs
  • Linkages
  • Training & capacity building

Service Delivery - Facility Based

Hep C with DAAs - Adults (pan genotypic)

Hep B with DAAs - Adults and children)

Onwards

Hep C with DAAs – Adolescents children

In West Bengal, Free Viral Hepatitis Screening and Treatment of Hepatitis B and C is available in 31 Centers of West Bengal.

The Paradox

  • 10% of people living with CHB -  Aware
  • 16 % of those aware of status – On treatment
  • 19% of people living with CHC -  Aware
  • 30 % of those aware of status – On treatment