Dr. Bella Mahajan and Chirdeep Malhotra
World Hepatitis Day is celebrated on 28th of July every year and is a World Health Organization (WHO) led initiative which serves to promote a greater understanding of hepatitis as a global health problem and encourage the implementation of control measures to prevent infection. World Hepatitis Day (WHD) was launched in 2008 by the World Hepatitis Alliance (WHA), a group seeking increased recognition of viral hepatitis as a major global health problem, and the event was first coordinated with WHO in 2011. This date is chosen in honour of Dr. Baruch Samuel Blumberg, the Nobel laureate who discovered Hepatitis B, and whose birthday is on 28 July. One of the four disease specific global awareness days officially recognized by the WHO, the others being Tuberculosis, Malaria and AIDS, World Hepatitis Day unites patient organizations, governments and the general public to boost the global profile of Hepatitis. This day brings the world together to raise awareness of the huge burden of viral hepatitis and to influence real change in disease prevention and access to testing, treatment and care.
What is Hepatitis?
Hepatitis is an inflammation of the liver commonly caused by hepatitis viruses A, B, C, D and E.
Symptoms
Hepatitis may present as an acute or a chronic infection.
Acute infection may present without symptoms or with limited symptoms. Typical symptoms of hepatitis are jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.
Chronic infection may lead to cirrhosis, liver failure or liver cancer. Hepatitis B and C viruses are the main cause of chronic hepatitis in millions of people.
Transmission
A, E:- Through consumption of contaminated food or water. Through lack of hygienic habits, such as hand washing before eating or after using the restroom. Hepatitis E can also be transmitted through contaminated blood.
B, C, D:- Through contact with infected blood or sexual contact without protection. By receipt of contaminated blood through transfusions, organ transplants, invasive procedures (injection or tattoo with reused needle) and mother to newborn transmission.
Prevention
Preventive measures change depending on the type of hepatitis viruses and the routes of transmission. However, an easy way to prevent infection is using basic hygiene rules and safe sex, avoiding contact with infected blood and ingestion of contaminated food and water, as well as through vaccination (Hepatitis A and B).
Treatment
Hepatitis A is self- limiting. Hepatitis B cannot be cured but it can be treated. The treatment regimens have also taken major strides. Hepatitis B (HBV) is vaccine preventable, and new and highly effective oral treatments are now available for Hepatitis C (HCV). After many years when the best available treatment for HCV required 24-48 weeks of treatment by injection and had poor cure rates, the newly available treatments take just 12 weeks and have a cure rate of 90-95%.
The theme for WHD 2016 is “Elimination”. To elevate the theme, a global movement called NoHep will be launched on WHD 2016. NoHep is a movement aimed at uniting people from across the world to take action, to speak out and be engaged to ensure global commitments are met and viral hepatitis is eliminated by 2030. For viral hepatitis, 2016 has been a pivotal year. Elimination featured highly at high level policy meetings including UNGASS (United Nations General Assembly Special Session), WHO SEARO (South East Asian Regional Office) and WHO EURO (European Regional Office) Regional action plan meetings in 2016. From 23-28 May, 194 member states convened at the 69th World Health Assembly and supported the Global Health Sector Strategy on Viral Hepatitis 2016-2021.
However, a WHO report of 2015 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 report states that there is no national public health agenda for viral hepatitis, neither is any routine screening done amongst the general population.
Key Actions which can be taken are:-
· Establishment of Hepatitis National plans and programs.
· Sharpening health system response to hepatitis control. A shift from passive to active surveillance is needed i.e. from a reactive approach to a proactive approach. The difference between the two approaches is the perspective each one provides in assessing actions and events.
· Use of an integrated approach in the fight against hepatitis, including prevention, control, diagnosis, treatment and monitoring of all hepatitis viruses.
· Increasing Hepatitis B vaccine coverage.
· Integrated treatment strategies involving gastroenterologists, hepatologists (liver medicine specialists), microbiologists, infectious disease experts and community medicine experts.
· Coordinating a global response to Hepatitis. A cohesive and effective strategy is needed.
Improving access to medicines, especially generics, and diagnostics in the low and middle income countries, creating and seizing global and national advocacy opportunities and financing National Hepatitis plans remains a challenge. The crucial importance of a facilitating policy framework is an important lesson for many developing countries that are currently on the verge of taking advantage of improved diagnostics and advances in therapeutics. All this should be based on accurate and comparable data that represents an evidence- based policy process. There is also the need to upskill the next generation of liver leaders in different areas such as policy and advocacy, and provide training in best practice patient care. Thus, a multi-stakeholder commitment is needed to achieve the elimination of viral hepatitis.
A concerted National Hepatitis Control program needs to be launched in India at the earliest and all the state governments and our national leadership should take urgent actions. Also viral hepatitis infections do not respect national boundaries and remain an important challenge to international health. More industry, research and funding partners should add viral hepatitis to their portfolios. Nothing short of a global commitment will do.
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