World Hepatitis Day – 28th July 2018 – Finding the Missing Millions

‘Finding the Missing Millions’ is the theme for this year’s World Hepatitis day being observed on 28th July, 2018 across the globe.Worldwide, around 300 million (30 crore) people are living with viral hepatitis unaware. Without finding the undiagnosed and linking them to care, millions will continue to suffer, and lives will be lost. On World Hepatitis Day, 28 July, we call on people from across the world to take action, raise awareness and join in the quest to find the “missing millions”.

Hepatitis literally means inflammation in the liver and commonly occurs due to different viruses, alcohol, drugs, fat and auto-immunity. Viral hepatitis can be either acute which is usually a self limiting disease remaining for few weeks or chronic lasting for months to years. Of the different viruses which cause viral hepatitis, hepatitis A virus and hepatitis E virus (HAV, HEV) cause acute hepatitis whereas hepatitis B, C and D (HBV, HCV, HDV) are notorious in causing chronic hepatitis even if they have an acute presentationinformed. HAV and HEV which cause AVH usually spread by feco-oral route and the infection usually occurs by the consumption of contaminated water. Patients with acute hepatitis either come sporadically or in the form of epidemics when a large population is affected usually by a common contaminated source.  HAV occurs more commonly in children and young adults whereas HEV infects adults more commonly than children. Patients with acute hepatitis usually present with fever, tiredness, loss of appetite, nausea/vomiting all together called the prodromal features followed later by abdominal discomfort, dark urine, and jaundice (yellow skin and eyes) with or without itching and clay colored stools. The diagnosis of acute viral hepatitis (AVH) is usually easy and is made with the help of typical clinical presentation and liver Function Tests (Blood test), ultrasound of the abdomen and a blood test to confirm the type of virus (For hepatitis A: IgM anti HAV, For hepatitis E: IgM anti HEV). As mentioned earlier, AVH is usually a self-limiting disease in the majority with symptoms usually lasting for less than 2 months; though a few persons are ill for as long as 6 months. Uncommonly, AVH can be complicated with Acute Liver Failure, associated with altered consciousness, bleeding tendency, kidney and other organ failure. This has been reported to occur more often when HEV causes AVH in pregnancy. Further AVH can also be complicated in few patients with Hemolysis (breaking of red blood cells) and cholestasis (Itching). Treatment of patients with AVH is usually symptomatic accompanied with good nutrition. In contrast to usual myths in AVH, patients should be given normal diet without restriction of any food items. Patients with severe acute hepatitis should be monitored carefully in the hospital and those developing acute liver failure should be evaluated for liver transplantation. There is no vaccine for HEV; hence to prevent infection the importance of clean and hygienic food and water cannot be overemphasized.  Children above two years should be given two doses of vaccine (6 months apart) for HAV which usually imparts a good immunity for 15-20 years in majority of individuals.

Both HBV and HCV which cause chronic viral hepatitis (CVH) spread by the parentral routes like blood transfusion, contaminated needles and instruments, razors and uncommonly by sexual route. In contrast to children, majority of adults after acute symptomatic infection with HBV will clear the virus and the disease becomes chronic only in around 10% of patients. In contrast to HBV, acute infection with HCV is usually asymptomatic and becomes chronic in the majority. World over there are around 40-50 crore (400-500 million) individuals infected together with hepatitis B and Hepatitis C virus infection. Majority of these patients (300 million) are asymptomatic and unaware of their infection and hence ‘finding missing millions’ is an appropriate theme for World hepatitis day 2018said Dr RK Dhiman, Professor and Head, department of Hepatology, PGIMER, Chandigarh.

 In India as well, there could be around 5-6 crores (50-60 million) patients with chronic viral hepatitis and testing these subjects for viral hepatitis is the only way to detect them. In PGI itself, almost 80-100 new patients of HBV or HCV are seen per month in the liver clinic run twice a week by the department of Hepatology of the Institute said Dr Ajay Duseja, Professor from the department of Hepatology, PGIMER, Chandigarh. Over the years, we have seen some decline in the number of cases with HBV infection but the number of cases with HCV infection has gone up. In fact combined together both HBV and HCV are still responsible for 60-65% of patients liver cancer seen in the liver clinic and are the second commonest cause for cirrhosis liver, informed Dr Duseja.

Unlike patients of acute viral hepatitis, patients with chronic viral hepatitis have non-specific symptoms in the form of fatigue, lethargy or right upper abdominal discomfort with enlargement of liver and spleen. Untreated, patients with CVH can progress on to cirrhosisliver which at a later stage can cause symptoms of jaundice, swelling of feet, fluid in the abdomen, bleeding from mouth and loss of consciousness. Patients with cirrhosis liver are also at risk of developing liver cancer. The diagnosis of CVH is made based on blood tests to check the liver functions and the activity of the virus (HBV or HCV) based on molecular tests. Ultrasound, CT scan, MRI and Endoscopy are useful in making the diagnosis of cirrhosis and liver cancer and liver biopsy is required in select patients with CVH. Over the years there has been significant advancement in the treatment of both HBV and HCV. A safe and effective vaccine is available against HBV which can be given at birth and requires three dosages for > 90-95% protection. Effective medicines are also available to control the hepatitis B infection. Unfortunately there is no vaccine for HCV and all that is recommended is to take the universal precautions while handling patients infected with HCV. But the good news is that the oral drugs available for HCV infection can cure the infection in almost 100% of patients.

World Hepatitis Day was launched by the World Hepatitis Alliance in 2008 in response to the concern that chronic viral hepatitis did not have the level of awareness, nor the political momentum, seen with other communicable diseases such as HIV/AIDS, tuberculosis (TB) and malaria. This is despite the fact that the number of people chronically infected with, and the number of deaths caused by, hepatitis B and C is on the same scale as these conditions.

 World Hepatitis Day has generated massive public and media interest, as well as support from governments, high-profile Non-Governmental Organizations and supranational bodies, such as the World Health Organization (WHO). Every year thousands of events take place around the world, from rock concerts and press briefings to ministerial meetings and fundraising events. In May 2010, the World Health Assembly passed a resolution on viral hepatitis which, together with vital commitments on prevention, treatment and patient care, made World Hepatitis Day an official WHO awareness day. In recognition of the birthday of Professor Baruch Blumberg, who won the Nobel Prize for discovering the hepatitis B virus, WHO decided that World Hepatitis Day will take place on 28 July every year.

On the occasion of the World Hepatitis Day (28th July 2018), the department of Hepatology, PGIMER, Chandigarh have planned various academic activities to make general public aware about the viral hepatitis. Keeping up with the theme of World hepatitis day I e ‘Finding the Missing Millions’, the department has planned a free screening camp for HBV and HCV for the general public and patients at New OPD Block at PGI on Saturday, 28th July 2018 from 11 AM to 1 PM. Even though this would be a symbolic gesture, our aim is to make people aware about getting tested for asymptomatic chronic infections like HBV and HCV so as to prevent its late consequences, said Dr Duseja.

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Editor in Chief of City Darpan, national hindi news magazine.

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