A major healthcare burden, viral hepatitis is standing at a pedestal with HIV/AIDS, malaria and tuberculosis. Hepatitis A virus (HAV) and Hepatitis E virus (HEV) cause both sporadic infections and epidemics of acute viral hepatitis (AVH). The high attack rate of HAV is found in the age group of 15-24 years followed by 5-14 years.

The prevalence is related to contaminated water and open defecation, leading to the need to stick to 'Swachch Bharat Abhiyan' and show seriousness towards improving the living standards. If you look into diagnostics or laboratories center, today there are about 4 crore people suffering Hepatitis D and 80-90 lakh people are suffering from hepatitis C in India itself.

Government has planned a National Action Plan for Viral Hepatitis and in 2018 launched National Viral Hepatitis Control Program (NVHCP) under National Health Mission.

"In this plan the two important thing and that was implemented was that we have to provide free diagnostics to people who were suspicious of having hepatitis or suffering from hepatitis that will be followed by providing free of cost drugs lifelong. Along with that whatever preventive measures need to be taken prevents it, promote it, for vaccination to pregnant women, to making the public aware of how does it spread. Action needs to be taken in the primary health center, secondary center, and tertiary center. I am sure by 2030, the aim was to get away with hepatitis C patients and reduce other Hepatitis occurrences," Dr. Ravi Gaur, COO, Oncquest Laboratories.

Hepatitis A and E comes from the transmission foodborne, hygienic issue or waterborne. Hepatitis D and C are a major challenge and leads to chronic disease, liver failure, and cancer. HEV outbreak is particularly dangerous for pregnant women leading up to acute liver failure in 10-22 percent of the cases. In HEV, the prevalence is dependent on living standard and requires maintaining hygienic conditions in the surroundings. HAV is responsible for 10-30% of acute hepatitis and 5-15% of acute liver failure cases in India. And, HEV is responsible for 10-40% of acute hepatitis and 15-45% of acute liver failure.  

"Viral Hepatitis A and E are predominantly because of poor hygiene, they are basically food and water borne diseases. That's where Swachch Bharat Abhiyaan will help as it stops open defecation as stool is carrier of infection. People get infected from there, they don’t wash their hands properly, scavengers are exposed to solid waste, sewage lines, contaminated water. These are the major causes of Hepatitis A and E," says Dr Gaur.

On the other hand, B and C is a challenge as it comes by IV fluids, needle pricks. "During surgery suppose patient has Hepatitis B and then blood get exchanged with someone else or blood transfusion happens then they will get affected. There is area of sexual transmission also. It also get transferred from pregnant mother to the infant. Wear gloves, wash your hands properly maintain proper hygiene," adds Dr Gaur.

People should make sure that therapeutic injections that are being administered are safe. Unsafe injections in India lead to 21 million Hepatitis B (HBV) infections (32% of global burden) and 2 million Hepatitis C (HCV) infections (40% of global burden).

"There guidelines are for safety workers, lab workers that they should be vaccinated by Hepatitis B and monitored regularly so that protection is adequate. Wearing gloves and masks so that infection is not transferred from staff to patient or the other way round. One should follow these steps to avoid spreading Hepatitis," says Dr Gaur.

Urban people are aware and know that it can be cured. But in certain rural areas and semi-urban areas people believe that you should keep away from people suffering from Hepatitis B and C. "People in rural and semi-urban areas believe that Hepatitis B and C is a lifelong thing and person is ostracized. But the fact is that it is not a lifelong thing and if proper treatment is given it can be cured. That is why all health should be confidential. If you take the adequate treatment then there is 100% cure of hepatitis B, which can become chronic if proper care is not taken. Whereas Hepatitis A and E are curable within 4-5 weeks if you take rest and proper medication. All the viruses require adequate rest and infection can be cured by antiviral drugs which are easily available now. Hepatitis C is not very common and Hepatitis D is very rare in India," adds Dr Gaur.

The role of Laboratory services is a very critical component of any response to control viral hepatitis. After NVHCP, there is a guideline on laboratory services that are aimed at standardization of protocols and algorithms.