Hepatitis B is a public health concern in India

News Excerpt: 

A recent study by Sir Ganga Ram Hospital, New Delhi, revealed that only 25% of respondents in India possess sufficient knowledge about Hepatitis B, including its transmission, effects on the liver, and the importance of vaccination. This necessitates targeted information campaigns to bridge these knowledge gaps.

Key points of the study:

  • A survey evaluated Hepatitis B knowledge among over 3,500 participants, excluding healthcare workers and those under 18.
    • Evaluate participants' knowledge across four critical  domains assessed were the cause/spread, affected organs/consequences, treatment options, and vaccination information.
    • Participants' knowledge was scored from -20 to +22, with vaccination status rigorously evaluated.
  • Only 22.7% of participants completed the full Hepatitis B vaccination course
    • Raising concerns given the virus's prevalence and vaccine effectiveness.
  • Disparities in vaccination uptake were noted, influenced by factors like gender, education, and urban-rural divide.
  • Importance stressed on increasing vaccination efforts and ensuring accessibility, especially for high-risk groups like the immunocompromised, extremes of age, needle injury recipients, transplant patients, and blood transfusion recipients.

About Hepatitis B:

  • Hepatitis B is a vaccine-preventable liver infection caused by the hepatitis B virus (HBV).
  • Hepatitis B is spread when blood, semen, or other body fluids from a person infected with the virus enter the body of someone who is not infected.
  • HBV infection affects around 296 million people globally
    • It causes approximately 887,000 deaths yearly due to complications like end-stage liver cirrhosis and liver cancer.
  • Infection rates remain high, especially in countries with lower socio-demographic indices such as India. This is surprising because there's been a vaccine for Hepatitis B for more than 30 years.

Transmission: 

  • Hepatitis B primarily spreads through perinatal transmission from mother to child and horizontal transmission, especially in endemic areas.
    • Other modes of transmission include needlestick injuries, tattooing, piercing, and exposure to infected blood and body fluids.
    • Sexual transmission is more prevalent in unvaccinated persons with multiple sexual partners.
  • Chronic infection is prevalent in infants and young children, with about 95% of cases developing chronic hepatitis if infected before the age of 5.
  • Infection acquired in adulthood leads to chronic hepatitis in less than 5% of cases.
  • Vaccination in infancy and childhood is crucial to prevent chronic infection, emphasizing its importance in public health strategies.
  • The hepatitis B virus can survive outside the body for up to 7 days, remaining infectious during this period.
  • The incubation period of the hepatitis B virus ranges from 30 to 180 days. 
    • The virus may be detected within 30 to 60 days after infection.
  • Chronic hepatitis B is more likely to develop if the virus is transmitted during infancy or childhood.

Symptoms:

  • Most people newly infected with hepatitis B are asymptomatic, while some experience acute illness lasting several weeks.
    • Yellowing of the skin and eyes (jaundice)
    • Dark urine
    • Feeling very tired
    • Nausea
    • Vomiting
    • Pain in the abdomen
  • When severe, acute hepatitis can lead to liver failure, which can lead to death.
    • Although most people will recover from acute illness.
    • Some people with chronic hepatitis B will develop progressive liver disease and complications like cirrhosis and hepatocellular carcinoma (liver cancer).
      • These diseases can be fatal.

Prevention: 

  • Hepatitis B is preventable with a vaccine.
  • All babies should receive the hepatitis B vaccine as soon as possible after birth (within 24 hours). 
    • This is followed by two or three doses of hepatitis B vaccine at least four weeks apart.
  • Booster vaccines are not usually required for people who have completed the three-dose vaccination series.
  • The vaccine protects against hepatitis B for at least 20 years and probably for life.
  • Hepatitis B can be passed from mother to child
    • This can be prevented by taking antiviral medicines to prevent transmission, in addition to the vaccine.
  • To reduce the risk of getting or spreading hepatitis B:
    • Practice safe sex by using condoms and reducing the number of sexual partners.
    • Avoid sharing needles or any equipment used for injecting drugs, piercing, or tattooing.
    • Wash your hands thoroughly with soap and water after coming into contact with blood, body fluids, or contaminated surfaces.
    • Get a hepatitis B vaccine if working in a healthcare setting.

Way forward:

  • Emphasize targeted public health interventions to enhance awareness and increase vaccination coverage among vulnerable populations, including women, older individuals, those with lower education levels, and rural residents.
  • Focus educational campaigns on the general public, with specific attention to the aforementioned groups, aiming to raise awareness about Hepatitis B transmission, its impact, and the critical need for vaccination.
  • Ensure people understand the importance of completing the full vaccination schedule for optimal protection against Hepatitis B, emphasizing the necessity for adherence to the recommended vaccination regimen.
  • Implement comprehensive strategies that integrate efforts to improve health literacy and enhance vaccination coverage, 
  • Recognizing the importance of these measures in achieving both national and global targets for Hepatitis B control.