Following Hepatitis in India initial unwelcome appearance in India during the 1950s, hepatitis has persisted as one of the most enduring illnesses, refusing to fade away quietly. At that time, it primarily spread through contaminated water and inadequate sanitation, leading to periodic outbreaks of hepatitis A and E.

Years later, despite advancements in vaccines, improved hygiene practices, and public health initiatives, hepatitis continues to take thousands of lives each year in India. While the specific threats may have changed, the core issue remains unchanged: silent transmission, lack of awareness, and delayed responses.

Before exploring the unique challenges faced by India, it is crucial to recognize that hepatitis is not a singular disease but rather a group of five viruses – A, B, C, D, and E. Each virus impacts the liver differently:

Hepatitis A and E: These types are transmitted through contaminated food and water, typically causing acute infections, and are more prevalent in regions with poor sanitation. Pregnant women are especially at risk for hepatitis E.

Hepatitis B and C: These viruses are spread through blood and bodily fluids and can result in chronic liver disease, cirrhosis, and liver cancer if not treated.

Hepatitis D: This virus only occurs in individuals already infected with hepatitis B, adding further complexity to the situation.

While hepatitis A and E are short-term illnesses that do not progress to chronic conditions, hepatitis B and C are long-term infections that can silently harm the liver over many years, frequently going undiscovered until it’s too late.

HEPATITIS IN INDIA: IS A LOW-PREVALENCE COUNTRY WITH A HIGH BURDEN

The nationwide seroprevalence for hepatitis B is roughly 0.85%, and for hepatitis C, it is 0.29%, according to the 2023 HIV Sentinel Surveillance Plus report. This technically categorizes India as a “low prevalence” country (less than 2%) according to World Health Organization (WHO) criteria.

However, these seemingly small percentages equate to millions of infected individuals, many of whom are entirely unaware of their condition.

As Dr. Kapil Sharma, the Director of Gastroenterology at Sarvodaya Hospital in Faridabad, states, “Many individuals are unaware of their infection until they start facing complications such as liver damage or cancer. By then, it is far too late.”

THE SPIKE THAT RETURNS EVERY MONSOON

Hepatitis in India India, the monsoon season is more than just a time of year; it serves as a public health warning. Hospitals see an increase in cases of acute viral hepatitis, particularly hepatitis A and E, which are associated with stagnant water, flooded drains, and contaminated food.

This year, Dr. Abhideep Chaudhary, the President-Elect of the Liver Transplantation Society of India (LTSI) and Vice Chairman of HPB and Liver Transplantation at BLK-Max Hospital in Delhi, reported a 40% increase in acute viral hepatitis cases over the last three weeks alone.

“Many patients do not realize the importance of hepatitis vaccination, particularly those transitioning from rural to urban areas,” Dr. Chaudhary noted.

Children are also impacted. Hepatitis A is notably common among those under 15, while hepatitis E is a significant cause of waterborne hepatitis, posing serious risks for pregnant women.

THE REAL COST OF DELAY

Fatigue, slight jaundice, and appetite loss are common early signs of hepatitis.

However, as Dr. Sanjiv Saigal, President of LTSI, cautions, “We are experiencing a seasonal epidemic that recurs annually, yet we remain unprepared each time.” In certain instances, acute hepatitis A or E can result in liver failure, necessitating an urgent transplant.

“There is a perilous misconception that jaundice resolves on its own,” Dr. Chaudhary adds. “Late diagnosis can result in life-threatening complications. Although these infections pose a public health threat, they continue to be underreported and poorly understood.”

One of the primary reasons hepatitis persists is the significant gap in early detection. Dr. Sharma points out that in India:

• Especially in rural and semi-urban areas, routine screening is rare.
• People are reluctant to seek prompt medical assistance because liver disease is stigmatized.

The medical infrastructure is under strain, lacking sufficient trained personnel to identify early symptoms.

The costs associated with treatment, particularly for hepatitis C, can be unaffordable for numerous families.

Although vaccines are available, their coverage is inconsistent. Many individuals either do not complete the entire vaccination series or are unaware of their risk in the first place.

UNSAFE MEDICAL PRACTICES FUEL THE FIRE

Important routes for the spread of hepatitis B and C include unsafe injections, unsterilized dentistry instruments, and unofficial clinics using dubious practices.

“Many infections arise from unsafe blood transfusions and contaminated medical instruments in smaller healthcare facilities,” states Dr. Sharma. While urban hospitals are more inclined to adhere to safety protocols, rural clinics frequently function with little oversight.

For hepatitis A and E, the fundamental needs—safe drinking water and proper hygiene—remain unattainable in numerous regions of the country. For instance, Kerala experiences annual outbreaks of hepatitis A.

Dr. E. Sreekumar, Director of the Institute of Advanced Virology, notes that floods and unpredictable rainfall have exacerbated access to clean water in recent years.

CHALLENGES IN PUBLIC AWARENESS AND WHAT MUST CHANGE

In spite of frequent outbreaks, the public’s knowledge of hepatitis is alarmingly inadequate.

“The majority of people cannot distinguish between the different types of hepatitis or identify the symptoms,” Dr. Sharma explains. This lack of awareness is particularly evident in slum areas and among migrant workers, where access to clean water and healthcare is already restricted.

Experts suggest several measures to help combat the rise of hepatitis in India:

Incorporate the Hepatitis B vaccine into all birth and school immunization initiatives.

Initiate mass screening efforts for high-risk populations, especially pregnant women, healthcare professionals, and injection drug users.

Guarantee that all blood banks and hospitals adhere to stringent infection control measures.

Provide subsidies for hepatitis treatments, especially for hepatitis C, to enhance affordability.

Utilize community health workers, educational institutions, and places of worship to enhance public awareness.

Train primary healthcare professionals to identify the early symptoms of hepatitis.

Dr. Monika Jain, Director of Liver Diseases at Sri Balaji Action Medical Institute, emphasizes the importance of daily hygiene: “We advise everyone to consume well-cooked meals, steer clear of street food during the rainy season, and ensure thorough handwashing.”

As Dr. Saigal points out, “We need to transition our focus from treating hepatitis to preventing it. This is the only way to halt this disease from silently causing destruction, one monsoon at a time.”

Although hepatitis is a longstanding adversary, it is one we are equipped to conquer. Now, we simply need to take action.