Rising hepatitis cases among Indian children more deadly than HIV and TB combined: What is causing it?

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Hepatitis has become a growing public health concern in India, with prevalence more than HIV and mortality rate exceeding nine times that of tuberculosis. Viral hepatitis is a systemic illness, predominantly causing inflammation of the liver usually presenting with fever, jaundice, abdominal pain, vomiting, nausea, loss of appetite and rarely, acute liver failure.

India's Hepatitis Crisis:

In an interview with HT Lifestyle, Dr Prashant Kadam, Consultant - Hepato-Pancreato-Biliary and Liver Transplant at Fortis Hospital in Mulund, shared, “The recent rise in Hepatitis cases among children in India can be attributed to many factors, including inadequate sanitation and hygiene practices, contamination of food and water supplies, suboptimal vaccination coverage, and increased exposure to hepatitis viruses within community and healthcare settings.”

He revealed, “Outbreaks of Hepatitis A and E are commonly associated with contamination of water sources, especially during the monsoon season when sewage overflows and contaminates drinking water supplies. Inadequate vaccine coverage against Hepatitis A also leaves many children vulnerable to infection. Additionally, poor sanitation and hygiene practices, including inadequate hand washing, can contribute to the spread of these viruses within communities.”

Children at Risk:

Bringing her expertise to the same, Dr Drisya, Consultant Physician at Meditrina Hospital in Palakkkad, explained, “The causative hepatitis virus is primarily divided into 5 types, A, B, C, D and E; of which except E, all are prevalent in India. These viruses can be broadly classified into blood borne or food borne; B, C and D being in the former category. India has one of the highest global prevalence of hepatitis B and C with almost 3.5 crore cases noted in 2022. These are transmitted through blood, bodily fluids, and infected syringes. Though they are less likely to cause acute infections or epidemics, they are prone to cause chronic liver inflammation, fibrosis and occasionally hepatocellular carcinoma. The high risk of vertical transmission of HBV from infected pregnant mother to baby is a cause of major concern.”

She elaborated, “On the other hand, hepatitis A and E cause acute, short-lasting infection and provide life-long immunity but are more prevalent. Historically, India used to be a high endemic zone and thus had relatively higher population immunity, resulting in mostly subclinical A/E infections. As we move to moderate endemicity, there has been a shift in the epidemiology with more severe infections and a higher median age. HAV is the most common causative agent and predominantly affects young children. Unhealthy food handling, lack of good sanitation practices, unhygienic personal habits outbreaks and lack of vaccination awareness contribute to hepatitis A outbreaks. Rains and post flood times commonly see drinking water contamination with sewerage, also giving rise to HAV/HEV infections. Rural areas or a denser population are highly prone to develop outbreaks.”

Is India Facing a New Public Health Emergency?

The growing numbers are hardly surprising as despite causing more than 50-100 times more infections than HIV, the funding for hepatitis is less than its tenth. Dr Drisya highlighted, “Poor diagnostic and screening facilities, social stigma, health fads, delayed health seeking behaviour, poor sanitation, high cost of treatment have led to continued high prevalence of hepatitis in India. National Viral Hepatitis Control Program (NVHCP), an Indian government initiative of 2018, targets at prevention and treatment of Hepatitis A, B, C and E by offering free screening, diagnosis, management and counselling.”

She suggested, “Promoting safe blood and blood products, preventive practices for those at imminent risk and safe injections would help in reducing blood borne hepatitis. The generic prevention to decrease the number of foodborne hepatitis outbreaks includes checking the water quality, chlorination of well water, improving food hygiene practices like compulsory hand washing. Indian Medical Association (IMA) and the Association of Physicians in India (API) has suggested immunization for people above age 10 years who eat outside quite frequently and the food handlers. If stringent implementation of universal access and immunization is done, incidence can be reduced by 90% and mortality by 65 %.”