Nothing hep about it

Dr Nirmaljeet Singh Malhi

In India, only after a person is extremely sick would s/he go to a hospital. Preventive healthcare is something which is sidelined not only in our personal priorities but in the national budget as well. 

Several factors contribute to this status quo. Similar to the national budget, a financial crunch usually prevents people from spending on prevention. Private healthcare facilities are rendered inaccessible due to their expensive nature, and a trip to public facilities may be taxing due to the substandard facilities and perennially long queues that are the norm there. 

While the urban population still has some leverage to access preventive healthcare, the rural masses remain vulnerable to many diseases as they normally have access only to government services. 

One such disease on the rise in the Indian population is the hepatitis B virus (HBV) infection.

Causes

One of the most notorious aspects of this virus is its highly contagious nature. Hepatitis is a blood-borne virus which mainly spreads through the blood.

n In India, it is mainly caused by transfusion of unscreened blood, unsafe surgical procedures and medical practices like the use of unsterile needles and equipment during a dental examination. 

n Intravenous drug users and even diabetics are at a higher risk because of unsafe needles. 

n Other causes include sharing personal care items like razors and toothbrushes. 

n Unprotected sex with an infected person may also be a cause.

n Mother to child transfer during pregnancy and/or at the time of delivery is another important cause.

Prevalence in rural India

Due to the population burden, the Indian healthcare system is plagued by substandard, ill-informed and unhygienic medical practices. It is an ideal set-up for blood-borne and highly contagious viruses like hepatitis to thrive and spread. 

According to WHO, the country has over 40 million hepatitis B patients, second only to China, and importantly, most of them are unaware of it. The National Center for Biotechnology Information(NCBI) found in a study that the prevalence is especially high among the tribal population in India, with almost 65 per cent of the population infected. Inter-caste marriages, cramped living conditions, illiteracy and poor health-care resources available to them contribute to this burden. The scenario is similar in the rural areas as well due to the similarity in their lifestyles, but there is a lack of formal study on the subject, therefore no solid data claims can be made so far. 

Prevention

The infection rate is on the rise. Many preventive measures are being undertaken by the government to stop this epidemic from claiming further lives. The National Action Plan-Viral Hepatitis B is one such programme. Today in India, hepatitis B Vaccine is available at the lowest price in the world. This vaccine is an important resource that, if tapped into, can prevent millions of annual deaths. Universal vaccination of all newborns with this vaccine, thus, is an important prevention strategy. 

We must realise that health check-ups are not a luxury, but a necessity. A regular check-up can help in timely identification of the problem and prevent time and energy spent on cure at a later stage or prevent it from becoming chronic. 

All medical institutions and practitioners will have to practice more caution. More awareness is needed to make people know of the issue. Clean and sterilised medical equipment, needles, syringes, healthy blood for transfusion are some of the basics that should be made available to all citizens. India already holds a major cut in the global burden of diseases, medical problems like hepatitis that can be potentially avoided should be dealt with preventive care measures. 

—The writer is head of the Department of Gastroenterology, SPS Hospital, Ludhiana

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What is Hepatitis B?

HBV is an extremely transmissible blood-borne virus, and if not identified in time, avenues for a cure are limited in this condition. It can be identified by several symptoms in most cases:

• Yellowing of eyes and/or skin i.e  jaundice
• Dark coloured urine
• Loss of appetite
• Nausea and/or vomiting
• General weakness 
• Fever
• Abdominal and/or joint pains

The virus continues to spread silently across the liver and damaging it. In the worst cases (as much as 85 per cent) especially if infection is acquired at birth or in early childhood, it eventually develops into liver cirrhosis, a condition where the liver is permanently scarred. It is also capable of turning into liver cancer. While HBV itself is not fatal most of the time, its chronic potential makes it fatal and the fact that it grows silently without detection in some cases. But once contracted, the virus has no absolute cure. If you are infected, you can only take measures to keep it under control and prevent it from spreading to others. Also, to prevent hepatitis D, it becomes more important to treat hepatitis B at the right time since HDV infection occurs only simultaneously or as a super-infection with HBV.