AIIMS experts advocate for robust data, surveillance in India's hepatitis elimination plan
AIIMS experts
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In an editorial, 'Hepatitis B virus prevalence in India: A wake-up call for action,' doctors highlighted that despite decades of interventions, HBV remains prevalent, and the progress toward elimination remains slow.
According to them, harnessing the momentum of telemedicine expansion initiated during the COVID-19 pandemic, along with decentralised healthcare delivery models, availability of generic antivirals and the use of artificial intelligence for patient management, could significantly enhance hepatitis B virus (HBV) care.
The editorial by AIIMS doctors - Dr Shekhar Swaroop and Dr Shalimar of the Department of Gastroenterology and Dr Subrat Kumar Acharya, former HoD of the same department and presently serving as the pro-chancellor at the KIIT University, Bhubaneswar, was published in the Indian Journal of Gastroenterology in June this year.
"As the world's most populous nation and a key player in global health, India must prioritise viral hepatitis as a central component of its public health strategy, not only to meet WHO targets, but to protect future generations from this entirely preventable disease," the doctors stated.
According to the Global Hepatitis Report 2024, approximately 29.8 million individuals in India were estimated to be living with HBV infection in 2022.
The HBV ranked as the third most common cause for cirrhosis, after alcohol and metabolic dysfunction-associated steatotic liver disease.
The HBV accounted for approximately 98,305 deaths in India in 2022, reflecting a significant disease burden.
Chronic HBV infection confers an increased risk of hepatocellular carcinoma (HCC), and approximately 25 per cent of these individuals will develop HCC during their lifetime. Additionally, HBV reactivation is an acute precipitant of acute on chronic liver failure (ACLF) in around 15% of the patients globally and in 7.7 per cent in South-East Asia, according to a recent meta-analysis, the editorial said.
To address this challenge, India launched the National Viral Hepatitis Control Program (NVHCP) in 2018, aiming to reduce the incidence, morbidity and mortality of HBV.
Initiatives under this programme include hepatitis B vaccination, universal screening of donated blood and interventions for preventing mother-to-child transmission.
"While significant progress has been made, particularly with third-dose hepatitis B vaccine coverage reaching approximately 93% in 2023 and the proportion of children aged 12-23 months receiving all three doses improving from 62.8 per cent (NFHS-4) to 83.9 per cent (NFHS-5), critical gaps still remain," the editorial pointed out.
Birth dose vaccination coverage stands at 63 per cent, while the diagnosis rate is 2.4 per cent and treatment coverage rate 0.0 per cent.
These figures underscore significant deficiencies in the current response and highlight urgent areas requiring improvement, the doctors stated.
Accurate prevalence estimates are essential for guiding public health strategies and resource allocation. In this context, the recent community-based prevalence study by Rajalatchumi et al. from Puducherry represents a valuable contribution. The researchers invited all adults from four villages of rural Puducherry for HbsAg testing, achieving a commendable 94 per cent participation rate.
The study found an adjusted prevalence of 2.5 per cent after adjusting for the sensitivity and specificity of the diagnostic test, higher than the NFHS-4 estimate. Interestingly, younger individuals showed a higher infection rate, and blood transfusion remained a risk factor, suggesting ongoing gaps in infection control and awareness, the doctors stated.
When compared to a 2013 study from the same region, which reported a prevalence of 2.96 per cent, there was little change over the past decade, pointing to significant gaps in public health strategies and infection control measures, they stated.
Despite methodological strengths, the study's generalisability is limited by regional heterogeneity across socio-economic status, transmission risk factors and healthcare access.
Nevertheless, this study is a timely and very relevant reminder of the persistent burden of HBV in India, the doctors said.
"Despite decades of interventions, HBV remains prevalent and the progress toward elimination remains slow. This is further hindered by limited public awareness, the absence of mandatory screening protocols and limited linkage to care," they said, adding nationally representative population-based surveys are rare and existing surveillance systems remain fragmented and under-resourced. PTI
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