V

iral hepatitis kills more people than any other communicable disease in the Southeast Asia region. In the next 10 years, over 5 million people in the Region will die of this disease and its consequences.

Today, more than 130 million people in Southeast Asia alone carry the hepatitis B or C virus, although they may appear healthy. It usually strikes people at their most productive age, and the cost of its impact, both to the family and the economy, is enormous.

The hepatitis B virus is 50 to 100 times more infectious than HIV, and just as lethal. Hepatitis E results in 2,700 still births every year. For such a major public health threat, hepatitis has a low profile, among policy-makers and the public. Most people cannot easily distinguish between the four most common types of viruses that cause the disease — hepatitis A, B, C and E.

Recognizing hepatitis as a threat to public health, the World Health Assembly passed a resolution to prevent and control the disease in 2010. The World Health Organization (WHO) has decided to observe 28 July 2011 as the world’s first ever World Hepatitis Day. It is thus an opportune time to ask: are we doing enough to protect ourselves from this disease?

Many people recognize the symptoms: Yellowing of the eyes and skin, or jaundice. Yet, jaundice is only the face of the disease and the common symptom for any of the four common types of viral hepatitis. These are easily contracted in different ways, from drinking water to casual contact to sexual intercourse. Even so, not every infected person shows symptoms.

WHO is developing guidelines, strategies and tools for surveillance, prevention and control of this disease. Prevention, focusing on the source and mode of spread of the virus, is crucial to control this disease.

Chronic hepatitis B and C are among the leading causes of preventable deaths in the 11 countries of WHO’s Southeast Asia region, including India. About 100 million hepatitis B carriers, and 30 million hepatitis C carriers, live in Southeast Asia.

However, about 60 percent of infected individuals are unaware of their status until they face one of the consequences such as cirrhosis or liver cancer — an aggressive cancer without a cure. Hepatitis C, in particular, has no vaccine or effective cure. Those who undergo blood transfusion, as well as injecting drug users, are at risk.

Due to a lack of knowledge and resources among healthcare workers, many providers in WHO’s Southeast Asia region do not comply with WHO and national guidelines and recommendations for hepatitis B and C screening, prevention, treatment and follow-up services. A patient requiring transfusion may receive blood that has been screened for HIV, but not for hepatitis B or C.

The hepatitis B vaccine can go a long way to prevent hepatitis B. It is more than 95 percent effective in preventing infections and their chronic consequences, and was the first vaccine that protects against a major human cancer. In WHO’s South Asia region, more than 130 million infants have received the three required doses of hepatitis B vaccine.

Hepatitis infection is also linked to personal hygiene, sanitation and urban health — hepatitis A and E are both commonly spread through eating or drinking contaminated food or water. Pregnant women are at high risk of hepatitis E. Hepatitis E acquired during pregnancy is also associated with prematurity, low birth weight and an increased risk of perinatal mortality.

In countries of WHO’s Southeast Asia region, more than 6.5 million people are infected with hepatitis E annually accounting for half the cases worldwide, leading to an estimated 160,000 deaths.

Hepatitis E outbreaks often occur in urban areas when leaky underground water pipes are contaminated with sewage. In developing countries, with increasing population pressure and rapid urbanization leading to people living in close, unsanitary conditions, such diseases are likely to increase rapidly. However, good hygiene and improved sanitation can go a long way towards preventing hepatitis A and E infection.

So what can be done to prevent and control hepatitis? To begin with, all countries, especially those urbanizing rapidly, need to make hepatitis a health priority. Lives could be saved through simple preventive measures such as hand washing, consuming cooked food and boiled water, using condoms and not sharing needles.

Countries need to make screening of all blood and blood products for hepatitis B and C mandatory. Governments should ensure that children are adequately immunized against hepatitis B. Healthcare workers, and the public, need to be educated on the risks. The surveillance system for hepatitis needs to be strengthened.

Unless we act now to create greater awareness among policymakers, healthcare workers, and the public, viral hepatitis will remain a major public health threat.

The writer is Regional Director of WHO Southeast Asia