Infected injections, unsafe blood transfusions see Hepatitis rising in India (July 28 is World Hepatitis Day)

India's Hepatitis burden is rising due to the use of infected injections and unsterilised medical equipment as well as unsafe blood transfusions.

In India, nearly two-thirds of the injections being used are unsafe, posing health hazards for the recipients. Unhygienic use of needles in acupuncture and tattooing also has a significant role in spreading hepatitis, according to experts.

There are five main Hepatitis viruses, referred to as types A, B, C, D and E. Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occurs as a result of parenteral contact with infected body fluids. Hepatitis B is also transmitted by sexual contact.

"Hepatitis B (HBV) and Hepatitis C (HCV) infections are silent diseases that remain asymptomatic for decades. Due to lower awareness, more than 80 percent HCV patients and over 60 percent patients with HBV are diagnosed at a stage when the disease is irreversible," Anil Arora, chairman and head of the Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi said.

Ajay Kumar, senior consultant gasteroenterology Indraprastha Apollo Hospitals told IANS: "Transmission of Hepatitis through infected syringes and blood is a significant problem in India." "Most patients in India get the Hepatitis B and C forms in childhood either through mother to child transmission or contact with other siblings," he said adding, many times after being infected the problem becomes chronic and they become permanent carriers of the virus.

He added that there was much need to organize a countrywide education campaign among health workers, patients and the community, especially in the rural areas.

Anupam Sibal group medical director and senior

gasteroenterologist at Apollo, who specialises in paediatric Hepatitis, said immunisation against the disease is an effective prevention method.

Under the Universal Immunization Programme (UIP), the government provides Hepatitis B vaccine and the operational cost of vaccination to states and union territories for preventing Hepatitis B infection.

Since April 2005, the government has also introduced auto-disabled (AD) syringes for all vaccinations under UIP in all states. AD syringes are single use, self-locking syringes that cannot be used more than once.

This prevents misuse and contamination and cross- infection through repeated use of unsterile injection or equipment. Routine screening of blood units for Hepatitis B and C has been made mandatory for all blood banks to detect and discard contaminated blood units, a senior health ministry official said.

Hepatitis viruses are estimated to be among the top 10 causes of death in India. According to the World Health Organization, 240 million people globally are chronically infected with Hepatitis B and around 150 million are chronically infected with Hepatitis C.

Approximately 500 million people worldwide are living with either hepatitis B or hepatitis C. This means 1 in 12 people suffer from this deadly disease.

As for Hepatitis C, one out of every 100 in India may be chronically infected by the virus and most among these 12 million people do not know they are infected.

According to government figures, prevalence of Hepatitis C has been observed to be relatively higher in Punjab, Andhra Pradesh, Puducherry, Arunachal Pradesh and Mizoram.

Interestingly, several studies conducted in these states have highlighted different risk factors which are believed to have led to the relatively higher prevalence of the condition.

"Hepatitis C usually affects people in the age group of 20 to 60 years while Hepatitis B is most common in the age groups 10 to 60 years," Kaushal Madan, senior consultant Hepatologist and Gastroenterologist, Medanta - The Medicity Hospital, Gurgaon said.