Context:

• On September 3, Bangladesh, Bhutan, Nepal and Thailand became the first four countries in the World Health Organization’s southeast Asia region to have successfully controlled hepatitis B.

Concerns:

• Despite the introduction of hepatitis B vaccine in the Universal Immunisation Programme in 2002 and scaling-up nationwide in 2011, about one million people in India become chronically infected with the virus every year.
• According to the Health Ministry, as on February 2019, an estimated 40 million people in India were infected. 

About hepatitis:

• Hepatitis is a medical condition in which there occurs inflammation of liver cells and its complications vary with type of infection.
• There are 5 types of hepatitis viz. A, B, C, D and E. Each type is caused by a different hepatitis virus.
• Hepatitis viruses is one of the common cause of liver damage.
• Hepatitis B and C are the most deadly. These two types are mostly responsible for liver damage.
• Hepatitis viruses B, C and D spread by contact with contaminated blood or body fluids.
• Hepatitis A and E spreads through unsafe food and drink. 
• Symptoms include yellowing of the skin and eyes, abdominal pain and swelling, yellow urine, pale or dark stools, chronic fatigue, nausea and loss of appetite. 
• WHO has appointed Amitabh Bachchan as its goodwill Ambassador for Hepatitis in South East Asia Region.

Prevalence of the disease;

• Hepatitis B infection at a young age turns chronic, causing over 1,00,000 premature deaths annually from liver cirrhosis or liver cancer. 
• A study published in 2013 found lower coverage of hepatitis B vaccine in eight of the 10 districts surveyed.
• According to the WHO, the coverage of hepatitis B third dose had reached 86% in 2015. 
• However, despite the high vaccination coverage, disease prevalence in children aged less than five years has not dropped below 1%.

Reasons for increasing numbers:

• One of the reasons for this is the sub-optimal coverage of birth dose in all infants within 24 hours of birth.
• The compulsion to increase birth dose to cut vertical transmission arises from two important reasons — about 70-90% newborns infected this way become chronic carriers of hepatitis B, and about 20-30% carriers in India are due to vertical transmission. 
• But even seven years after the Health Ministry approved the birth dose in 2008, its coverage remained low — 45% in 2015 and 60% in 2016 
• In the case of institutional delivery, the birth dose vaccine coverage is low — 76.36% in 2017. One of the reasons for the low coverage is the fear of wastage of vaccine when a 10-dose vial is used.
• Unfortunately, health-care workers are very often unaware of the WHO recommendation that allows hepatitis B open-vial policy.(  Opened vials of hepatitis B vaccine can be kept for a maximum duration of 28 days for use in other children if the vaccine meets certain conditions)

National Viral Hepatitis Control Program

• The National Action Plan was developed by experts from across the country, in line with India’s commitment and keeping the global perspective in mind. 
• The Plan provides a strategic framework, based on which National Viral Hepatitis Control Program was framed and launched in July, 2018 under National Health Mission by Ministry of Health & Family Welfare. 
• This program is also in line with our global commitment towards achieving Sustainable development Goal (SDG) 3.3. India has affirmed this commitment at the 69th World Health Assembly.
• The aim of the program is to combat hepatitis and achieve countrywide elimination of Hepatitis C by 2030, achieve significant reduction in the infected population, morbidity and mortality associated with Hepatitis B and C viz. Cirrhosis and Hepato-cellular carcinoma (liver cancer) and Hepatitis A and E.
• A National Steering Committee was formed to formulate the National Action Plan for Viral Hepatitis in January 2017. Various working groups were formed which looked at various thematic areas. The Plan was formed in consultation with nearly 110 experts, program managers, state officials and community members.
• The Technical Guidelines is intended to serve as a reference document for practising physicians and provide standardized testing and treatment protocols to ensure consistency in diagnosing and treatment of the disease, in the scientifically most appropriate and cost-effective manner. This will be taken down to the lowest level of health care through the Ayushman Bharat programme
• The preventive, promotive and curative interventions need to come together, especially since symptoms for Hepatitis B and Hepatitis C often remain dormant for long.
• Vaccination against Hepatitis B to the health care workers and high-risk population will also be initiated under this program. No child should suffer from Hepatitis B.
• Use of social media and field outreach through mobile vans of the Ministry of I&B to improve public awareness on the disease.

Conclusion:

• India is one of the few countries in the world to roll out management of Hepatitis B and hepatitis C in a public health approach and offer free diagnostics and drugs lifelong to its beneficiaries.
• Integrating the interventions within the existing health systems framework under National Health Mission are further complementing the efforts of increasing access to testing and management of viral hepatitis.
• Coordination and collaboration with other national programs and schemes to provide a promotive, preventive and curative package of services will further augment the government of India’s determined efforts towards achieving the goal.