Hepatitis C: The silent epidemic

About 150 million people worldwide live with Hepatitis C virus infection, with the disease killing nearly 3.5 lakh people each year.

In India nearly 12 million are estimated to be infected by Hepatitis C. Most infections remain unknown, undiagnosed and untreated.

66-year-old BK Singh is founder of a private weather software company. Twelve years ago, around the time that his company was poised to take off, Mr Singh developed cough, diarrhea and fatigue. Doctors treated the symptoms, but the problems persisted. Then one doctor suggested he undergo test for Hepatitis C, a viral infection.

“Lo and behold I found it was positive. I didn’t realise how it came and where it came from and how it happened. It is only afterwards I realised that it has been lying in my body for nearly 18 years. I was working in Mumbai and once I was admitted in the hospital for some other thing and I got blood transfusion,” says Mr Singh.

His liver was cirrhotic and the source of infection identifiable. Hepatitis C virus is transmitted through blood to blood contact, like transfusion of contaminated blood, blood products, organs and tissues.

Mandatory screening of donated blood for Hepatitis C virus was introduced as late as 2002 under the National Blood Policy. Blood banks now screen for Hepatitis C along with Hepatitis B, HIV, Syphillis and Malaria.

But many had already been infected before the policy came into being.

Dr S K Acharya, who is Professor and Head of the Department of Gastroenterology at All India Institute of Medical Sciences (AIIMS), points out that population studies as well as donor screening data show that about 1% of our population is chronically infected with hepatitis C. “Many of them will not know about it, but you can identify this high risk population today who are likely to have Hepatitis C. For example people who have received blood transfusion, people who had surgeries before 2002. Actually unsterilised needle and syringe practices are one of the major source of our country.Tattooing and piercing are also identified as risk factors.”

Hepatitis virus is highly infective. However, transmission through the sexual route is low.

The worry is that the health authorities have not taken any pro-active step to screen them. They remain undiagnosed and untreated, posing a risk of transmission.

For most people, early detection is purely by chance when they donate blood or undergo medical tests for jobs abroad.

29-year-old Parul Gaur led an active life as an HR recruiter and mother of a one and a half year old baby. She was 15 when she underwent blood transfusion.

Last year, she donated blood at a mobile blood camp, but was not told anything was wrong. She learnt she had Hepatitis C only this year when she donated blood at the AIIMS Trauma Centre because the centre followed a policy of informing the donor.

A worried Parul Gaur said, “The day I received this news, I had gone for a job interview. Everything was going well in my life and suddenly this happened. My baby was delivered through Caesarian section. My doctors were not aware that I was infected with Hepatitis C, nor was I. I am worried the surgical procedure may have infected others. I plan to get in touch with the hospital and warn them that they should check on a patient’s Hepatitis C status like they do for HIV. My daughter is small. When she turns two, she too will be tested for Hepatitis C. I hope she is not positive.”

35-year-old Niranjan Kumar, who works in the Excise Department in Uttar Pradesh, survived a bullet injury in 1997. But the surgery left him with Hepatitis C infection.

At the country’s premier research institution, All India Institute of Medical Sciences (AIIMS), it was found that the Hepatitis C virus was responsible for nearly 25 per cent of patients with liver cancer or liver cirrhosis. Hepatitis C is one of the leading causes for liver transplant.

There are five hepatatrophic viruses that selectively infect human liver, alphabetically named ABCDE. Of these Hepatitis B and C can cause chronic liver disease. While Hepatitis B has a vaccine to prevent it, no vaccine is available for Hepatitis C.

People infected often show no symptom for decades by which time permanent scarring of liver or cirrhosis may have taken place.

Those with liver damage and scarring need immediate drug therapy. If untreated, Hepatitis C virus in these cases can be fatal.

Others who show no liver damage can wait. But follow ups have to be regular so that treatment can be started if and when they develop liver disease. The risk of liver cirrhosis and liver cancer progresses quicker in the presence of high alcohol intake, HIV infection, and diabetes.

For Bhupesh Kumar Bharti drug therapy came too late. The 30 year old had received blood transfusion as a child. When he vomited blood, doctors in Patna failed to diagnose it. Two years were lost.

Bhupesh said, “I was not diagnosed in Patna. The doctors there said it was nothing, everything would be fine.”

Doctors say for patients like Bhupesh, liver transplant is the only option.

For most patients, it is a complex and expensive process to knock of the Hepatitis C virus from their system.

A combination of two drugs – interferon injected once a week and daily ribavirin pills – are given. The treatment lasts from six to 12 months costing up to Rs. 6 lakh for the drugs and tests.

In the absence of a national treatment programme, many forgo the treatment because they cannot afford it.

Hepatitis C has been called a viral time bomb by WHO.

While Hepatitis patients increase, the Government has so far ignored the epidemic.

Anshu Prakash, who is Joint Secretary, Ministry of Health and Family Welfare, said this is going to change. “This year in the 12th Five-Year plan we have also approved, and it is going to be implemented shortly, a surveillance for viral Hepatitis. There have been cases of outbreaks. We find some villages have been impacted because the villagers have been going for injection to a particular pharmacist, who was using the same syringe to give injections to everybody. These are documented cases.”

Experts say these initial plans by the government may be too little too late to defuse the time bomb or check the silent killer.

 

The article appeared in NDTV.com on October 26th, 2013.

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