Hepatitis B is under control in India, Nepal, Thailand and Bangladesh. - Seeker's Thoughts

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Hepatitis B is under control in India, Nepal, Thailand and Bangladesh.

Hepatitis B does not spread by kissing, holding hands, hugging, coughing, sneezing or sharing crockery and utensils.

Chronic hepatitis B mainly affects babies and young children who get hepatitis B. It's much less common in people who become infected later in childhood or when they're an adult.

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.

What is Hepatitis B?

Hepatitis B is a medical condition and an infection of the liver that is caused by a virus. The virus is spread by through the blood and body fluids.

The problem is that only some people with hepatitis B experience symptoms, which usually develop two or three months after exposure to the hepatitis B virus.

Some of the people infected in adulthood won’t experience any symptom and will fight off the infection without realizing that they had it, however, they are able to pass the virus on to others while they are infected.

Hepatitis B in adults will usually pass within 1 to 3 months. This is known as acute hepatitis B and rarely causes any serious problems.

Occasionally, the infection can last for 6 months or more. This is known as chronic hepatitis B.

What is Controlled Hepatitis B?

The virus is said to be controlled when the disease prevalence is reduced to less than 1% among children less than five years of age. 

One million people in India became chronically infected with the virus every year. According to the Health Ministry, 40 million people were estimated to be infected as of February 2019.

Hepatitis B infection at a young age turns severe and chronic, which has caused over 1,00,000 premature deaths in India per year.

Gradually since 2002, the government has worked to reduce the cases of Hepatitis B, in which the government scaled up a nationwide programme in the Universal Immunisation Programme to fight against the Hepatitis B. 

A study published in 2013 found lower coverage of hepatitis B vaccine in eight of the 10 districts surveyed.

But the coverage has witnessed an increase with the introduction of a pentavalent vaccine on a pilot basis in Kerala and Tamil Nadu in December 2011 and national roll-out in 2014-2015.

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%. One of the reasons for this is the sub-optimal coverage of birth dose in all infants within 24 hours of birth.
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Hepatitis B can be spread by:

  • A mother to her newborn baby, particularly in countries where the infection is common – all pregnant women in the UK are offered screening for hepatitis B, babies of infected mothers are vaccinated immediately after birth to help prevent infection
  • Injecting drugs and sharing needles and other drug equipment, such as spoons and filters
  • Having sex with an infected person without using a condom

Anyone who has had unprotected sex, including anal or oral sex – particularly people who have had multiple sexual partners, people who have had sex with someone in or from a high-risk area, men who have sex with men, and commercial sex workers are more prone to get diseases.

  • Having a tattoo, body piercing, or medical or dental treatment in an unhygienic environment with unsterilized equipment
  • Having a blood transfusion in a country where blood is not tested for hepatitis B – all blood donations in the UK are now tested for the infection
  • Sharing toothbrushes or razors contaminated with infected blood
  • The skin is accidentally punctured by a used needle (needle stick injury) – this is mainly a risk for healthcare workers
  • The blood of someone with hepatitis B getting into an open wound, cut or scratch – in rare cases, being bitten by someone with hepatitis B can also spread the infection

How Hepatitis B dose is given?

If the mother is infected, the Hepatitis B birth dose is given in the first 24 hours. It helps prevent vertical transmission from the mother to child.

Vertical transmission, the transfer of a disease, condition, or trait from one generation to the next either genetically or congenitally, such as the spread of infection through breast milk or through the placenta.

70-90% newborn infected through vertical transmission become a chronic carrier of hepatitis B, and India has 20-3- % carriers due to vertical transmission. Therefore, the dose at the time of the birth should be increased. As even after the health ministry approved the birth dose in 2008, the coverage remains low.

In 2015, 45%, in 2016, 60 %, and in 2017 coverage was provided according to the ministry’s report. India has some population which does not have access to hospitals at the time of childbirth, yet children who are delivered in institutions should at least get the dose to prevent hepatitis B.

In India, only 80 % of deliveries are institutional deliveries, while, 20 % of deliveries still remain out of reach of hospitals.

Why does Hepatitis B vaccination is not provided in hospitals?

WHO recommends that hepatitis B has open- vial policy, that means that opened vials of hepatitis B vaccine can be kept for a maximum duration of 28 days for the use in other children if the right conditions are provided. Many health workers are not aware, and the fear of wastage remains the reason for the low coverage.

People should be more aware of the merits of birth dose, as once the public demands, the change happens in the attitude of institutions.

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