Chronic Hepatitis B: Challenges and Successes in India
Madhumita Premkumar, Yogesh Chawla
Abstract
About 257 million persons are infected with chronic hepatitis B (CHB) globally, resulting in 887,000 deaths annually. More than 90% of the deaths and disability as a result of viral hepatitis can be attributed to CHB and chronic hepatitis C infections. Transmission is believed to mostly occur horizontally during early childhood by close physical contact, although up to 30% of cases are due to vertical transmission. India harbors 10% to 15% of the global pool of HBV and has 40 million HBV carriers, of whom 15% to 25% develop cirrhosis and complications leading to health care costs and premature death. Of the 26 million infants born each year, 1 million run the lifetime risk for HBV infection. There is population heterogeneity with the point prevalence of HBV in India estimated to be 2.4% (95% confidence interval [CI]: 2.2%-2.7%) and in tribal areas as high as 15.9% (95% CI: 11.4%-20.4%). Clusters of HBV infection are noted in regions like Ladakh (12.7%), Arunachal Pradesh (21.2%), and the Nicobarese (23.3%), Shompen (37.8%), and Jarawa (65%) tribes of the Andaman and Nicobar Islands. About 16 billion injections are prescribed annually worldwide, and more than half are unsafe. India contributes to 25% to 30% of the global load, with a frequency of 2.9 injections per person. Causality can be attributed to unsafe injections in 46%, 38%, and 12% of cases in HBV, hepatitis C virus (HCV), and HIV transmission. 5 Hepatitis B surface antigen (HBsAg) positivity plateaus at 2% to 3%