Medical experts around the country have expressed concern at the increasing prence of viral hepatitis cases in India, suggesting that it be declared a public health issue.

As many as 12 million people may be chronically infected in India and most are unaware of it. According to experts, lack of awareness about the disease and its treatment coupled with the fact that it has no visible symptoms in its early stages have contributed to its spread. Dr Bobby John, utive Director of Global Health Advocates, India says, The situation seems alarming, even with the currently known numbers of people with the disease- which are estimated between 25 and 40 million people living with Hepatitis B and C. This is far higher than the prence of HIV or any cancer.According to him, with a coordinated mix of prevention, treatment and awareness programs, the growing burden of viral hepatitis could be effectively tackled.
GHA is a non-governmental organization that focuses on engaging all sections of society to fight diseases, and aid in formulation and implementation of effective public policies.

These diseases being silent killers with long gestation periods have so far not attracted the attention of the policy makers. What is required today is to draw the attention of our policy makers and draw up a comprehensive policy towards addressing the issue, says Dr Samir Shah, the Founder Trustee of National Liver Foundation (NLF) and Head of the Department of Hepatology, Global Hospitals,
Mumbai.

Leading gastroenterologist Dr Sudhanshu Patwari, who is the convener of the Gujarat state chapter of National Liver Foundation, says,
Hepatitis is a silent killer, and is far more easily transmitted than HIV. There is an urgent need to formulate effective screening, prevention and control strategies.

Unlike Hepatitis A, Hepatitis B and C remain silent and keep affecting the liver for a long period of time before showing any signs. During this silent phase, the person carrying the virus can potentially be a source of infection for others, he says.It is estimated that liver diseases are among the 10 ten killer diseases in India, causing lakhs of deaths every year. Besides, there are those who suffer from chronic liver problems, needing recurrent hospitalization and prolonged medical attention, which leaves them and their families physically, mentally, emotionally and financially devastated.

Medical experts are of the opinion that studies so far have indicated that some liver related diseases like Hepatitis B and Hepatitis C virus could burgeon into an epidemic much larger in scale than HIV. More epidemiological studies are required to fully assess the scale and extent of the viral hepatitis epidemic

 In India, says Dr Parveen Malhotra, Head of Department, Gastroenterology, at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak. Most people who were infected long ago with HBV or HCV are unaware of their chronic infection or their high risk of developing severe chronic liver disease. Unknowingly they transmit the infection to other people. Hence, today, we are experiencing a silent epidemic. Additionally, the HCV being asymptomatic does not help detect it at an early stage.

According to medical experts, awareness about Hepatitis is inexplicably low and the majority of those infected are still unaware. Inadequate education and awareness about the disease conditions often results into millions of hepatitis diseases cases going either unreported or reported at an advanced stage, Dr Shah says. Dr Ajit Sood, a gastroenterologist at the Dayanand Medical College and Hospital, Ludhiana, says, While most Hepatitis transmissions have resulted from IDU and syringe reuse, blood transfusions remain a significant risk factor as well. The total number of infected persons needs to be confirmed to understand the Hepatitis disease burden. This requires a political commitment to address viral hepatitis.

Dr John, on this issue, says, Besides lack of awareness among the general public, absence of proper epidemiology data at the national and state levels is hindering the framing of a national hepatitis campaign. We also need to work on clinical guidelines and awareness among primary medical care providers about Viral Hepatitis, and strengthen mechanism to encourage screening of individuals,
he says.
Doctors suggested that affordable measures, such as vaccination, safe blood supply, safe injections, and safe food can reduce the transmission of viral hepatitis infections.

What is viral hepatitis?

Hepatitis is the inflammation of the liver, which can be caused by toxins, certain drugs, heavy alcohol use and bacterial or viral infections. Viral Hepatitis is the liver inflammation caused by one of the five hepatitis viruses, referred to as types A, B, C, D and E

• Hepatitis A virus (HAV) is usually transmitted by the faecal-oral route, either through person-to-person contact or ingestion of contaminated food or water. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life threatening. Most people in areas of the world with poor sanitation have been infected with this virus.
• Hepatitis B virus (HBV) is transmitted through exposure to infectious blood, semen and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth, or from family members to infants in early childhood. Transmission may also occur through unsafe sexual intercourse, transfusions of HBVinfected blood and blood products, contaminated injections, and sharing of needles and syringes among injecting drug users. HBV also poses a risk to healthcare workers who sustain accidental needle-stick injuries while caring for HBV-infected people. A safe and effective vaccine is available to prevent HBV infection.
• Hepatitis C virus (HCV) is mostly transmitted through exposure to infected blood. This may happen through transfusions of HCVinfected blood and blood products, contaminated injections during medical procedures, and sharing of needles and syringes among injecting drug users. Sexual or interfamilial transmission is also possible, but is much less common. There is no vaccine against HCV. Both HBV and HCV can cause cancer to humans. Antiviral agents against HBV and HCV exist. Treatment of HBV infection has been shown to reduce the risk of developing liver cancer and death. HCV is generally considered to be a curable disease but for many people this is not the reality. Access to treatment remains a constraint in many parts of the world.
•  Hepatitis D virus (HDV) infections occur exclusively in persons infected with HBV. The dual infection of HDV and HBV can result in more serious disease. The hepatitis B vaccine provides protection from HDV infection.
• Hepatitis E virus (HEV), like HAV, is transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in the developing world and is increasingly recognized as an important cause of disease. HEV infection is associated with increased morbidity and mortality in pregnant women and newborns.
• From the Hepatitis family of viral infections, the most common and serious is HBV and HCV.
• Hepatitis B and C spread through unsafe injection practices, unprotected sex and transfusion of infected blood. The infection may
• also spread from mother to baby at birth.Sharing a razor or toothbrush with a hepatitis infected person, getting body piercing or tattoo done with infected tools, sharing needles, or even the use of unsterilized instruments during a dental procedure spread the infection 

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