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Despite 3-year data collection, Centre may not have accurate count of Hepatitis cases

Hepatitis causes inflammation of the liver. While viral Hepatitis A and E are water- or food-borne illnesses, B and C are caused through unsafe sex, infected blood transfusion or syringes.

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Until last year, Indian medical professionals had no clue about how widespread viral Hepatitis was. That changed last week, when the Union government released the first-ever surveillance and disease data on Hepatitis, gathered in the period 2011-2013.

According to the report, up to 8,04,782 cases of Hepatitis were recorded in the three-year period. Apart from these cases, 291 instances of Hepatitis outbreaks involving 15,601 cases were recorded in India, and up to 58 deaths were recorded. 

Hepatitis causes inflammation of the liver. While viral Hepatitis A and E are water- or food-borne illnesses, B and C are caused through unsafe sex, infected blood transfusion or syringes. 

But many say it is doubtful that the data compiled by the government is comprehensive. Five high-burden states– Maharashtra, Gujarat, Kerala, Uttarakhand and Punjab– have reported more than 20 outbreaks each in the past three years. A major flaw of the surveillance data, doctors pointed out, is that in Goa, Chhattisgarh, Delhi and Arunachal Pradesh, no outbreaks of Hepatitis have been reported. “Punjab has the largest number of injectible drug addicts, which may suggest why Hepatitis B and C can be a major problem there. Also, reporting systems in states that seem high-burden is very good, therefore more cases are reported. It is surprising why no data has been reported from certain other states,” said Dr Ravi Mohanka, liver transplant surgeon, Global Hospital, Parel.

Also, the data shows that the major burden of viral hepatitis is due to water-borne infections, and there are peaks of infections during the monsoons between June and September. “This is closely linked to the issue of poor sanitation and lack of safe drinking water. Unless we can ramp up our public health and development activities to ensure we can provide sanitary facilities at household level (eg through toilets) and through provision of safe drinking water, we will struggle to control this portion of the viral hepatitis burden,” said Dr Anant Bhan, researcher, Global Health and Bio-Ethics.

Among 599,605 (74.5%) cases tested for Hepatitis A, 44,663 (7.4%) were positive, and among 187,040 (23.2%) tested for hepatitis E, 19,508 (10.4%) were positive. The origins of 740,611 (92%) reported cases was not determined. “Lab testing mechanisms in India are not strong. The cases were deemed Hepatitis on symptomatic observations but origins of majority of cases have not been traced,” said Dr Mohanka.

Experts have criticized the methodology of data collection. Pushing for prevention requires age-wise collection of data, that is missing in the report. “Vaccination for Hepatitis A is also important to consider in decreasing the burden, but for that we need to better understand the age distribution of infection, which is not currently included,” said Bhan.

In 2009, Integrated Disease Surveillance Programme, operated through India's National Center for Disease Control (NCDC), became active in all Indian states. 28,850 government-run primary health care centers and hospitals and 2,923 designated private facilities serve as reporting units, which collect and report data on Hepatitis cases (any acute onset of jaundice) and outbreaks.

The burden of Hepatitis in India is predicted to be much more than the indications in the latest database. “Most patients approach private sector for treatment, numbers of which have not been recorded. It is a start to begin with, but we can definitely do better. Surveillance in the country is poor and reporting is not mandatory, which makes the data skewed,” said Bhan. 

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