National Viral Hepatitis Control Program

Ministry of Health and Family Welfare has launched the ‘National Viral Hepatitis Control Program’, with the goal of ending viral hepatitis as a public health threat by 2030 in the country.

Viral hepatitis in India

Viral hepatitis is increasingly being recognized as a public health problem in India. Hepatitis A Virus (HAV) and Hepatitis E Virus (HEV) are important causes of acute viral hepatitis and Acute Liver Failure (ALF). Due to paucity of data, the exact burden of disease for the country is not established. However, available literature indicates a wide range and suggests that HAV is responsible for 10-30% of acute hepatitis and 5-15% of acute liver failure cases in India. It is further reported that HEV accounts for 10-40% of acute hepatitis and 15-45% of acute liver failure.

Hepatitis B surface Antigen (HBsAg) positivity in the general population ranges from 1.1% to 12.2%, with an average prevalence of 3-4%. Anti-Hepatitis C virus (HCV) antibody prevalence in the general population is estimated to be between 0.09-15%. Based on some regional level studies, it is estimated that in India, approximately 40 million people are chronically infected with Hepatitis B and 6-12 million people with Hepatitis C. Chronic HBV infection accounts for 40% of Hepato-cellular Carcinoma (HCC) and 20-30% cases of cirrhosis in India. Chronic HCV infection accounts for 12-32% of HCC and 12-20% of cirrhosis.

A systematic review of available information from published studies and from large unpublished reliable datasets, to assess the prevalence of chronic HCV infection in the Indian population has recently been done to assess the prevalence of overall HCV infections, and by age, sex, risk factors and place in the country. This meta-analysis data estimated that India (current population approx. 1.3 billion) has 5.2-13 million anti-HCV positive persons. As the data on HCV viremia amongst the anti-HCV positive persons were not available, data from elsewhere was used to estimate that India has about 3 million to 9 million persons with active HCV infections.

Aim

• Combat hepatitis and achieve country wide elimination of Hepatitis C by 2030
• Achieve significant reduction in the infected population, morbidity and mortality associated with Hepatitis B and C viz. Cirrhosis and Hepato-cellular carcinoma (liver cancer)
• Reduce the risk, morbidity and mortality due to Hepatitis A and E.

Key Objectives

1. Enhance community awareness on hepatitis and lay stress on preventive measures among general population especially high-risk groups and in hotspots.
2. Provide early diagnosis and management of viral hepatitis at all levels of healthcare
3. Develop standard diagnostic and treatment protocols for management of viral hepatitis and its complications.
4. Strengthen the existing infrastructure facilities, build capacities of existing human resource and raise additional human resources, where required, for providing comprehensive services for management of viral hepatitis and its complications in all districts of the country.
5. Develop linkages with the existing National programmes towards awareness, prevention, diagnosis and treatment for viral hepatitis.
6. Develop a web-based “Viral Hepatitis Information and Management System” to maintain a registry of persons affected with viral hepatitis and its sequelae

Components

The key components include:

1. Preventive component: This remains the cornerstone of the NVHCP. It will include
• Awareness generation
• Immunization of Hepatitis B (birth dose, high risk groups, health care workers)
• Safety of blood and blood products
• Injection safety, safe socio-cultural practices
• Safe drinking water, hygiene and sanitary toilets
2. Diagnosis and Treatment:
• Screening of pregnant women for HBsAg to be done in areas where institutional deliveries are < 80% to ensure their referral for institutional delivery for birth dose Hepatitis B vaccination.
• Free screening, diagnosis and treatment for both hepatitis B and C would be made available at all levels of health care in a phased manner.
• Provision of linkages, including with private sector and not for profit institutions,for diagnosis and treatment.
• Engagement with community/peer support to enhance and ensure adherence to treatment and demand generation.
3. Monitoring and Evaluation, Surveillance and Research Effective linkages to the surveillance system would be established and operational research would be undertaken through Department of Health Research (DHR). Standardised M&E framework would be developed and an online web based system established.
4. Training and capacity Building: This would be a continuous process and will be supported by NCDC, ILBS and state tertiary care institutes and coordinated by NVHCP. The hepatitis induction and update programs for all level of health care workers would be made available using both, the traditional cascade model of training through master trainers and various platforms available for enabling electronic, e-learning and e-courses.

To access the complete guidelines, click here.

Source : Ministry of Health and Family Welfare

Related resources

1. A handbook on Safe Injection Practices guidelines
2. Viral Hepatitis : Prevention, Control and Treatment guidelines
3. National Action Plan for Combating Viral Hepatitis in India