Editorial Highlights Gaps in Diagnosis, Treatment, and Surveillance Despite Decades of Intervention
New Delhi:
India must adopt a comprehensive and multi-sectoral approach to eliminate hepatitis B, focusing on robust epidemiological data, universal diagnostic access, stronger surveillance, and private sector engagement, according to leading gastroenterology experts from the All India Institute of Medical Sciences (AIIMS), New Delhi.
In an editorial titled “Hepatitis B Virus Prevalence in India: A Wake-up Call for Action”, published in the Indian Journal of Gastroenterology (June 2024), the doctors emphasised that despite multiple national-level initiatives, the prevalence of hepatitis B virus (HBV) remains high, and progress toward elimination has been slow.
India Home to Nearly 30 Million HBV Cases
Citing the Global Hepatitis Report 2024, the experts stated that approximately 29.8 million people in India were living with HBV infection in 2022. The virus is currently the third leading cause of liver cirrhosis, following alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease.
HBV was also responsible for an estimated 98,305 deaths in India in 2022. Chronic HBV infection significantly increases the risk of hepatocellular carcinoma (HCC), with nearly 25% of those infected likely to develop it during their lifetime. Moreover, HBV reactivation remains a leading cause of acute-on-chronic liver failure (ACLF), affecting 7.7% of such patients in South-East Asia.
Experts Recommend Leveraging Telemedicine, AI, and Decentralised Models
The authors — Dr Shekhar Swaroop, Dr Shalimar (AIIMS), and Dr Subrat Kumar Acharya, former HoD and current Pro-Chancellor at KIIT University — proposed leveraging telemedicine platforms, AI-driven patient management, and generic antiviral access to strengthen HBV care.
“India must prioritise viral hepatitis as a public health priority, not just to meet WHO elimination targets, but to protect future generations from this preventable disease,” the editorial stated.
Progress Under NVHCP, But Gaps Persist
The editorial acknowledged the National Viral Hepatitis Control Program (NVHCP), launched in 2018, as a critical step in combating HBV. Initiatives under the programme include:
- Hepatitis B vaccination
- Universal blood donor screening
- Prevention of mother-to-child transmission
Improvements have been observed — notably, the third-dose vaccine coverage reached 93% in 2023, and full vaccination among children aged 12–23 months increased from 62.8% (NFHS-4) to 83.9% (NFHS-5).
However, critical gaps remain:
- Birth dose vaccination coverage: 63%
- Diagnosis rate: 2.4%
- Treatment coverage: 0.0%
These figures indicate a major shortfall in early detection and clinical care linkage, the experts warned.
Community Study Reveals Persistent Prevalence
The editorial also highlighted a community-based study by Rajalatchumi et al. from Puducherry, which reported a 2.5% adjusted HBV prevalence — higher than NFHS-4 estimates. The study involved HBsAg testing in four rural villages, achieving an impressive 94% participation rate.
Younger individuals were found to be at higher risk, with blood transfusions remaining a key transmission factor, reflecting gaps in awareness and infection control.
“When compared to a 2013 study from the same region with a prevalence of 2.96%, little has changed over the decade, suggesting stagnation in public health outcomes,” the doctors noted.
Urgent Need for Nationally Representative Data
The editorial pointed out that India lacks nationally representative, population-based prevalence surveys, and its surveillance systems are fragmented and underfunded.
“Despite decades of effort, HBV prevalence remains high due to limited public awareness, absence of mandatory screening, and poor linkage to care,” the doctors concluded.
The experts called for data-driven strategies, decentralised healthcare delivery, stronger political commitment, and integration of private healthcare providers to meet the WHO’s 2030 hepatitis elimination goals.
