NEW DELHI: More than 250 million people live with chronic hepatitis B infection, leading to increasing deaths each year, said the World Health Organisation (WHO) as it released new guidelines on the prevention, diagnosis and treatment of this chronic viral infection.
These guidelines provide a substantial simplification and expansion of eligibility for treatment to overcome barriers to access to HBV testing and treatment.
WHO’s Global health sector strategy sets actions and targets to eliminate viral hepatitis by 2030 by driving new infections and deaths down to half a million each globally - a reduction of 90% and 65%, respectively, the WHO said.
Dr Rajeev Jayadevan, former President of the Indian Medical Association (IMA), Cochin, said, “The new guidelines are aimed at tightening the drive to eliminate the virus eventually and to reduce the barriers for treatment through simplified decision-making protocols.”
Hepatitis B, a virus that lives long-term in the body, is challenging to get rid of and requires long-term antiviral medication to prevent complications.
“Although silent in a large number of cases, it is a cause of liver cirrhosis and liver cancer worldwide, especially in low and middle-income countries,” he said.
Dr. Jayadevan, a top gastroenterologist, said that the guidelines will help people who don’t have access to sophisticated lab tests to become eligible for treatment without mandatorily requiring specific tests. This makes treatment-related decisions easier, he added.
India harbours 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.
The WHO said that the 2024 guidelines prioritize simplified treatment criteria for adults and adolescents and expanded eligibility for antiviral prophylaxis for pregnant women to prevent mother-to-child transmission of HBV.
The guidelines also focus on enhancing HBV diagnostics through point-of-care viral load testing, addressing diagnosis of Delta coinfection – a significant cause of HBV-related morbidity and mortality – using testing protocols and approaches to delivering high-quality HBV services.
HBV infection is a significant public health problem and cause of chronic liver disease, the WHO said.
Most of the global burden of chronic hepatitis B (CHB) is due to mother-to-child transmission at or shortly after birth.
“Considerable progress has been made towards eliminating mother-to-child transmission of HBV through universal infant HBV immunisation, including the timely hepatitis B birth dose. However, hepatitis B birth-dose coverage is only 45% globally, with less than 20% coverage in the WHO African Region,” it said.
“For people with CHB infection, antiviral treatment is highly effective. It can improve survival and reduce progression of liver disease and the development of liver cancer. However, major testing and treatment gaps remain,” it added.
Dr Jayadevan said many new Hepatitis B infections occur at birth when the virus passes from an infected mother to the baby.
“Unfortunately, if this is not recognised and addressed, the child has a 90% chance of going on to develop chronic Hepatitis B.”
In contrast, unvaccinated adults infected with the hepatitis B virus can clear the virus spontaneously in over 90% of cases - even without medications.
“The new guidelines propose aggressive treatment of hepatitis B positive mothers with antiviral medication from the second trimester onward to reduce the risk of transmission to the child. In addition, immediate newborn vaccination within 24 hours is essential. By bringing more eligible people under this umbrella, we will be able to reduce the number of people with chronic hepatitis B in the future,” he said.
For those who are not infected at birth, it is preventable by a 3 part vaccination series.
The Indian government introduced hepatitis B vaccination into its Universal Immunization Program (UIP) in 2002.
“This single measure has prevented numerous infections already and complications resulting from it,” Dr Jayadevan added.