World Hepatitis Day 2024: In-Depth Interview with Dr. S K Sarin Part - 2
Summary
TLDRIn this insightful discussion, Dr. Serin highlights the global impact of viral hepatitis, particularly in India, emphasizing the urgent need for action. He outlines the importance of distinguishing between infection and disease, the effectiveness of treatments for Hepatitis B and C, and the significance of India's National Viral Hepatitis Control Program. Dr. Serin advocates for increased public awareness, testing, and treatment to combat the stigma and reduce the high mortality rates associated with these chronic infections. He also stresses the importance of a 'whole of society' approach to eliminate hepatitis by 2030, treating all infected individuals to prevent transmission and new infections.
Takeaways
- 🌐 Globally, 96% of the 1.3 million hepatitis-related deaths are due to Hepatitis B and C, highlighting their significant impact on public health.
- 💉 Vaccination and immunization are critical in combating viral hepatitis, especially since Hepatitis A and E can be cleared by the body, unlike the chronic infections of Hepatitis B and C.
- 💊 Effective treatments exist for Hepatitis B and C, with Hepatitis C having a cure rate of 90-95% within 12 weeks using oral medications.
- 🇮🇳 India has a National Viral Hepatitis Control Program offering free testing, treatment, and monitoring for Hepatitis C, a privilege few countries provide.
- 🚫 The mindset of infected individuals often leads to unnecessary fear and avoidance of normal life activities, despite the fact that infection does not equate to disease.
- 📉 The risk of cirrhosis and liver cancer significantly decreases with proper treatment of Hepatitis B and C.
- 📈 Awareness and early detection are crucial for reducing hepatitis-related deaths, emphasizing the need for public education and participation.
- 📊 India's National Viral Hepatitis Control Program, despite being well-structured, requires more visibility and public engagement to be fully effective.
- 🌟 Celebrity involvement in awareness campaigns, similar to those for TB, could significantly boost public understanding and empathy towards hepatitis.
- 🏥 The healthcare system and government need to prioritize hepatitis prevention, screening, and treatment, especially in resource-constrained settings.
- 🎯 The goal is to eliminate hepatitis by 2030, which requires a whole-of-society approach, including education, testing, and treatment for all infected individuals.
Q & A
What is the global status of viral hepatitis, particularly in India?
-Viral hepatitis, particularly Hepatitis B and C, is a significant public health issue with 96% of the 1.3 million deaths due to hepatitis being caused by these two types. India has a National Viral Hepatitis Control Program since 2018, which provides free testing, treatment, and monitoring for Hepatitis C.
What is the difference between Hepatitis A, B, C, and D in terms of infection persistence?
-Hepatitis A and E are typically cleared by the body, while Hepatitis B, C, and D are chronic infections that persist for life unless treated. Hepatitis B treatment aims to suppress the virus, similar to HIV, with clearance being rare.
What is the significance of the theme 'Time to take action against hepatitis'?
-The theme emphasizes the urgency to increase awareness, improve screening, and ensure treatment accessibility to combat the high mortality rate associated with Hepatitis B and C.
How effective are the current treatments for Hepatitis B and C?
-For Hepatitis C, there are very effective drugs that can clear the virus within about 12 weeks, with a 90-95% clearance rate. Hepatitis B treatment involves daily medication to suppress the virus, significantly reducing the risk of cirrhosis and liver cancer.
What is the importance of distinguishing between being infected with Hepatitis B and having the disease?
-It's crucial to differentiate because only 1 to 10% of those infected will develop the disease. Many infected individuals may not show symptoms and can live normal lives if the virus is suppressed with treatment.
Why is awareness and testing for Hepatitis C important, especially for certain groups?
-Awareness and testing are important because Hepatitis C can be asymptomatic yet lead to severe liver damage or cancer. High-risk groups such as those who have received blood transfusions, IV drug users, and individuals who have undergone surgery should get tested.
What is the role of the Indian government in combating viral hepatitis?
-The Indian government has established a National Viral Hepatitis Control Program that offers free hepatitis C drugs, testing, and monitoring. The program aims to increase visibility and awareness to reduce the stigma and improve public participation.
How can public figures and celebrities contribute to raising awareness about hepatitis?
-Public figures like actors can have a significant impact on raising awareness by participating in campaigns, sharing their personal experiences, and advocating for the importance of testing and treatment.
What are the challenges faced by the National Viral Hepatitis Control Program in India?
-While the program provides free services, challenges include low public participation, lack of awareness, and the stigma associated with hepatitis, which hinder early detection and treatment.
What is the significance of the 'WOM' program in hepatitis awareness?
-The 'WOM' program involves women who are hepatitis positive becoming ambassadors to educate and support others. Their personal experiences make them effective in spreading the message and reducing fear and stigma.
What are the future aspirations for hepatitis care and management globally?
-The aspiration is to treat all infected individuals, not just those with the disease, to reduce the pool of potential transmitters. This approach aims to eliminate hepatitis by the end of the century, ensuring future generations are free from hepatitis B and C.
Outlines
🌏 Global Status of Viral Hepatitis and Public Health Impact
The speaker discusses the global status of viral hepatitis, particularly in India, emphasizing the significant impact on public health. They highlight that 96% of the 1.3 million hepatitis-related deaths are due to hepatitis B and C, which are chronic infections that the body cannot clear without treatment. The speaker underscores the importance of vaccination and treatment, noting that effective drugs for hepatitis C can cure the infection within 12 weeks and significantly reduce the risk of cirrhosis and liver cancer. They also mention India's national viral hepatitis control program, which offers free testing, treatment, and monitoring, and stress the need for increased awareness and action to combat the disease.
📢 Raising Awareness and National Control Programs
This paragraph focuses on the need for greater visibility and awareness of hepatitis B, comparing its death rate to that of tuberculosis and malaria. The speaker advocates for strong public campaigns to educate about hepatitis, similar to those that have been successful for other diseases. They discuss India's National Viral Hepatitis Control Program, noting that while the government has provided free drugs and testing, public participation is lacking. The speaker calls for increased testing among high-risk groups and emphasizes the importance of early detection and treatment to prevent advanced liver disease and cancer.
👩🏫 Education and Community Outreach for Hepatitis Awareness
The speaker discusses the importance of education and community outreach in raising awareness about hepatitis. They mention a program called 'WOM' where women who are positive for hepatitis B become ambassadors to educate others. The speaker encourages listeners to educate others about the disease and to dispel myths about transmission. They also highlight the need for healthcare professionals to be vigilant about potential transmission in clinical settings and the importance of early treatment to prevent the progression to more severe conditions.
💉 Vaccination and Treatment Options for Hepatitis
The paragraph delves into the availability of vaccines for hepatitis B and the lack of a vaccine for hepatitis C. It mentions the inclusion of the hepatitis B vaccine in the national immunization schedule for newborns and the availability of catch-up schedules for adults. The speaker addresses the absence of a hepatitis C vaccine but notes the existence of effective treatments, such as direct-acting antivirals, which can cure the infection in most cases. They also discuss the importance of testing for hepatitis C, especially for those who have undergone surgeries or procedures where there may have been a risk of exposure.
🌟 Future Aspirations for Hepatitis Management
The speaker shares their aspirations for the future of hepatitis care and management, advocating for a shift from selective treatment to treating all infected individuals to prevent further transmission. They express hope that by 2030, a global approach similar to that for HIV will be adopted for hepatitis B and C, treating all infected individuals regardless of whether they show symptoms of the disease. The speaker envisions a future where new generations are free from hepatitis B and C, thanks to widespread vaccination and treatment.
Mindmap
Keywords
💡Viral Hepatitis
💡Hepatitis B and C
💡Vaccination
💡Treatment
💡Public Health Impact
💡Chronic Infections
💡Awareness
💡National Viral Hepatitis Control Program
💡Stigma
💡Prevention
Highlights
Global status of viral hepatitis, particularly in India, and its significant impact on public health.
96% of 1.3 million hepatitis-related deaths are due to hepatitis B and C, which are chronic infections.
Hepatitis B treatment aims to suppress the virus, with clearance being rare, similar to HIV.
The importance of differentiating between infected and diseased patients in the context of hepatitis.
Hepatitis C can be cured with very effective drugs within about 12 weeks.
India's National Viral Hepatitis Control Program offers free testing, treatment, and monitoring since 2018.
The need for increased public awareness and participation in combating hepatitis.
The importance of testing for hepatitis C, especially among high-risk groups.
The role of Hepatitis B in causing liver cancer and the need for early treatment.
The potential of using public figures like Amitabh Bachan to raise awareness about hepatitis.
The progress and challenges of the National Viral Hepatitis Control Program in India.
The need for better prioritization of hepatitis prevention, screening, and treatment in healthcare systems.
The importance of early detection and treatment in reducing liver cancer risks associated with hepatitis B and C.
The role of women as ambassadors in raising awareness and combating hepatitis, especially among women who are hepatitis B positive.
The aspiration for a global shift towards treating all hepatitis B and C patients by 2030.
The importance of vaccination for hepatitis B and the absence of a vaccine for hepatitis C.
The future hopes for the elimination of hepatitis, with a focus on early detection, treatment, and vaccination.
Transcripts
[Music]
so um since we're talking about
hepatitis can you share a global status
of viral hepatitis particularly in India
and its impact on Public Health what are
the most critical action needed to
combat viral hepatitis effectively like
we talked you said the vaccination
immunization is required and because we
talking about for this year's theme is
time to take action time to take action
against hepatitis to protect our
world yes uh hepatitis 96% of the deaths
of the 1.3 million deaths which which
occur due to Hepatitis B and C are of
all the hepatitis deaths 96% are because
of hepatitis B and C let me tell you a
important
part uh the bloodborn viruses B and C
are chronic infections chronic means
body cannot clear them Hepatitis A and E
they are cleared by body but B and C and
D they persist for your life life unless
treated Hepatitis B the treatment is to
suppress the
virus clearance is rare like in
HIV so in Hepatitis B if you give the
drug it will supress the virus but if
your virus is suppressed you're as good
as anybody and we therefore need to
differentiate infected from diseased
patients so 30 million are infected Ed
but the disease will occur in 1 to 10%
of
them but the the mindset of the
remaining is so bad that they feel that
oh something has happened I got two
patient subjects yesterday one was 32
years a lady and one was a boy who was
37 both had not
married because they thought they are
sick so it is so important for us to say
we have so many
infections so having an infection is not
equivalent to
disease I would say for Hepatitis B and
C for policy matters hepatitis C is
treated by drugs we have very effective
drugs they can clear cure you of the
hepatitis C in about 12 weeks time they
are oral drugs you take a pill a day for
3 months finished and 90 95% clearance
if you have hepatitis C and if you get
the drugs then chances of curosis liver
cancer all of them decrease and good
part is India has a national viral
hepatitis control program from 2018 now
it will be 6 years and nadas sa had
launched it at that time and it is free
hepatitis C drugs are free very few
countries in the India in the world have
this privilege for patients the testing
is free the treatment monitoring
everything is free so if you know of
somebody who has hepatitis C please help
them our Hepatitis B the treatment is
effective you take a pill a day the
yearly cost may not be more than 4,000
rupees or so and the virus is suppressed
then you are as good as anybody the risk
of curosis the risk of liver cancer
significantly decreases so what we need
to do is to take it in your hands don't
depend always on doctors or on the
governments or policies decide if I have
Hepatitis B I must get rid of it if not
get the virus suppressed if I have
Hepatitis C I will get it cured because
they are effective drugs I will not let
have my body go to the stage of curosis
or cancer and even if it occurs you have
transplant you have every possibility so
the deaths can be reduced but by
awareness but if you are
late then like blood vit or jaundice and
others then it is a different situation
now the next part of your thing is about
the
policies I think India is amongst the
very few countries despite being so
large is to have a powerful National
viral hepatitis control program but it
needs to be more you know visible like
my my desire is like the Prime Minister
sometimes says for
TB the number of deaths due to Hepatitis
B are no less maybe more in fact the who
says every 30 seconds there is a person
who is dying due to Hepatitis B so like
in last 20 minutes 40 people have died
due to Hepatitis B somewhere in the
world and the number of deaths due to
Hepatitis B are not less than combined
deaths by TB and malaria so you put TB
and malaria where we have more
visibility why not more visibility more
awareness like your campaign for
Hepatitis B and trying to eliminate it
and also the empathy to you know support
them is absolutely necessary we have to
eliminate we just don't have to control
have to get rid of it we have to do that
sir and Sir like you mentioned how uh
prime minister emphasizes on TB and more
than that more deaths happens because of
hepatitis so I think I was very small I
I still remember that people got more of
awareness about TV in fact of when I was
78 or 10 years around I got to know
about TV how because of a public
advertisement Mr amitab batan uh was
into a public awareness campaign
advertisement in which he talked about
TV how it is transmitted what other the
solutions we have and stuff like that I
think these kind of strong campaigns we
need for hepatitis as well that can
raise awareness on this and you know can
uh can make more aware people about this
absolutely and as doctors like you we
have in our country that is great but
more than that I believe people watch
more of actors and then they make impact
on people got the right person amitab
bachan has Hepatitis B exactly and he
did a campaign once or twice so will you
go to him and tell him again you go to
amitab batan G and then say Sir one more
time and every time and be with people
let us see the elimination part in case
he's hearing or has some approach on
this video I think it will he is one of
the best you know known persons and his
voice would make a difference truely sir
thank you so we also talked about
National viral hepatitis control program
uh in along with that I want to know the
views on that and how far it has
progressed and what necessary steps
needs to be taken to combat hepatitis to
achieve Countrywide elimination of
hepatitis C by 2030 which is the program
aims for and how can healthare system
and government better
prioritize hepatitis prevention
screening and treatment especially in
resource oriented constraint settings
well hepatitis C I think the government
did
everything uh they provided the drugs I
know that they have not been adequately
used by people uh the screening the
virus the RNA everything is free what is
lacking is the public
participation yeah what is lacking is we
hardly have you know 10 to 15% of the
infected India has 7 million lakh
estimate and we have hardly treated
maybe few
lcks so I would like to say that the
testing the knowledge about hepatitis C
is very important all those who got
vaccination like small pox and others
all diabetics who get injections all
those who are
repeatedly using drugs IV drug users and
they share their needles and syringes
all that group must be tested I already
told you that hepatitis C testing should
also be done in those with dialysis
those who got blood transfusion before
99 or maybe even 2005 till then the
blood banks were not very effective our
testings were not so I would say uh this
is called
recall then all blood banks who find
anybody positive for BNC should inform
the person that please come and get
tested all these are part of the viral
hepatitis control program but the public
participation for that needs to be
energized and through interviews like
you siman it will make a difference for
Hepatitis B I already told you high risk
groups so ensure if you are listening
this ensure if your friends are probably
susceptible pass this message each one
of you please listen and educate 10 and
that person should educate another 10
and all these schools should have a
competition maybe for a week yesterday
we had a competition here almost 200
students participated you will be amazed
their knowledge they knew all about wh
guidelines of 2024 a sixth class student
made a rubic you know puzzle using rubic
cubes on hepatitis so what I'm saying is
each one of you who is listening uh go
down to the school levels and don't be
scared you know it hepatitis BNC they
don't come by eating together or shaking
hands and all that
or so don't be scared get treated body
FL one must remember like if you are
infected sometimes saliva has lot of
hepatitis B not C too much or your if
you have an injury and you're positive
it is and any Doctor Who is Hepatitis B
should definitely disclose to the
patient or get virus negative before you
know he can transmit the virus so these
are some of the tips that I have given
you the viral hepatitis control program
in India has been you know somewhat it
was our own ilbs was lucky to be as a wh
Center to help in the conception to
creation and now we feel that the
government has done very well but uh the
public
participation awareness the stigma they
are the bigger blocks and we have to
overcome we started a program called wom
wom is women who are he is be positive
women who are positive become the
ambassadors suppose I am a woman and I
am Hepatitis B positive I would not go
and tell my husband the baby is born I'm
so scared because you go for anal
checkup in a clinic and they say your
hepatitis be positive now this woman
cannot go home she is so
scared such women those who have
survived all this then we have been
running it for almost now 20 years this
program and these uh women are made as
an
ambassador 100 200 of them will go and
say don't worry this is not your problem
but if you are talking to everyone you
may save many many more and their family
lives can improve so it is a whole of
society
approach the infection is deadly the
infection is problematic the infection
is a cause of concern but if we are
standing together and our message is
clear I think so they are the best
people to spread message because they
have experienced it they have gone
through it gone through it and they have
lived the agony they have lived the
despair the
isolation you know we we have a study
called beat b how do you beat the
Hepatitis B because people come and
doctors say say no no you come after one
year because you're not fit to take
treatments I'm trying to get the
guidelines Chang because you ask the
agony of the patient his isolation he
can't
sleep B is a DNA
virus and disease disease treatment work
treatment
orus and it is gone and you have a
strong mind all those who have not
married find someone if the spouse
likely spouse has any issues doctors
like me will solve this problem but get
married in
24 latest by
25 great okay so since we're talking
about suppressing the hepatitis and we
don't talked about all the types of
hepatitis we have a b c d and e so uh I
have few question regarding vaccinations
one do we have vaccination for all these
five hepatitis second you talked about
immunization and vaccinations and how we
can eradicate through vaccinations so do
actually the vaccination card the plan
of a newborn baby when when the baby is
born they get in 2 months 3 months and
every month they have scheduled some
vaccines so so does that also include
the hepatitis yes it does include
Hepatitis B in fact it is part of the
National schedule and now there are new
five in one pentavalent vaccines have
come which included again dpia whatever
meil so all these vaccines are part of
the National schedule and the cards are
given even for adults you will have 013
016 schedule is available and uh the
vaccine especially Healthcare workers
should get their antibody done not rest
of the population that is done now
hepatitis C since you asked does not
have a vaccine okay B has a vaccine a
has a vaccine but not C it's a difficult
RNA virus like Corona it was so
difficult but that was a global Calamity
so people developed now they're working
on a mRNA vaccine for
C but C the good part is that it is
generally quiet and the treatable
curable the bad part is that people are
not aware like for example people got
cesarian sections they got hysterctomy
or they got a prostate surgery long ago
now they are coming with Advanced liver
disease due to hepatitis C or a cancer
due to Hepatitis C so one more time
anybody who's got a surgery or a
procedure done anytime I would say don't
worry about 99 or 2005 do get your
hepatitis C test if it is the RNA is
positive get treated on that the
hepatitis A vaccine is uh given in all
the countries developed countries but in
India generally the kids have Hepatitis
A by food and water so they are already
immunized hepatitis A the immunity is
lifelong
but now wealth is there in India
everywhere so they all carry their
bottles and they don't drink and hygiene
Theory I would say hepati is a vaccine
in those who are somewhat Middle High
upper middle or Rich class they should
get the vaccine done foreigners
Travelers they get Hepatitis A vaccine
Hepatitis E vaccine is not there so we
have to be careful that in Winters and
other things we have good proper hype
portable good drinking water and food is
not exposed and handled by poor people
so you
protect I those are very handy dips
which we can take the time okay so and
uh what are the options available
available for people who are diagnosed
with Hepatitis B and C the treatments
available like you said a we all are
immunized by our birth if a person gets
them and B we also have but C is
something yeah see the drugs are
available there are two drugs SOS and
wellas it comes as or DEET these are the
drugs they are given in the National
program also at least soft and DEA and
by taking that your 90% chance of
getting rid of the virus and uh the
drugs are not expensive India has some
of the cheapest the best generic
medication uh Pharmacy and hepatitis B
drugs are tenob t and Ana these drugs
are available and they are genetics are
very cheap in fact India exports to
every country and they are safe so all
these drugs are generally safe but I
would say we do see in a given week and
in India the liver cancers due to B andc
are is still a problem if patient has
curosis he needs a treatment for liver
disease with a specialist care and if
there is a cancer then also specialist
care sometimes you require transplant
for BNC which is readily done very
successful programs so I think those who
have an advanced disease are uh treated
in a specialized Center but our aim is
early detection early screening and uh
you know treating them early enough and
preventing those by proper vaccination
if we take these steps clearly and
policies which are very clear are
adopted uh by all stakeholders whether
you drug user or dialysis groups and
others I think we can prevent hepatitis
C we should be able to eliminate maybe
if not 2030 uh within the next few years
or so but those who are hidden the
biggest problem is where are those
people so going ahead we have come to
end of this awareness program I want to
know your views your hopes and
aspirations for the future of hepatitis
care and management both in India and
globally you just told us uh you know
diagnosing them making them people will
identify who are they treating them
eradicating it but the aspirations ahead
for
that yeah actually Hepatitis B has been
treatment has been Complicated by
doctors uh they make guidelines whom to
treat and whom not to treat this guy has
fibrosis so he should be treated his DNA
is high he should be treated his liver
has inflammation like his sgbt is high
he should be treated others are just
watched because they know that out of
100 people maybe 10 will have disease so
they want to treat the disease they do
not want to treat the
infected but my opinion is different and
my my opinion is that the infected will
give the infection to others and every
year several lacks of new Hepatitis B
are detected I mean infected so in my
opinion all infected and all diseased
all of them should be treated so my
Approach is from treat
select to treat all yeah and this I have
been proposing for last 4 years or so
and I'm happy to say that the Chinese
associations have moved a little bit
that side wh has moved a little towards
this side and my feeling my aspiration
is by 2030 globally like HIV where we
treat
all we will treat all for Hepatitis B we
treat all hepatitis C we don't isolate
you have the virus but no disease we
treat whether you have infected or
infected plus disease
in Hepatitis B also we should treat the
infected and anybody who Hepatitis B
positive and those who are diseased both
together so that the pool of infected
and the pool who are carrying the virus
to transmit it to the others disappears
if we take this
policy we will require 65 years more or
70 years more to get rid of heati by end
of this Century we can be called because
all newborns will be protected yes and
all infected will be treated and average
age of Indian is 70 years so you require
a complete new generation of Indians who
are free of hepatitis B they are living
without fear of B or C and then there's
no scope of hepatitis yes no scope you
are immunized you're vaccinated
finished okay that's great sir thank you
so much Dr serin for for your valuable
insights your contribution you have made
to this campaign of public Awareness on
the occasion of world hepatitis day it
matters a lot because all these uh tips
treatment options uh future plans are
coming from the expert of this field so
thanks a lot for your time and your
valuable Insight it matters a lot thank
you siman and thank you Shas both of you
for coming here and it's a pleasure I
hope through you the message goes and if
there is something wrong with I have
said get back to me and say Doc you're
wrong here doc you should improve I'm
ready but I committed sure sir thank you
thanks a lot thank you
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