World Hepatitis Day 2024: In-Depth Interview with Dr. S K Sarin Part 1
Summary
TLDRIn this informative video script, Dr. Serin discusses various types of hepatitis, emphasizing the importance of vaccination, particularly for newborns and high-risk groups. He highlights the Yellow Ribbon Campaign's role in raising awareness and the need for societal empathy towards those affected by hepatitis. The script also addresses misconceptions about transmission, the significance of testing and treatment, and the goal of eliminating Hepatitis B by 2030.
Takeaways
- 📌 Hepatitis A, B, C, D, and E are different types of viral infections affecting the liver, with A and E being typically acquired through contaminated food or water.
- 👶 Hepatitis A is common in children and often goes unnoticed, while Hepatitis E can affect adults and pregnant women, causing epidemics.
- 🧬 Hepatitis B and C are blood-borne viruses, with B being a DNA virus and C an RNA virus. Hepatitis D only occurs in individuals already infected with Hepatitis B.
- 💉 The yellow ribbon campaign was initiated in 1998 to raise awareness about Hepatitis B, emphasizing the importance of vaccination and prevention.
- 🏥 Dr. Serin, a renowned hepatologist, has been instrumental in promoting hepatitis awareness and vaccination programs in India.
- 👨⚕️ Healthcare workers are particularly at risk and should ensure they are vaccinated and have sufficient antibody levels to protect against Hepatitis B.
- 🚫 Hepatitis B is a silent killer that can persist in the body for decades without symptoms, leading to serious complications like liver cancer.
- 👶 The World Health Organization (WHO) aims for 90% birth dose coverage of the Hepatitis B vaccine by 2030 to prevent new infections.
- 💪 Vaccination against Hepatitis B is crucial for newborns and adults alike, providing lifelong protection against the virus.
- 🌐 Stigma associated with Hepatitis B can lead to social isolation and hinders people from getting tested and treated.
- 🌟 Empathy and understanding are vital in supporting those affected by Hepatitis B, with campaigns like 'Empathy Empowering People Against Hepatitis' working to combat stigma.
Q & A
What are the different types of Hepatitis mentioned in the script?
-The script mentions Hepatitis A, B, C, D, and E as the different types of Hepatitis.
How is Hepatitis A typically contracted?
-Hepatitis A is typically contracted through contaminated food or water.
What does the 'e' in Hepatitis E stand for?
-The 'e' in Hepatitis E stands for 'epidemic', indicating that it can affect many people at once and is also transmitted through food and water.
What is the primary mode of transmission for Hepatitis B?
-The primary mode of transmission for Hepatitis B is from mother to baby, accounting for about 95% of cases.
How does the script describe the nature of Hepatitis C?
-The script describes Hepatitis C as an RNA virus that is generally transmitted through injections and other means involving contact with infected blood.
What is the significance of the Yellow Ribbon Campaign mentioned in the script?
-The Yellow Ribbon Campaign is a public awareness initiative aimed at raising awareness about Hepatitis B, launched in 1998, and it signifies jaundice and the liver.
What is the importance of the birth dose coverage for Hepatitis B vaccination mentioned by Dr. Serin?
-The birth dose coverage for Hepatitis B vaccination is crucial as it provides lifelong protection against the virus, and the WHO target for 2030 is to achieve 90% coverage.
What is the difference between immunization and vaccination as explained by Dr. Serin?
-Immunization refers to having antibodies against a disease, while vaccination is the process of receiving a vaccine to stimulate the body to produce those antibodies.
Why is it important for healthcare workers to be immunized against Hepatitis B?
-Healthcare workers are at a higher risk of exposure to the Hepatitis B virus due to their work environment, so being immunized ensures they are protected and can prevent the spread of the virus.
What is the impact of Hepatitis B on an individual's health if left untreated?
-If left untreated, Hepatitis B can lead to chronic liver disease, cirrhosis, liver cancer, and even death.
What is the script's message regarding the stigma associated with Hepatitis B?
-The script emphasizes the need to eliminate the social stigma associated with Hepatitis B, which often leads to discrimination and isolation of affected individuals, and promotes empathy and support for those living with the disease.
Outlines
😷 Hepatitis Awareness: Types and Transmission
The paragraph introduces the different types of Hepatitis, focusing on Hepatitis A and E, which are transmitted through contaminated food and water. It emphasizes the silent nature of Hepatitis A in children and the epidemic form of Hepatitis E, particularly affecting pregnant women. The speaker, Dr. Serin, discusses the importance of awareness and prevention, highlighting the Yellow Ribbon Campaign and the goal of achieving 90% birth dose coverage for Hepatitis B vaccination by 2030.
📚 The Yellow Ribbon Campaign and Hepatitis Education
This section delves into the origin and impact of the Yellow Ribbon Campaign, which was initiated in 1998 to raise awareness about Hepatitis B. The campaign was inspired by two schoolgirls and has since been supported by the government of Delhi, leading to the first newborn vaccination program launched in 2001. The paragraph underscores the significance of public awareness and policy changes in combating Hepatitis.
🧬 Understanding Hepatitis Viruses: Characteristics and Symptoms
The paragraph discusses the nature of Hepatitis viruses, differentiating between Hepatitis A, B, C, D, and E. It explains that Hepatitis B and C are transmitted through body fluids and can lead to chronic infections, while Hepatitis D only occurs in the presence of Hepatitis B. The symptoms of Hepatitis B are often silent, and the virus's DNA nature allows it to persist in the body, potentially leading to severe liver diseases like cancer.
🚨 The Silent Impact of Hepatitis B and the Importance of Vaccination
This section highlights the stealthy progression of Hepatitis B and the critical need for vaccination, especially for newborns and high-risk groups. It emphasizes the importance of testing pregnant women for Hepatitis B to prevent mother-to-child transmission and the necessity of completing the full vaccination course for lifelong protection against the virus.
🛑 Addressing Misconceptions: Immunization vs. Vaccination
The paragraph clarifies the difference between immunization and vaccination, stressing that vaccination does not automatically equate to full immunization. It discusses the importance of antibody levels in determining immunity and the need for healthcare workers to ensure their own protection against Hepatitis B to effectively care for their patients.
🌟 A Call to Action: Eradicating Hepatitis B Through Awareness and Vaccination
The final paragraph serves as a call to action, urging all healthcare workers to get their Hepatitis B antibody levels checked and vaccinated if necessary. It also encourages the general public to get vaccinated against Hepatitis B, regardless of age, to prevent the spread of the disease. The paragraph concludes with a pledge to work towards the eradication of Hepatitis B by raising awareness, ensuring vaccinations, and treating those infected.
Mindmap
Keywords
💡Hepatitis
💡Vaccination
💡Contamination
💡Epidemic
💡DNA Virus
💡RNA Virus
💡Immunization
💡Stigma
💡Yellow Ribbon Campaign
💡Healthcare Workers
💡Public Awareness
Highlights
Hepatitis A and E are primarily spread through contaminated food and water, affecting children and adults respectively.
Hepatitis B, C, and D are transmitted through body fluids, with B being predominantly mother-to-child.
Hepatitis B is a DNA virus that can survive in extreme temperatures, unlike the fragile RNA virus Hepatitis C.
Almost 90% of Indian children are estimated to have had Hepatitis A due to poor hygiene practices.
Hepatitis B can remain silent in the body for decades before causing severe symptoms like liver cancer.
The Yellow Ribbon Campaign was initiated in 1998 to raise awareness about Hepatitis B.
Delhi became the first state in India to launch a newborn Hepatitis B vaccination program in 2001.
India's current coverage for the Hepatitis B birth dose vaccine is only about 40%, far from the WHO target of 90% by 2030.
Healthcare workers are urged to ensure they are immunized against Hepatitis B to protect themselves and their patients.
Adults of any age should consider getting vaccinated against Hepatitis B, not just newborns.
Hepatitis C can take 20 to 30 years to develop into a disease after infection.
People who received blood transfusions or surgeries before 1999 are advised to get tested for Hepatitis C.
Hepatitis A in adulthood can cause severe symptoms and may require a liver transplant.
Hepatitis E can cause epidemics, especially affecting pregnant women and those with compromised immune systems.
The stigma associated with Hepatitis B can lead to social marginalization and hinder treatment and awareness.
An empathy campaign aims to support and empower people against Hepatitis, reducing social stigma.
The goal is to eliminate Hepatitis B by treating infected individuals and vaccinating newborns.
Transcripts
this is Hepatitis A B C D and E so a CH
only is small little finger is for the
children hepatitis A occurs in kids so
you will never forget it it comes by
food contaminated food or water and you
ingest and the liver gets the insulting
virus it swells up and has jness the
second important is
e child hood mature you get Hepatitis E
and this is also a virus which is by
Food Water contamination and all that it
is an epidemic e means think about
epidemic form of virus affects pregnant
women other people so now knowing about
A and E are food Bor and water Bor now
what about the other three the hepatitis
b c and d hepatitis A is very
interesting dise did you get Hepatitis A
I'm sure you would have had all Indian
children have it when you are a small
kid you get Hepatitis you said
childhood you must not have noticed so
almost 90% of Indian children would have
Hepatitis A because it comes from a
school unless you're carrying your water
bottle with you and you're not eating
out at all you are so hygiene conscious
maybe you are then you may not get it
but most people people in villages
cities will have it's a silent disease
when it comes it has advances like
fibrosis therosis liver cancer so of all
the patients with hepatitis B about 1%
to 5% get liver cancer every year
hepatitis C 2% to
5% this is a wh Target for 20130 that
birth dose coverage should become
90% are you immunized or
[Music]
vaccinated hello everyone my name is
siman CH and I welcome you all on behalf
of voice of healthcare to a wonderful
special initiative where we raise
awareness on public health issues today
as we Mark World hepatitis day 2024 with
this we aim to raise awareness on this
disease on the special occasion with we
have our guest Dr s serin sir does not
need an introduction but just for the
sake of this interview and the formality
which we have to do for public I'll
introduce sir uh sir is the director of
Institute of liver and buery Sciences
president of National Academy medical
Sciences a clinician a gastrologist
hepatologist and also a padmabhushan
awarde Welcome to our show sir thank you
siman thank you for inviting
me thank you so much sir for taking our
time for this uh special initiative to
raise public Awareness on health issues
uh we know that the amount of work you
have done in this your dedication of
preventing and treating hepatitis is uh
is a commitment which is shown to all
public out there your campaign like uh
yellow ribbon campaign with the rooll to
hepatitis vaccination program
exemplifies your commitment for this
role thanks a lot for this sir I would
like to start the discussion with you by
knowing and letting us know our uh
audience about what exactly is Hepatitis
what are its symptoms treatments
available side effects as we want to
know in leand terms and you are the best
person to tell us about that well thank
you siman and siman is a very familiar
name it looks like a name from the movie
ddlt and uh Shrea thanks for coming over
all the way and being part of this uh
public awareness so let me first start
with the yellow ribbon
campaign now we were trying to raise
awareness about Hepatitis B and I got a
mail in 1998 eight from two girls one
was in class 7th and one was in class
9th from
Mumbai to join a International
Conference which we were doing and I was
intrigued I said why these young girls
and the students are coming of course
their mother was a doctor so these girls
came from Mumbai all the way traveled in
the train in the night and they brought
two
ribbons for
me and uh that time jet Milani s was
there as the law Minister one for Ram
Jet Milani so they pinned it on and I
asked the incentives and just like and I
suddenly
realized that you know the the student
Community is amongst the best community
they get ideas brighter than any one of
us and therefore on the same day we got
100 6 700 yellow ribbons made and that
was the launch of the yellow ribbon
campaign in Delhi about 15 years before
the wh the wh World hepatitis day is
July 28th started in
2010 on the birth of uh uh Dr Bloomberg
who discovered Hepatitis B but we
started this campaign of yellow ribbon
of hepatitis awareness in 1998 thanks to
the those two girls and that is on
December 4 December 1 is 's day December
4 is the day where Delhi has been
celebrating or rather
observing uh hepatitis awareness day so
this is the
story and uh I think the yellow ribbon
signifies jaundice liver in some way and
I'm very thankful that the government of
Delhi supported and we continued but why
are we talking about all this
it makes a difference yes it does make
in 98 when the yellow riban campaign was
there we had Dr haran as the delhi's
health Minister he took it to the
president of India Dr Narayan who said
wearing a cap I may show you some of
those pictures hepatitis is an important
problem and we should try and get
Tri Sheila diit G was chief minister
Delhi and Delhi became the first in 2001
to launch the newborn vaccination
program on 15th August 2001 followed one
day later by Sim and that was the
journey that started and then the
Planning Commission the then uh Dr CP
takur was the health Minister and the
public awareness at bhari G released a
stamp and so the what I'm saying is
these observations of these days is does
make a difference in the minds of public
and the policy makers yes sir now your
question on of hepatitis and why we
should do about it so let's look at
these five fingers to all the
viewers shre are you seeing them clearly
yes sir yes he is our cameraman he's a
traine I'm told in the Trinity College
and sha is with us so five finger sorry
four fingers one th this is Hepatitis A
B C D and E so a chyi is small little
finger is for the children hepatitis A
occurs in kids so you will never forget
it it comes by food contaminated food or
water and you ingest and the liver gets
the insulting virus it swells up and has
chice the second important is e
adulthood mature you get Hepatitis E and
this is also a virus which is by Food
Water contamination and all that it is
an epidemic e means think about epidemic
form of virus affects pregnant women
other people so now knowing about A and
E are food Bond and water Bond now what
about the other three the hepatitis b c
and d the B you all know is generally
mother to baby almost 95% is Mother Baby
hepatitis C is generally injections and
other so both B and C are by body fluids
and by you know uh transmission from man
to man or woman to
woman and D is a virus which piggybacks
on the B hepatitis Delta as it is called
only occurs when Hepatitis B is there
now everyone you know about the Corona
virus yes sir which type of virus is it
RNA or DNA RNA everyone knows now RNA
DNA so let me tell you Hepatitis B is a
DNA virus okay hepatitis C is an RNA
virus RNA virus is are very fragile you
put them into temperature and the virus
dies in a very short time but Hepatitis
B is a DNA virus it survives it will
survive daily eat 50° for weeks together
it will survive your refrigerator for
maybe minus 80 refrigerator for a week
or two It Never Dies why I'm saying this
if you have a hospital where there are
patients who have got blood and they are
infected with hepatitis B and their
blood is now on the railing on
somewhere then the next person come
comes healthcare worker or a patient who
has a cut he has his hand there and you
can get the infections there so
Hepatitis B is a very sturdy virus it is
unless properly
sterilized the virus doesn't die and
therefore everyone healthcare workers
have to remember it then your question
was about what are these symptoms and
how do these viruses occur
you know Gandhi g said if you slap you
put your things what body
does in Hepatitis B the slap it takes is
the virus comes but body accepts it
because it comes from mother to the baby
like you get your nose you are an army
officer's daughter Air Force Air Force
officer daughter as you told me so you
get all those genes from your parents
so these things the virus also comes
from mother and the baby's system
accepts it and it doesn't Revolt what
does it mean if you get Hepatitis B from
mother and the baby has it the rest of
the life the body accepted at its
own the body does not fight it
accepts now what does it mean these
people will remain silent it will be a
silent killer for
ages so how do you know whether this
patient is going to develop disease why
are some people developing disease
that's a different story but the mode of
transmission is mother to baby generally
and it remains silent so all those who
have ladies who are likely to deliver
they should all be tested for hepatitis
B and think that everyone is infected
think so every newborn must be
vaccinated so you can protect but now
let's see those who have got Hepatitis B
over a period of time let's say 20 years
30 years now body says there is
something funny we must get this virus
out and the activity starts we call it
immune active State till then it is
immune tolerant State we tolerate but 20
years in some people 15 years in some
people 50 years the immune active state
starts the people get jaundice and they
may get
problems and out of 100 people 10 will
have immune active uh injury State the
remaining 90 may
continue now those who get immune active
State 1 to 10% of them will develop
cancers and others but even immune
tolerant can develop so Hepatitis B is a
disease which is because of a DNA virus
it persists and most often we come to
know about it when you have symptoms and
symptoms are in the form of jaundice or
swelling or Advanced Li
disease now hepatitis A and E both are
acute viruses
just
motions similarly hepatis A and E will
they will cause symptoms and maybe four
to 6 weeks after you have taken
something funny
then you get loss of
appetite sometimes you have vomiting
nausea and then you get jaundice and
other things but hepatitis A is very
interesting disease did you get
Hepatitis A no I'm sure you would have
had it all Indian children have it when
you are a small kid you get Hepatitis
you said
childhood you must not have noticed so
almost 90% % of Indian children would
have Hepatitis A because it comes from a
school unless you're carrying your water
bottle with you and you're not eating
out at all you are so hygiene conscious
maybe you are then you may not get it
but most people in villages cities will
have and this spontaneously goes away
four 5 days like any viral fever
hepatitis A goes away but if you got
hepatitis A in
adulthood maybe after 25 30 years then
it is a serious disease then it can
cause liver failure severe jaundice
itching uh sometimes people even need
liver transplants and all that and same
is true of Hepatitis E it's an acute
infection Suppose there is a rainy
season like this so there is some
excreta from an infected person all the
people will get infect the whole village
like kpur had like 70,000 people Delhi
19 56 had almost 40 50,000 people who
got Hepatitis E so now with the better
quality of Water Sanitation hygiene we
don't get Hepatitis C but if it is there
it is a serious problem especially in
pregnant women so now you know all about
hepati now hepatitis
C hepatitis C is by needles injections
and blood before
99 India was not testing the virus was
discovered in ' 89 and from 99 most
blood banks have started so now our
blood is generally safe it doesn't have
B it doesn't have C but for people who
got blood transfusion and I want all of
you to who are listening please remember
please accept this those who got blood
transfusion surgeries operations heart
coronaries or any procedure before 99 do
get your tested for hepatitis C because
there was no such testing now
fortunately we are safe but if your
hepatitis C positive you have remained
it takes 20 to 30 years before disease
occurs it's a very slow disease process
so oh what happens I have got hepatitis
C but if you have got it get tested get
the RNA done like for Corona it's an RNA
virus so if you have got it you have to
get it
it's a silent disease when it comes it
has advances like fibrosis curosis liver
cancer so of all the patients with
hepatitis B about 1% to 5% get liver
cancer every year hepatitis C 2% to 5%
get liver
cancer have I told you everything
everything sir all right the kind of
information we got from you is I think
now it's clear to all our audience what
exactly hepatitis types of hepatitis and
how it gets transmitted most importantly
yes so I think we are aware of hepatitis
now so moving on to my next question uh
uh we know how extensively IBS is
working so before IBS let me tell you
more about Hepatitis B because this is
important see Hepatitis B is transmitted
from mother to the baby
what India needs is to
ensure that the babies are
protected so in India the coverage for a
birth dose vaccine is just about
40% we need four dosages of vaccine for
the newborn at Birth within a day 24
hours at 6 weeks 10 weeks and 14 weeks
so everyone please remember remember
four dosages are required and this is a
who Target for
2030 that birth dose coverage should
become
90% in India most deliveries are
institutional 79 80% are in the
hospitals or dispensaries or so but our
birth dose is only 40% or so so what I
want to urge is that everyone who
delivers a baby must certainly get the
newborn baby must must be given the
vaccine and the vaccine is so good the
corona vaccine there was so much debate
yes
sir Hepatitis B no such questions it is
so effective if you give it to the baby
lifelong protection it's almost 100% And
the advantage is it is cheap and it is
given free by the
government even if it is not available
sometimes you are far off what happens
500 rupes 1,000 rupees so vaccines are
you vaccinated I I believe so but put
vaccination course Hepatitis
B ah so this is the important thing this
is are you vaccinated sh yes sir so
first question are you immunized or
vaccinated okay so the difference
between immunization and vaccination I
want to
explain vaccination is not equivalent to
immunization immunization means I have
antibodies antibody
level you know you understand but in
Hepatitis B everyone who gets the
newborn will be
immunized because they have no other
problem but people who are drinking
alcohol obese or diabetic or maybe above
50 or healthcare workers and others in
them immunization is only in about 90
95% 5% are not there so remember all of
you should get antibody level done
once especially healthcare workers that
I am immunized Number Two healthcare
workers doctors nurses they think oh
nothing can happen to me they are just
not careful so I'll give you some data
that healthcare workers in Delhi
especially only 40 to 45% have all three
dosages in adults you need three dosage
zero for 1 month later and then 6 months
later why do we give this Gap because
body cells get used to how do we make a
hepatitis B vaccine let me tell you one
portion of the virus the surface protein
is taken and antibodies are raised so
when you get a vaccine it is a very
tinal part of the protein of the virus
you give it body thinks it is Hepatitis
B it makes antibodies so when you get a
vaccine you are protected so in
Hepatitis B unfortunately healthcare
workers are not so well vaccinated to my
message on this hepatitis day is you
will not touch a
patient my dear healthcare workers you
will not touch a patient unless your
antibodies are enough it means you're
immunized it means your antibody level
is about 10 but it is always better to
have a bank balance so keep your
antibody level above 100 if it is not
above 100 get another shot be strong
against Hepatitis B and then you can
tell your patient look I am immunized
against Hepatitis
B hope that makes a difference a lot sir
one last thing on
immunization everybody should get
hepatitis B vaccine it is a myth that
only children should newborn should get
it tomorrow suppose you you need a blood
transfusion you need a surgery then you
can't get immunized you need 6 months
you have a knee problem you have a
fracture somebody not you then it is
always better that every single adult
every single adult has been immunized
against Hepatitis B whatever is your age
maybe you're 80 still take it doesn't
matter so you at least know this deadly
virus which kills almost 1.3 million
people across the world I am not going
to die due to Hepatitis B neither my
friends nor my relatives is that right
yes so let's take a
pledge you on 28th of July 2024 all
healthc care workers will get their
immunization levels above 100 antibodies
and all Indians adults will get their
vaccination complete and all newborns
will be having four dosages of hepatitis
B vaccine including birth
dose is right so we have a pledge now
all right we will work on this yes
sir and I think the impact uh these
vaccinations actually make on global
level to people it helps us eradicate
the disease from the root yes you're
protected see how do you eliminate a
disease how do you eliminate one those
who are infected remove get the virus
out of them treat them second those who
are likely to be born protect them so if
you protect all new borns the next
generation is healthy all those who are
infected and there are
29 lakhs approximately three uh how much
is uh 3 CR is how much is 30 million
almost 30 million Indians are with
hepatitis
B it used to be uh 4.5 CRS now it is
about 30 million is the
estimate and if 30 million are suffering
from this if you treat them this is the
pool these are the infected people but
they don't know only coverage for
treatment only awareness or detection in
India is about 15% of the 30 million
only 15% have been detected 85 don't
know their
status and of those who are detected 3%
have been
treated so imagine a tenis how can you
eliminate a disease so through you
through this voice of health care we
would like everyone to do the
following the following means whenever
you go to a hospital or on your birthday
or on your health checkup get Hepatitis
B tested if you are positive
unfortunately get treated it is not you
who have got the virus you got it from
your mother mother got it from her
mother so don't get scared number two
all those who have infection of
hepatitis B already their family members
must get tested simple logic
all the relatives in the family should
get Hepatitis B testing normal
percentage maybe 2% 1% of hepatitis but
in the family it can be 20% so
immediately we find out all those who
are infected now we have to treat them
so don't be scared now the problem is
the
stigma hepatis B
I mean they are marginalized this in in
them but why is the
myth because you Club it with HIV people
think this is sexual transmission
Hepatitis B this fellow must have done
something wrong the wife is not very
pure the husband is something so this
social stigma
prevents people to disclose prevents
people to accept they can't tell to
their bosses in their workplaces they
can't tell to their wives if the wife
tells to the husband the wife is sent
home so what I want to say Do not punish
people who are
already punished in a way because they
got it you can't choose your mother you
got it from your mother what can you do
so one of the messages is that we should
have uh you know a kind of empathy with
them and we run a campaign called
empathy empowering people against
hepatitis we are running it from 2018
it's a program which I feel happy it was
it used to be done in the parliament of
India for last 4 years every year they
do in Parliament it is just to give the
voice to the people to confidence to the
people you are not at fault you are
saying we should embrace them with
warmth
and to detect those who have Hepatitis B
I would recommend all of you to get
tested anybody who's going for any
surgery or anything should get tested
all the family members those who have
got dialysis or those who have others
should also get tested so if you know
the pool of infected treat them finished
those who are getting born if they are
protected you can eliminate hepatitis it
is simple and I think it if you
understand standing is clear and the
society whole of society approach is
there to accept them support them the
leaders are
bold that's great and and like sir said
it it all comes from the understanding
the awareness which we are doing with
the help of Dr Serene to raise awareness
about hepatitis and there's no need to
be scared of that it will be transmitted
like way if you're working you're eating
together or something like that
everything has a solution get it
vaccinated get it eradicated get it
eliminated from your body and slowly and
gradually your country will eradicate uh
Hepatitis B and it will impact on global
level as well yes we will thank you
thank you sir
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