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Journalism of Courage
The World Health Organisation (WHO) recently announced the reclassification of hepatitis D as cancerous, emphasising the urgency for preventing viral hepatitis, which is a growing public health crisis.
“Every 30 seconds, someone dies from a hepatitis-related severe liver disease or liver cancer. Yet we have the tools to stop hepatitis,” Tedros Adhanom Ghebreyesus, MD, WHO Director-General, said in an official news release. The WHO’s announcement stems from the International Agency for Research on Cancer’s (IARC) reclassification of hepatitis D as carcinogenic, supported by data from a study published in ‘The Lancet Oncology.’
“In India, the prevalence of hepatitis D, caused by a virus, is low in the general population but may be underestimated in high-risk groups such as intravenous drug users and those with chronic hepatitis B. Public education on safe blood usage, avoidance of needle-sharing and safe sex practice like using barrier contraception prevents transmission,” says Dr Piyush Ranjan, vice-chairperson, Institute Of Liver Gastroenterology & Pancreatic Biliary Sciences, Sir Ganga Ram Hospital, New Delhi.
Why hepatitis D is considered carcinogenic
All types of hepatitis are associated with acute liver infection; however, only hepatitis B, C, and D can lead to chronic infections with a higher risk of liver cirrhosis, failure or cancer. According to the authors of the study’s findings, hepatitis D is associated with a two- to six-fold higher risk of liver cancer compared with hepatitis B.
Hepatitis D is a serious liver infection caused by the hepatitis D virus (HDV). However, it is an incompetent virus that requires hepatitis B virus (HBV) for replication. This means it cannot cause infection alone and triggers co-infections only with the hepatitis B virus. So hepatitis D only affects people who already have hepatitis B either simultaneously or sequentially.
Hepatitis B & D co-infection runs a more severe course for risk of cirrhosis and liver cancer. Hepatitis B can cause liver cancer even without causing cirrhosis as it gets integrated in the DNA of cells. Hepatitis D virus augments the carcinogenic effect of Hepatitis B.
As per the data, 75 per cent of hepatitis D patients could develop liver cirrhosis within 15 years. People who have contracted hepatitis B alone are 50 per cent less likely to develop liver cancer as compared to people who have hepatitis B and D coinfection.
What is the mode of transmission?
The mode of transmission is similar to hepatitis B and C, that is through parenteral route or injections and transfusion, mother to child transmission and sexual contact.
How is hepatitis D diagnosed?
A blood test (HDV-RNA test) shows antibodies.
How can we prevent Hepatitis D?
Universal hepatitis B vaccination indirectly prevents hepatitis D. Despite hepatitis B being included in the national immunisation programme, the vaccine coverage is a dismal 50 per cent. Managing infections among those already affected remains difficult owing to the limited availability of approved therapies, although emerging options like bulevirtide give an assurance. The carcinogen tag is expected to enhance global surveillance, funding and research to reduce the burden of HDV-related liver cancer.
Prevention also relies on safe blood bank practices, safe sex, screening and avoiding needle sharing.
How to take the Hepatitis B vaccine?
Hepatitis B vaccine may be given in any of the following schedules: Birth, 1 and 6 months; birth, 6 and 14 weeks; 6, 10 and 14 weeks; birth, 6, 10 and 14 weeks. In catch up vaccination, use 0, 1 and 6 months schedule.
An adult, especially if in a high risk comorbidity group, should take the hepatitis B vaccine in three shots. The second dose is given a month after the first, and the third dose is given six months after the second.
