Everything about Hepatitis B and Hepatitis C

Headline : Hepatitis B and C major killers, but few know it

Details :

In News:

  • On the World Hepatitis Day, the Union health minister pledged to join a campaign initiated by the Institute of Liver and Biliary Sciences (ILBS) to create awareness about the disease.

Context of the topic:

  • In India, more people are dying of Hepatitis B and C than HIV, malaria and dengue combined and yet the awareness about the disease remains low.

 

In Focus: Hepatitis

What is Hepatitis?

  • Hepatitis is an inflammation of the liver.
  • The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer.
  • Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.

Note: Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue.

Types of Viral Hepatitis

  • Viral infections of the liver that are classified as hepatitis include hepatitis A, B, C, D, and E.
  • A different virus is responsible for each type of virally transmitted hepatitis.
  • These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread.
  • In particular, types B and C are the most common cause of liver cirrhosis and cancer.

Causes:

  • Hepatitis A and E are typically caused by ingestion of contaminated food or water.
  • Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids.
    • Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.

Hepatitis A

  • Hepatitis A infections are in many cases mild, with most people making a full recovery and remaining immune from further Hepatitis A Virus (HAV) infections. However, HAV infections can also be severe and life threatening.
  • Most people in areas of the world with poor sanitation have been infected with this virus.
  • Transmission of the Virus:
    • Through consumption of contaminated water or food.
    • Certain sex practices can also spread Hepatitis A Virus (HAV).
  • Vaccination availability:
    • Safe and effective vaccines are available to prevent HAV.

Hepatitis B

  • Hepatitis B is a viral infection caused by Hepatitis B Virus (HBV) that attacks the liver and can cause both acute and chronic disease.
  • According to WHO, in 2015, 257 million people suffered from Hepatitis B infection (defined as Hepatitis B surface antigen positive).
  • Infections in India: India harbours 10-15% of the entire pool of Hepatitis B virus carriers in the world and 15-25% of these patients are likely to suffer from cirrhosis, scarring of the liver and liver cancer and likely to die prematurely.
  • Transmission of the Virus:
    • Exposure to infective blood, semen, and other body fluids.
    • From infected mother to infant at the time of birth or from family member to infant in early childhood.
  • Vaccination availability:
    • Safe and effective vaccines are available to prevent HBV.
    • All infants should get a shot as soon as possible after birth, preferably within 24 hours. It, however, can be taken at any age

Hepatitis C

  • Transmission of the Virus (HCV) :
    • Through unsafe injection practices
    • Transfusion of unscreened blood and its products
    • Sexual practices that lead to exposure of blood of an infected individual
  • Vaccination availability:
    • There is no preventive vaccine for Hepatitis C, which is a major cause of liver cancer.

Hepatitis D

  • Transmission of the Virus:
    • The Hepatitis D Virus (HDV) infections occur only in those who are infected with HBV.
    • The dual infection of HDV and HBV can result in a more serious disease and worse outcome.
  • Vaccination availability:
    • Hepatitis B vaccines provide protection from HDV infection.

Hepatitis E

  • Hepatitis E Virus is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries
  • Transmission of the Virus:
    • Consumption of contaminated water or food.
  • Vaccination availability:
    • Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.

Hepatitis B and C: Major Risks

  • According to the global hepatitis  report,  2017  Hepatitis B and C, the two main types of the five different hepatitis infections (A,B,C,D,E), are responsible for 96% of overall viral hepatitis related mortality.

 

About National Viral Hepatitis Control Program

  • The National Viral Hepatitis Control Program has been launched by Ministry of Health and Family Welfare, on the occasion of the World Hepatitis Day, 28th July 2018.
  • It is an integrated initiative for the prevention and control of viral hepatitis in India to achieve Sustainable Development Goal (SDG) 3.3 which aims to ending viral hepatitis by 2030.
  • This is a comprehensive plan covering the entire gamut from Hepatitis A, B, C, D & E, and the whole range from prevention, detection and treatment to mapping treatment outcomes.

Aim

  • Combat hepatitis and achieve country wide elimination of Hepatitis C by 2030
  • Achieve significant reduction in the infected population, morbidity and mortality associated with Hepatitis B and C i.e. Cirrhosis and Hepato-cellular carcinoma (liver cancer)
  • Reduce the risk, morbidity and mortality due to Hepatitis A and E.

Key Objectives:

  • Enhance community awareness on hepatitis and lay stress on preventive measures among general population especially high-risk groups and in hotspots.
  • Provide early diagnosis and management of viral hepatitis at all levels of healthcare
  • Develop standard diagnostic and treatment protocols for management of viral hepatitis and its complications.
  • Strengthen the existing infrastructure facilitiescapacity building of existing human resources and raise additional human resources, where required, for providing comprehensive services for management of viral hepatitis and its complications in all districts of the country.
  • Develop linkages with the existing National programs towards awareness, prevention, diagnosis and treatment for viral hepatitis.
  • Develop a web-based “Viral Hepatitis Information and Management System” to maintain a registry of persons affected with viral hepatitis and its sequelae.

Components:

  • Preventive component
    • Awareness generation & behaviour change communication
    • Immunization of Hepatitis B (birth dose, high risk groups, health care workers)
    • Safety of blood and blood products
    • Injection safety, safe socio-cultural practices
    • Safe drinking water, hygiene and sanitary toilets
  • Diagnosis and Treatment
  • Monitoring and Evaluation, Surveillance and Research
  • Training and Capacity Building

 

Way ahead:

  • To make the programme successful and to ensure all persons suffering from Hepatitis B and C get treatment, there is need of more funds.
  • However, with the recent reductions in the costs of diagnosing and treating viral hepatitis, countries can scale up investments in eliminating the disease.
  • Also, mass campaigns are needed to create awareness about its vaccination.

 

Section : Social Issues

Mrunal’s Handouts on Census, Health, Education and Poverty

Handout 16: – EF6_P1_Census_Health_Edu_Poverty_Batch1

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Why the latest Ebola outbreak in Congo is a growing concern?

Headline : Why the latest Ebola outbreak in Congo is a growing concern?

Details :

News Context

  • Ebola outbreak in Democratic Republic of Congo has become the second-deadliest in history with 1,220 confirmed and probable cases, including 772 deaths, since Aug 2018.
  • However, despite a worsening Ebola epidemic, the World Health Organization has decided not to declare the outbreak a global health emergency.

Note: The deadliest Ebola outbreak was in West Africa (Guinea, Sierra Leone and Liberia) from 2014-16, that killed more than 11,300 people.

 

About Ebola

  • Ebola is a virus that can spread quickly and can be fatal in up to 90% of cases.
  • Symptoms: Fever, vomiting, diarrhea, muscle pain and at times internal and external bleeding.
  • Incubation period (time before the symptoms of a viral infection appear): 2- 21 days
  • Spreading of the virus: The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
    • The virus is most often spread by close contact with the bodily fluids of people exhibiting symptoms and with objects such as sheets that have been contaminated.
    • Health care workers are often at risk of being infected, and burial practices that call for close contact with Ebola victims can spread the disease.
  • Treatment: There is no licensed treatment for Ebola, however, receiving early care such as rehydration and treatment of other symptoms helps to improve survival chances.
    • However, recently, a new experimental Ebola vaccine has been shown to be effective.
  • Presently affected areas: North-eastern provinces of Congo sharing borders with Rwanda, South Sudan and Uganda.

 

Why WHO has not declared Ebola a global health emergency?

  • According to WHO, the epidemic does not meet the global emergency criteria because it has remained limited to two northeastern provinces and has not reached other countries, even though the affected areas share borders with Rwanda, South Sudan and Uganda.
  • Also, the WHO experts are moderately optimistic that the outbreak could be contained within a foreseeable time.

Challenges in containing Ebola:

  • This is the first Ebola outbreak to occur in a war zone, where multiple rebel groups are active in Congo’s northeast, killing hundreds of people in recent years.
  • Attacks have led to a traumatized population that can be cautious of outsiders, which makes it difficult for health workers to treat the affected population and explain them about the importance of safe burials and other preventative measures.
  • The health teams often faced attacks from the people and in some cases had to shut down their clinics
Section : Social Issues

A Rare Opportunity Editorial 11th Apr’19 IndianExpress

Headline : A Rare Opportunity Editorial 11th Apr’19 IndianExpress 

Details : 

Rare diseases:

  • A rare disease affects a small percentage of people.
  • Most rare diseases are chronic and severe, leading to death or disability.

Problems in diagnosis, understanding and treatment:

  • Since these diseases are not found commonly, doctors are typically unaware about them and therefore either misdiagnose or do not diagnose them.
  • This further decreases recorded incidence of the disease, which in turn diminishes interest in understanding the disease and finding treatments for it.

Needs support of government:

  • The issues related to rare diseases can only be overcome by strong support from the government.

National Policy for the Treatment of Rare Diseases suspended in 2018:

  • However, in 2018, the Union government suspended the National Policy for the Treatment of Rare Diseases.
  • This came as a shock to those patients who were relying on the money allotted through the policy for life-saving treatments.
  • The Centre said that the current policy for rare diseases needed to be reframed due to challenges in implementation and costs.
  • The Union Health Ministry termed the policy “untenable” as the implementation of the policy was moved out of the Public Health Division to the National Health Mission (NHM).

Low public health expenditure necessitated this decision:

  • India’s meagre 1.15 per cent of GDP allocation to healthcare means government has to make a decision of “balancing” disease incidence.
  • In this, rare diseases lose out due to the high cost of treating them.

But patients with rare disease should not be discriminated against due to costs:

  • A utilitarian calculation is not the right basis for public policy because it perpetuates marginalisation and subverts the state’s duty to treat its citizens equally.
  • The Delhi High Court recognised the rights of rare disease patients, and said that low disease incidence cannot be the state’s basis for denying someone the right to life enshrined under Article 21 of the Constitution.

Need a new rare disease policy:

  • The Delhi HC has also demanded that the government promptly frame a new rare disease policy that incorporates global best practices.
  • To respect the HC’s directions, a new policy must be founded on non-discriminatory ideals.
  • Policymakers will have to address fiscal constraints without devaluing lives of patients with rare diseases.

The new policy should be different from the earlier policy:

  • The government should create a new policy that is based on different fundamentals.
    • Attention should be on all rare diseases: The earlier policy had a narrow focus on allocating funds to treat a select few rare diseases that could be treated, while it excluded untreatable diseases. This is problematic as only 5 per cent of all rare diseases are treatable, and thus effectively excludes 95 per cent of rare diseases from its purview. The new policy should deal with this.
    • Greater resources: A new and inclusive rare disease policy should allocate substantial resources to research for the development of new platform therapies that could commonly treat different rare diseases, while simultaneously bringing down the costs of current treatments.
    • More research: More research will also facilitate greater interest in rare diseases in the medical community, increasing rates of diagnosis and improving medical care. Increased focus on research could help develop cheaper treatments.
  • Take care of cost of treatment: Giving incentives to pharmaceutical companies to develop treatments for rare diseases has resulted in discovery of treatments but their cost is prohibitively high. In India, where most patients are un-insured and rare diseases fall outside the insurance system, this increases patient dependence on government financing. Ways must be found to incentivize discovery of new treatments while keeping treatment costs affordable.

Conclusion:

  • Low incidence makes rare diseases “unprofitable” and companies are reluctant to invest in them.
  • The government must not abandon the rare disease community to the market mechanism

Everything about Autism

Headline : AIIMS doctors develop application to help in timely diagnosis of autism 

Details : 

The News

  • In the backdrop of the World Autism Awareness Day, doctors at AIIMS have developed a mobile app for early diagnosis of Autism Spectrum Disorders.
  • World Autism Awareness Day is observed on April 2 every year.

About the App

  • The app developed is called PedNeuroAiimsDiagnostics.
  • It is a questionnaire-based app which has 2 sections of questionnaire
  1. Section A has questions to assess the social interaction and communication skills
  2. Section B has questions to analyse the response given to questions in section A.
  • Based on the response to the questionnaire the app analyses if the child has any of the Autism Spectrum Disorders
  • Accordingly the following cases are considered to be suffering with ASD
  • A child who cannot babble or point or gesture by 12 months
  • Couldn’t say single word by 16 months
  • Couldn’t say any two-word spontaneous phrases by 24 months
  • Loss of language or social skills at any age.
  • The App is easy to use with even a paediatrician can assess the test results.
  • The app is very sensitive in that detects 98% of cases.
  • It is also very specific in that it predicts specifically which of the ASD in 92% of the cases.

 

In focus: Autism Spectrum Disorders

About ASD

  • Autism is a developmental disorder associated with the neurological condition of the child.
  • It shows signs in the first 3 years of child development.
  • Autism is a brain malfunction mainly associated with impairments in 3 main areas
  • Communication skills
  • Social interactions 
  • Repetitive and restricted activities
  • Autism mainly occurs due to abnormalities in brain structure and function which can occur due to varied reasons.
  • As a result Autism is grouped under a spectrum of disorders called Autism Spectrum Disorders.

 

 

Common behavior pattern

  • In general autistic individual s have different ways of ‘sensing’ their world
  • Lack of emotional connection
  • Lack of eye contact while communicating
  • Not reacting or inconsistently reacting when their name is called out
  • Hypersensitivity to noise
  • Lost in own thoughts
  • Hitting or biting themselves
  • Lack of non-verbal communication
  • Inability to follow objects visually
  • Inability to make friends
  • Repetitive body movements
  • Repeating their own sentences

 Causes

  • There is no single cause for Autism.
  • Different children suffering from Autism are due to different causes.
  • Some commonly identified factors include
  • Gene mutations: No single gene is associated with Autism.
  • Environmental stresses
  • Parental age at the time of conception
  • Maternal illnesses during pregnancy
  • Mother who is a victim of drug and alcohol abuse
  • Oxygen deprivation to the child’s brain etc
  • However it should be noted that there is no conclusive direct correlation with any of the factors above listed.

 

Types

  • Since no two individual suffer from Autism due to same cause, different conditions are grouped under ASD.
  • It can vary between mild learning and social disability, to more complex emotional and physical disabilities.

Asperger’s syndrome

  • Mild form of Autism
  • Obsessive interest in a particular object or subject

Pervasive developmental disorder

  • This is more severe than Asperger’s syndrome
  • No two people suffering from the disease will exhibit the same symptoms
  • Common symptoms include
  • Poor social interaction
  • Impaired language skills

 

Autistic disorder

  • Most severe form of ASD.
  • Multiple impairments
  • Mental retardation and seizures

Note: Rett syndrome and Childhood disintegrative disorder are rare ASDs

Section : social issues

Objectives of Ayush Mission

The Government has launched the National AYUSH Mission with the objectives of:

 providing cost effective AYUSH Services, with a universal access through upgrading AYUSH

Hospitals and Dispensaries,

 co-location of AYUSH facilities at Primary Health Centres (PHCs), Community Health Centres

(CHCs) and District Hospitals (DHs),

 strengthening institutional capacity at the state level through upgrading AYUSH educational

institutions, State Govt. ASU&H Pharmacies, Drug Testing Laboratories and ASU & H enforcement

mechanism,

 supporting cultivation of medicinal plants by adopting Good Agricultural Practices (GAPs) so as to provide sustained supply of quality raw-materials and support certification mechanism for quality standards,

 Good Agricultural/Collection/Storage Practices and supporting setting up of clusters through convergence of cultivation, warehousing, value addition and marketing and development of infrastructure for entrepreneurs.

National Pharmaceutical Pricing Authority (NPPA)

.

Consider the following statements about National Pharmaceutical Pricing Authority (NPPA)

1.     It functions under the Ministry of Consumer Affairs, Food and Public Distribution

2.     It fixes/revises the prices of controlled bulk drugs and formulations

Select the correct statements

a     1 Only

b     2 Only

c      Both 1 and 2

d     Neither 1 nor 2

Explanation:

Solution (b)

Ministry of Chemicals and Fertilizers

About

·      NPPA is an organization of the Government of India which was established, inter alia, to fix/ revise the prices of controlled bulk drugs and formulations and to enforce prices and availability of the medicines in the country, under the Drugs (Prices Control) Order, 1995.

·      The organization is also entrusted with the task of recovering amounts overcharged by manufacturers for the controlled drugs from the consumers.

·      It also monitors the prices of decontrolled drugs in order to keep them at reasonable levels.

Functions of National Pharmaceutical Pricing Authority

·      to implement and enforce the provisions of the Drugs (Prices Control) Order in accordance with the powers delegated to it.

·      to deal with all legal matters arising out of the decisions of the Authority;

·      to monitor the availability of drugs, identify shortages, if any, and to take remedial steps;

·      to collect/ maintain data on production, exports and imports, market share of individual companies, profitability of companies etc, for bulk drugs and formulations;

·      to undertake and/ or sponsor relevant studies in respect of pricing of drugs/ pharmaceuticals;

·      to recruit/ appoint the officers and other staff members of the Authority, as per rules and procedures laid down by the Government;

·      to render advice to the Central Government on changes/ revisions in the drug policy;

·      to render assistance to the Central Government in the parliamentary matters relating to the drug pricing.