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

What is Trachoma?

• It is a chronic infective eye disease caused by infection with the bacterium Chlamydia trachomatis which is transmitted through contact with eye and nose discharge of infected people, particularly young children who are most vulnerable to the infection.

• It is also spread by flies which come in contact with the infected person and is most common under poor environment, low personal hygiene and inadequate access to water.

• It is one of the causes of the avoidable blindness and one of the 18 Neglected Tropical Diseases (NTD).

• During 1950s, India was a hyperendemic to Trachoma. About 50%-80% children from North-west India were affected by it.

Everything about Chandrayaan-2

• Chandrayaan-2, the lunar mission, will be launched in April this year.

• Under this mission ISRO for the first time will attempt to land a rover on the Moon’s south pole.

• In Chandrayaan-1 mission, ISRO has spotted water on the moon.

• Chandrayaan-2 is a further extension of the project as it also involves landing a rover on the moon.

Chandrayaan-2

• It is India’s second mission to the Moon.

• It is developed by the Indian Space Research Organisation (ISRO).

• The mission is planned to be launched to the Moon by a Geosynchronous Satellite Launch Vehicle Mk III (GSLV III).

• It is a totally indigenous mission comprising of an Orbiter, Lander and Rover.

The Orbiter:

• The Orbiter would orbit around the moon and perform the objectives of remote sensing the moon.

• The payloads on the Orbiter will collect scientific information on lunar topography, mineralogy, elemental abundance, lunar exosphere and signatures of hydroxyl and water-ice.

The Lander:

• After reaching the 100 km lunar orbit, the Lander housing the Rover will separate from the Orbiter.

• After a controlled descent, the Lander will soft land on the lunar surface at a specified site and deploy a Rover.

The Rover:

• The six-wheeled Rover will be made to land near the yet-unexplored south pole of the Moon. It is a very tricky area with rocks formed a million years ago. This could possibly help us understand the origin of universe.

• Most of the lunar missions in the past have explored the area around the equator of the moon.

• It will move around the landing site in semi-autonomous mode as decided by the ground commands.

• The instruments on the rover will observe the lunar surface and send back data, which will be useful for analysis of the lunar soil.

Quiz-Q24- Asserssion and Reasoning Question

Paragraph: DIRECTIONS for Question No. 24: The following question consists of two statements, one labelled ‘Assertion’ (A) and the other labelled ‘Reason’ (R).

Examine these two statements carefully and decide if the Assertion and the Reason are individually true and if so, whether the Reason is a correct explanation of the Assertion.
Select your answer using the code given below: (a) If both A and R are true and R is the reason. (b) If both A and R are true and R does not explain A. (c) If A is true and R is false (d) If A is false and R is true.

PQ24. Assertion (A): The material of the wire used in electric fuses contain low melting point materials. Reason (R): A fuse is used as a safety device to prevent damages to electrical circuits when excessive electricity passes through it.

A.
B.
C.
D.

Answer: A

Exp: The fuse elements are made of low melting point materials, e.g. tin (Sn) or zinc (Zn) and alloys thereof. In all buildings fuses are inserted in all electrical circuits. There is a maximum limit to the current which can safely flow through a circuit. If by accident the current exceeds the safe limit, the wires may become overheated and may cause fire. If a proper fuse is there in the circuit, it will blow off and break the circuit. A fuse is thus a safety device which prevents damages to electrical circuits and possible fires.

Everything about Missiles

What is a missile?

  • A missile is essentially a sophisticated bomb which after being released is governed by the laws of ballistics.
  • The laws of ballistics means only the force of gravity acts upon it.
  • It can be made more accurate and faster by attaching a propulsion system to the bomb and then it is called a rocket.
  • If guided and controlled, a rocket can be made deadlier and that is what a missile is.
  • The missiles can carry tons of nuclear warheads at speeds way higher than fighter planes.

Classification

Missiles are classified variously based on the launching system. Thus, missiles can be:

  • Surface-to-Surface Missile
  • Surface-to-Air Missile
  • Surface (Coast)-to-Sea Missile
  • Air-to-Air Missile
  • Air-to-Surface Missile
  • Sea-to-Sea Missile
  • Sea-to-Surface (Coast) Missile

Based on the working principle, missiles can be:

  • Ballistics
  • Cruise

Classified by range and proposed use, missiles can be:

  • Short RMedium RaIntermediate RangeMissile
  • Intercontinental Ballistic Missile

How is a ballistic missile different from a cruise one?

  • A ballistic missile is used to hit a predetermined target —launched such that it burns most of its fuel to attain the desired velocity in the first phase (also called the boost phase).
  • Such a missile can only be guided during the powered phase of flight.
  • 31 countries have operational ballistic missile systems.
  • India’s Agni and Prithvi are ballistic missile.
  • A cruise missile is a small pilotless craft that carries an explosive warhead.
  • It has wings and an engine, but is built more economically.
  • It is steered by inertial navigation system (INS), that’s also used by airplanes.
  • A cruise missile can be made so accurate that it can be aimed at any specific place like a door or a window.
  • Its flight can be guided for a longer period.
  • BrahMos is a cruise missile system.

Intercontinental Ballistic Missile

  • Ballistic missiles are categorised according to their range, which is the maximum distance along the surface of the earth from the point of launch to the point of impact of its payload.
  • Until recently, Russia, US, China, the UK, France and Israel were the only countries with operational ICBM technology.
  • With Hwasong-15, North Korea’s joined this club.
  • With over 5,000-km range, India’s Agni-V also qualifies for this club.

Which countries have the longest range of operational ballistic missiles?

Russia, US and China have many missile systems that qualify for the ICBM range.

Everything about World Malaria Report 2017 by WHO

The global figures

• The report shows that there were 5 million more malaria cases in 2016 than in 2015.

• The estimated global tally of malaria deaths reached 445,000 in 2016 compared to 446,000 the previous year.

• The African Region continues to bear an estimated 90% of all malaria cases and deaths worldwide.

• About 80% of the deaths were accounted for by 15 countries, namely India and 14 countries in Sub-Saharan Africa.

India specific findings

• India accounts for 6% of global malaria cases and 7% of the total deaths are caused by it.

• The WHO figures also suggest that India is unlikely to reduce its case burden beyond 40% by 2020.

Limitations

• Maldives, Sri Lanka and Kyrgyzstan achieved malaria-free status in 2015 and 2016 respectively.

Major impediments in eliminating malaria front in India are:

1.Weak surveillance system: India and Nigeria were able to detect only 8% and 16% of cases respectively by using their detection system.

• These two are major contributors to the global burden of malaria.

2. Resistance to chloroquine: In India, cases of plasmodium vivax were also traced.

• It is the milder cousin of the p. Falciparum.

• This can be due be resistance to chloroquine which is the first line treatment to p. vivax infections.

3. Low funding and resistance: Due to low funding per person at risk and resistance to certain frontline insecticides, India is only expected to achieve a 20%-40% reduction.

Target 2020

• WHO Global Technical Strategy for Malaria has called for reductions of at least 40% in malaria cases incidence and mortality rates by the year 2020.

Problem in achieving the target

• According to the latest malaria report, the world is not on track to reach these critical milestones.

• A major problem is insufficient funding at both domestic and international levels.

• Around US$ 2.7 billion was invested in malaria control and elimination efforts globally in 2016.

• This is well below to meet the targets of WHO global malaria strategy.

• This results in major gaps in coverage of insecticide-treated nets, medicines and other life-saving tools.

Controlling malaria

• In most malaria-affected countries, the most common and effective ways to prevent malarial infection are the followings:

1 Sleeping under an insecticide-treated bed net (ITN)

2 Spraying the inside walls of homes with insecticides

3 Artemisinin-based combination therapies are the most effective in controlling malarial cases

A wake-up call

• World is at the crossroads in the response to malaria.

• WHO is hoping that this report will serve as a wake-up call for the global health communities. Meeting the global malaria targets will only be possible through greater investment and expanded coverage of core tools that prevent, diagnose and treat malaria.

• Robust financing for the research and development of new tools is equally critical.

Lymphatic Filariasis

Introduction

• The national health policy had aimed at eliminating filariasis by 2015 but the deadline was extended to 2017 and now has been shifted to 2020.

• But India is likely to miss the target date of stamping out elephantiasis or lymphatic filariasis.

Filariasis

• Filariasis, called hathipaon (elephant foot) locally, can cause limbs, usually the leg, knee downwards, to swell enormously or hydrocele (swelling of the scrotum), causing disfigurement and disability.

• It is caused by various coiled and thread-like parasitic worms.

• These parasites after getting deposited on skin penetrate on their own or through the opening created by mosquito bites to reach the lymphatic system.

• The disease is caused by the nematode worm, either Wuchereria bancrofti or Brugia malayi and transmitted by ubiquitous mosquito species Culex quinquefasciatus and Mansonia  annulifera/M.uniformis respectively.

• The worms produce about 50,000 microfilariae (minute larvae) that enter a person’s blood stream and get passed on when a mosquito bites an infected person.

• The larvae develop into adult worms that can live upto 5-8 years and more in humans. They damage the lymphatic system though no symptoms may show for years.

• It is found that though changes to lymphatic vessels occurred early in the infection, treatment could reverse these in most cases.

Lymphatic filariasis (LF)

• Lymphatic Filariasis (LF), commonly known as elephantiasis is a disfiguring and disabling disease, usually acquired in childhood.

• In the early stages, there are either no symptoms or non-specific symptoms but the lymphatic system is damaged.

• The long term physical consequences are painful swollen limbs (lymphoedema or elephantiasis).

• Hydrocele in males is also common in endemic areas.

• Due to damaged lymphatic system, patients with lymphoedema have frequent attacks of infection causing high fever and severe pain.

National Filaria Control Programme (NFCP)

• After pilot project in Orissa from 1949 to 1954, the National Filaria Control Programme (NFCP) was launched in the country in 1955 with the objective of delimiting the problem, to undertake control measures in endemic areas and to train personnel to man the programme. The main control measures are:

1 Mass DEC administration

2 Antilarval measures in urban areas

3 Indoor residual spray in rural areas.

Strategy to tackle the disease

• Mass drug administration (MDA) in endemic districts ensuring coverage of over 65% population is the global strategy to eliminate the disease.

• Since 2004, the health ministry has been carrying out mass drug administration as part of the Hathipaon Mukt Bharat (Filaria Free India) programme for preventive medication.

• This involves giving at least 65% of the population in endemic districts two drugs:

1 Tablets of diethylcarbamazine citrate (DEC)

2 Albendazole once a year for five years

• Children below two years, pregnant women and seriously-ill people are not eligible for these drugs.

• After five years of MDA and 65% coverage, a transmission assessment survey is conducted to see if the district qualifies for stoppage of mass drug administration.

• The new three-drug combination, IDA, involves adding tablets of Ivermectin to the DEC and albendazole tablets and has been shown to reduce microfilariae by 99% with the first dose itself.

• The two-drug regimen (DEC and albendazole) reduces the disease by 60-80% and hence requires five rounds.

• The new drug regimen is expected to help clear the infection faster as IDA would require just two rounds.

Challenges

• India stopped the MDA in 96 of the 256 districts last year. But many of the 96 districts failed a treatment assessment survey by external evaluators.

• The surveillance that identified the 256 endemic districts is now outdated. A fresh survey could push up the number of endemic districts to over 300. This would require an overhaul of programme strategy and consequently, the chances of meeting the 2020 target are slim.

• It’s also a challenge to get people to take as many as four tablets simultaneously, especially when they have no symptoms. Health workers must ensure the person consumes the tablets right then which doesn’t always happen.

• Recently added drug Ivermectin has to be given according to bodyweight, which could mean adding 2-4 tablets to the existing drug regimen depending on the person’s body weight.

• That could be an additional challenge to the programme, the success of which hinges on community compliance (ensuring people take the medicine) and coverage (ensuring medicines reach at least 65% of the population).

• WHO gives India albendazole free of cost but it has to buy 70% of the required DE, 30% is free. Government will now have to find the funds to buy Ivermectin and meet the cost of expanding the programme. Budget approvals for the same are still in the pipeline.