In India, which bears around 11% of the global burden of hepatitis B patients, the fight against elimination of hepatitis took a hit during the COVID-19 pandemic. After several countries reported cases of severe hepatitis in children who contracted COVID-19, a study from Madhya Pradesh showed that of the 475 COVID-positive children investigated 8% had a unique form of hepatitis or COVID Acquired Hepatitis.

While initial investigations linked these cases of hepatitis to adenovirus infection, a new study has suggested that it may be caused by three factors: adenovirus, adeno-associated virus 2 (AAV2) and an underlying genetic predisposition to the disease.

In 2016, at the World Health Assembly, countries across the world had pledged to eliminate viral hepatitis by 2030. While some countries met the 2020 global target of reducing the incidence of hepatitis B in children under 5, most countries failed to meet this target, the World Health Organization said in June 2022.

"Timely access to the hepatitis B birth dose is still low in many low- and middle-income countries. Meanwhile, lack of awareness, limited political commitment, as well as stigma and discrimination continue to stop people accessing testing and care," WHO's statement read. Several factors like lack of a national registry and less awareness about the disease delay its elimination from India, say experts.

Around 35.4 crore people globally are still living with this life-threatening infection and at least one person dies from viral hepatitis every 30 seconds. That's over 1 million deaths per year – a greater toll than that from HIV and malaria combined, the WHO said.

Hepatitis: Symptoms and Treatment

Hepatitis predominantly affects the liver by inflaming it. Heavy alcohol use, toxins, heavy medications and certain autoimmune conditions can inflame the liver and cause the disease. However, hepatitis is mostly caused by a virus.

If a person has chronic hepatitis, such as type B and C, they may not show symptoms at all until the disease starts to damage the liver. Those with chronic hepatitis may further develop chronic liver diseases such as cirrhosis, liver failure, or liver cancer.

Conversely, people with acute hepatitis such as type A may show symptoms such as fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, and jaundice pale stools and joint pain after a few weeks after exposure. Most recover with no lasting liver damage.

While there is no specific treatment for Hepatitis A, vaccines are available for this type. Prevention and supportive care are key. Those with Hepatitis B and C are administered a combination of drugs such as interferon therapy and ribavirin. While there are vaccines for type A and B, Hepatitis C does not have a vaccine yet.

In the long path to elimination of Hepatitis, lack of awareness about the disease acts as a big roadblock. On World Hepatitis Day, FactChecker spoke to Dr Ashish Kumar, professor and Senior Consultant of Gastroenterology & Hepatology, Sir Ganga Ram Hospital in New Delhi and Dr Devendra Desai, Consultant Gastroenterology, PD Hinduja Hospital & MRC in Mumbai, to debunk six common myths about the disease and help build awareness.

Myth #1: All hepatitis viruses are basically the same

Fact: There are five types of hepatitis viruses: Hepatitis A, B, C, D and E. The Hepatitis D virus is not found in India and only occurs in people also infected with Hepatitis B virus.

While Hepatitis viruses A and E are transmitted enterically (transmitted by infected food and water), viruses B and C are transmitted parenterally (through infected needles or blood) or sexually.

Hepatitis viruses A and E cause a short illness called Acute Viral Hepatitis, which lasts for a few weeks and resolves by itself in 99% of cases. Its main symptom is jaundice.

Hepatitis B and C cause a long-lasting illness called Chronic Viral Hepatitis, which lasts for years, having only mild symptoms such as fatigue, but may cause permanent damage to the liver leading to cirrhosis, explained Dr Kumar. Hepatitis D can pass via blood, or contact with other body fluids

Myth #2: Hepatitis B spreads by casual contact

Fact: Casual contact means accidental touch or shaking hands or light kiss. None of the hepatitis viruses are transmitted in this way, said Dr Desai. His views were echoed by Dr Kumar when he said, "Hepatitis B is not spread by touching, coughing, sharing utensils, sharing towels, hugging, or even kissing. However, it can be spread by sharing of razor, sharing of needle, sexual intercourse, or when infected body fluid enters the body though cuts and abrasions, etc."

None of the viruses can be passed through casual contact. These viruses are not airborne. Hepatitis A and E are transmitted via infected food and water, while B and C are transmitted parenterally or sexually.

Myth #3: Hepatitis is a hereditary disease.

Fact: Hepatitis A, C and E are generally not transmitted from mother to newborns. Hepatitis B can be transmitted from mother to the newborn during delivery and to prevent this transmission, it is essential to screen all pregnant women for HBV and then administer a medicine known as HBIG along with HBV vaccine to the newborn of HBV+ mother, within 12 hours of delivery.

"There can be multiple members affected by Hepatitis B and to a lesser extent, Hepatitis C, in families. So, it is always advisable to test all the family members for Hepatitis B and C viruses," said Dr Desai.

Myth #4: People with any type of hepatitis shouldn't have sexual intercourse

Fact: People suffering from Hepatitis A, C and E can have sexual intercourse without any fear of transmission, confirmed Dr Kumar.

The doctors said people suffering from HBV should use barrier contraception (condom) while having intercourse with an unvaccinated person. However, if the partner is fully vaccinated and immunized against Hepatitis B, then there is no risk of sexual transmission. It is advisable that spouses of Hepatitis B patients be first screened for the virus and then vaccinated, explained Dr Kumar.

"For Hepatitis B, the partner should be vaccinated, and adequate titers of protective antibodies should be confirmed," Dr Desai added.

Myth #5: Hepatitis virus cannot survive outside human body

Fact: Hepatitis virus can absolutely survive outside the human body. While Hepatitis viruses A and E can survive in infected food and water, viruses B and C can survive on infected needles or instruments, and in body fluids.

Similarly, Dr Desai said Hepatitis B virus can survive outside the body for at least seven days. During that time, the virus can still cause infection if it enters an uninfected person's body. "This can be eliminated by proper cleaning as the virus is very susceptible to disinfection," he said.

Myth #6: Hepatitis and HIV are similar

Fact: Hepatitis types and HIV or human immunodeficiency virus are two different types of viruses. According to Dr Kumar, the only similarity is that Hepatitis B and C have similar modes of transmission to HIV. However, Hepatitis B and C affect the liver, while HIV virus infects many organs of the body.

Further, HIV and hepatitis can occur at the same time and cause more severe illness. According to a 2018 study, Hepatitis B (11%) and C (13%) co-infection was found to be significantly higher in HIV-positive individuals in comparison to the normal population. Hepatitis virus infection leads to rapid progression of liver cirrhosis in HIV-infected patients, the study stated.