Hepatitis B is a public health concern in India; but very few know about its transmission, effects & vaccination

Public knowledge and awareness about Hepatitis B, a deadly disease that can cause end-stage liver cirrhosis and liver cancer, is dismal in India, according to a new study conducted by Sir Ganga Ram Hospital, New Delhi.

Just 25 per cent of respondents had adequate knowledge about the disease, including its transmission methods, effects on the liver and the critical importance of vaccination.

“This lack of awareness suggests that misconceptions and insufficient education on Hepatitis B are widespread, necessitating targeted information campaigns to bridge these knowledge gaps,” the hospital said in a statement on March 22, 2024.

Hepatitis B virus (HBV) infection is a major global and national health issue. Public awareness and knowledge about it are crucial for prevention, diagnosis and treatment.

HBV infection affects around 296 million people globally. It causes approximately 887,000 deaths yearly due to complications like end-stage liver cirrhosis and liver cancer.

Infection rates remain high, especially in countries with lower socio-demographic indices such as India. This is despite the fact that an effective vaccine against the disease has been available for over 30 years.

The hospital stated that Hepatitis B surface antigen (HBsAg) positivity prevalence is between two per cent and eight per cent. HBsAg is a protein on the surface of HBV. It can be detected in high levels in serum during acute or chronic HBV infection.

A recent meta-analysis has even suggested an overall prevalence of 3.70 per cent. This translated to about 37 million HBV carriers in India, according to the hospital.

The study

Sir Ganga Ram Hospital “crafted a cross-sectional survey to understand the insights into the public’s averseness and vaccination practices against Hepatitis B in India”.

“Over 3,500 participants, excluding healthcare workers and individuals below 18 years, were surveyed to evaluate their knowledge across four critical domains: The cause and spread of Hepatitis B, the organs affected and the consequences, available treatment options, and vaccination information,” the statement noted.

The survey used a scoring system ranging from -20 to +22 to quantify the participants’ knowledge, with vaccination status also being rigorously assessed.

Only 22.7 per cent of participants had completed the full Hepatitis B vaccination course. This low vaccination rate was alarming, according to the hospital, given the virus’s prevalence and the vaccine’s effectiveness in preventing cirrhosis and liver cancer.

The study also highlighted disparities in vaccination uptake. These were influenced by factors such as gender, education levels and the urban-rural divide.

“These disparities underline the importance of not only increasing overall vaccination efforts but also ensuring that these initiatives reach and are accessible to all segments of the population, particularly those most at risk of developing HBV infection like those with immuno-compromised states, extreme of ages, accidental needle pricks tattooing, transplant recipients and the ones who receive blood transfusion,” the statement added.

Dr Anil Arora, chairman of the Institute of Liver Gastroenterology and Pancreatic Biliary Sciences at the hospital and principal investigator of the study, laid emphasis on targeted public health interventions to improve awareness and vaccination coverage.

Educational campaigns should focus on the general public, with particular emphasis on women, older individuals, those with lower education levels and rural residents, who demonstrated lower knowledge scores and vaccination rates in the study participants, according to Arora.

People should also be made aware about the importance of completing the full vaccination schedule for adequate efficacy. This was because it was not uncommon for people to have one or two doses of vaccination and forget the last one, Arora noted.

Dr Ashish Kumar, a co-author of the study, observed that comprehensive strategies addressing both health literacy and vaccination coverage were vital for achieving the national and global targets for HBV control.

Dr Praveen Sharma was the third co-author of the study.