Abstract:
Hepatitis, an inflammation of the liver caused by viral infections, remains a significant global health issue. Among the five main types—hepatitis A, B, C, D, and E—hepatitis B and C are the most severe, often leading to chronic liver disease, cirrhosis, or hepatocellular carcinoma. Although preventable and treatable, hepatitis still affects millions, especially in low- and middle-income countries where awareness, diagnosis, and healthcare access are limited. In India, particularly in regions like Punjab, unsafe medical practices and the spread of unqualified practitioners contribute to the ongoing problem.
Hepatitis: Let’s Break It Down
July 28 is observed annually as World Hepatitis Day in remembrance of its founder, Dr. Baruch Blumberg. Undoubtedly, the virus affects millions of households. It’s quite alarming that India ranks second after China.
A comprehensive review of hepatitis:
This RNA virus resides in the host’s liver. Seven different types of hepatitis have been identified, distinguished by how they are acquired (mode of transmission) and their clinical symptoms. Here’s a breakdown:
Hepatitis A:
Mode of transmission:s
Fecal-oral route, meaning consuming water and food contaminated with infected feces.
The World Health Organization estimates that in highly endemic regions, nearly all children are infected with hepatitis A by age 10, often without symptoms. Recently, reports from India indicated a surge—30-40% of hepatitis A and E cases reported between late July and August 2025, primarily due to poor sanitation and contaminated water. Children under 15 and pregnant women are particularly at risk.
Outbreaks are occurring in:
Europe: Austria, Czechia, Hungary, Slovakia
India: Kerala, Delhi-NCR, Mumbai.
Risk factors for hepatitis A:
Poor sanitation,
Unsafe drinking water,
Contaminated food,
Close contact with infected persons,
Poor personal hygiene,
Occupations like food handlers and healthcare workers,
Drug use,
Living in overcrowded conditions.
Hepatitis B:
This form of hepatitis is considered a global health burden because recent data from the World Health Organization report that 254-257 million people worldwide live with chronic HBV infection, representing 3.2% to 3.3% of the global population. Only 13-14% of those infected are diagnosed, and just 2.6-8% receive treatment. Activities that increase risk include:
Unprotected sexual contact,
Sharing needles or syringes,
The use of contaminated syringes for drug injection is a leading cause.
Mother-to-child transmission:
This can occur during pregnancy. Therefore, pregnant women should definitely undergo hepatitis B screening.
Beauty shouldn’t come at the risk of infection:
While Sikhs are naturally beautiful inside and out and have nothing to do with beauty studios, it’s important to recognize that such facilities can be potential sources of hepatitis B infection. How?
Using unsterilized equipment like razors, scissors, needles, and nail clippers on multiple clients increases vulnerability.
Unsterilized piercing or tattooing needles pose a major threat.
Waxing sticks can cause cross-contamination if double-dipped.
Procedures involving skin puncture, such as permanent makeup or ear and nose piercing, increase the risk if sterilization and hygiene protocols are not followed.
“Safe blood tests save lives."
In my experience, I have encountered many people obsessed with regular health checkups, often undergoing tests once or twice a month.
During blood draws, ensure the technician wears gloves and uses unused, properly sterilized syringes. Do not hesitate to voice concerns if you feel unsure.
Hepatitis B is also the source of hepatitis D.
Hepatitis C:
Lack of awareness leads to high dropout rates in hepatitis C treatment in Punjab, according to a study (The Times of India, Apr 15, 2025).
This type is prevalent in Punjab, with estimated prevalence rates ranging from 0.56% to 3.6%, compared to the national average of 0.32%.
Major contributors:
Injection drug use,
Unsafe medical practices,
and low public awareness.
Punjab bears a disproportionate share of India’s hepatitis C burden. While proactive public health initiatives—such as free treatment, wide screening, and a robust referral network—have made significant progress, challenges remain in treatment adherence and community awareness.
Improving patient education about treatment importance, outcomes, and availability—and ensuring supportive follow-up—will be essential if Punjab is to reach its goal of eliminating hepatitis C by 2030.
Hepatitis E: On July 29, 2025, the Times of India published an article about increasing concerns regarding hepatitis E under the headline, 'Monsoon Causes a Surge in Hepatitis Cases in the Capital.' Causes of hepatitis E include: consuming contaminated water, inadequate sanitation and poor hygiene, eating undercooked meat, and zoonotic transmission (from animals to humans). Pigs, deer, and wild boars are known reservoirs for HEV. Human infection can occur through direct contact with infected animals or meat.
Monsoon Precautions to Prevent Hepatitis E:
- Drink safe water.
- Practice good food hygiene.
- Eat only fresh, home-cooked food.
- Wash fruits and vegetables thoroughly with clean or boiled water.
- Avoid raw salads, juices, or uncooked street food.
- Cook meat thoroughly, especially pork.
3. Improve personal hygiene:
- Wash hands with soap and clean water before cooking or eating, after using the toilet.
- Use hand sanitizers only as a backup—soap and water are best.
4. Ensure proper sanitation:
- Use toilets; avoid open defecation.
- Dispose of waste properly; keep surroundings clean.
- Keep water tanks and containers covered and cleaned regularly.
5. Avoid stagnant water:
- Prevent mosquito breeding (although not directly related to Hep E, it improves overall monsoon hygiene).
- Avoid walking in contaminated floodwater.
6. Be cautious when pregnant:
- Pregnant women are at the highest risk of severe Hepatitis E.
- They should take extra precautions with water and food safety.
Global Message (WHO-aligned):
"Hepatitis Can’t Wait—Act Now, Save Lives."
(Inspired by WHO's campaign slogan)
"Curb the Quacks: A Fight for Safe Healthcare" emphasizes the rise of unqualified practitioners—people posing as medical professionals—especially in developing areas like rural India, including Punjab. These fake doctors exploit weaknesses in the healthcare system by offering inexpensive, quick treatments that often cause more harm than good. Quacks frequently administer unsafe injections, misuse antibiotics, and misdiagnose serious illnesses, leading to complications such as drug resistance, delayed treatment, and the spread of infections like hepatitis B and C. In Punjab, unsafe practices by unlicensed practitioners are a major cause of the high hepatitis C rates.
While quacks may appear to be healers, they operate in the shadows of medicine, turning hope into harm. It’s time we say no to quackery and yes to safe, scientific, and ethical healthcare.
Seek medical attention immediately if you notice symptoms or risk factors that could indicate hepatitis (A, B, C, D, or E):
Key Symptoms That Require Medical Attention:
- Yellowing of eyes or skin (jaundice)
- Dark-colored urine
- Pale or clay-colored stools
- Fatigue or unusual tiredness
- Loss of appetite
- Nausea or vomiting
- Abdominal pain, especially in the upper right side (liver area)
- Fever (particularly with Hep A or E)
- Joint pain (more common with Hep B)
Seek immediate medical help if:
- You or someone you know has a sudden onset of jaundice.
- A pregnant woman develops symptoms like vomiting, fatigue, or jaundice (HEV is especially dangerous in pregnancy).
- Symptoms are persistent, worsening, or accompanied by confusion, drowsiness, or bleeding (signs of severe liver damage).
- You had recent exposure to contaminated water, unsafe injections, or unprotected sex and feel unwell.
- You’ve been in contact with someone diagnosed with hepatitis.
- You are part of a high-risk group (healthcare worker, IV drug user, dialysis patient).
Also consider medical testing if:
- You recently traveled to areas with poor sanitation.
- You received a tattoo, piercing, or dental procedure at an unregulated place.
- You are planning a pregnancy and are unsure of your hepatitis status.
- Have you ever shared razors, needles, or toothbrushes with others?
Early detection improves outcomes. Hepatitis is manageable and even curable—especially types A, B (preventable), C (treatable), and E (self-limiting or dangerous during pregnancy). But early diagnosis is crucial to prevent serious liver damage. Early diagnosis is crucial in avoiding serious liver damage.