Around the world, one in twelve people are living with viral hepatitis. Many Tibetans are infected with this life-threatening disease. Yet many are unaware that they are infected and most importantly, many still don’t know about this disease and ways to prevent it.

28 July, 2015 is an important day, marked throughout the world in honor of the birthday of Nobel Laureate Professor Baruch Blumberg who discovered the Hepatitis B virus. As we mark World Hepatitis Day, we strengthen our resolve to defeat this silent epidemic. From today onwards till the end of July, 2015, CTA Department of Health is urging all the Tibetan settlement offices, health centers, NGOs, monasteries and schools to organize innovative awareness and education events in the various Tibetan communities throughout India and Nepal.

Viral hepatitis is a group of infectious diseases known as Hepatitis A, B, C, D and E which cause both acute and chronic liver conditions, killing a total of about 1.4 million people annually. However, until now, Hepatitis has been largely ignored or unknown particularly in developing countries and in the underprivileged communities.

Therefore, the World Health Organization has designated this year’s theme as ” Prevent Hepatitis: Act now“. According to WHO, approximately 780,000 persons die each year from hepatitis B infection. The key message conveyed by this official theme centered on the following four main issues surrounding prevention of hepatitis: know the risks, demand safe injections, vaccinate children, get tested and seek treatment. This year’s themes resonates the pressing need to firstly know the risks that can result in hepatitis infection which include unsafe blood, unsafe injections, and sharing injection equipment. Secondly, the message stresses the importance of using safe injections. About 2 million people a year contract hepatitis from unsafe injections. Therefore, using sterile and single-use syringes can prevent these infections. Thirdly, this year’s theme emphasizes the importance and need for safe and effective vaccination to protect oneself from Hepatitis B infection for life. Most importantly, getting testing and seeking effective treatment can help to treat Hepatitis mainly Hepatitis B and C.

Hepatitis means inflammation of the liver and also refers to a group of viral infections that affect the liver. The most common types are Hepatitis A, B and C. Viral hepatitis is also the leading cause of liver cancer. Hepatitis is caused by a group of viruses known as hepatitis viruses. Hepatitis A is usually spread by eating or drinking food or water contaminated with its virus. Whereas hepatitis B is also a sexually transmitted disease, spread only from infected mother to child, direct contact with infected blood, semen and other body fluids. Hepatitis C is spread most commonly through direct contact with the blood of a person who is infected.

All forms of viral hepatitis pose serious health threats, but building public awareness can help prevent new cases and more effectively treat this disease. A safe and effective vaccine protects against hepatitis A and B. While there is no vaccine for hepatitis C, early detection and therapy can prevent liver damage, cirrhosis, and liver cancer; reduce the risk of death; and potentially cure the infection.

In the context of the Tibetan population inside and outside Tibet, CTA Department of Health recognizes Hepatitis B as a major public health problem. High cost of the Hepatitis B diagnostics along with expensive treatment lead to loss of lives, associated disabilities and poor quality of life; and huge economic burden to the infected individuals and their families.

Lack of accurate prevalence data about Hepatitis B was a significant hurdle for the Health Department to further plan appropriate initiatives to control Hepatitis B among the Tibetan community. Therefore, Health Department in collaboration with John Hopkins University conducted a prevalence study of Hepatitis B in 2013 among a sample of 2769 people in a Tibetan settlement in South India. As per the findings, the prevalence of Hepatitis B has been reported as 8.9% among the Tibetan population in India. The prevalence of Hepatitis B is highest in the age group of 35-50 and it is slightly more among males than in females. The study also concluded that prevalence of hepatitis B is lower among those who had previously vaccinated and whose family members are not currently infected.

To reduce the burden of Hepatitis B, Department of Health is actively engaged in planning and implementing hepatitis B control initiatives. Under the Mother and Child program, all children under five years of age are being provided free hepatitis B vaccination and Hepatitis B immunoglobin is provided free of cost to the newborns of the infected mother. However, it is important to screen and provide vaccination to children above 5 who might have not been previously vaccinated since the risk of chronic Hepatitis B and liver cancer is greater among those who have been infected with Hepatitis B at a younger age. Therefore, through the generous funding of Leis Amis through SARD, we have been implementing a “Hepatitis B prevention project” among the Tibetan school children to screen, vaccinate and treat a total of 2000 school children between the ages of 6 and above. This project started in August of 2014 in 11 Tibetan schools in India namely STS Chauntra, STS Poanta, STS Dekyiling, Ngoenga School for children with special needs, CST Kalimpong, CST Darjeeling, CST Mungod, CST Dalhousie, CST Mussoorie, CST Shimla and STS Puruwala. As of now, a total of about 2526 children have been screened for Hepatitis B. And, a total of about 1817 students are currently being vaccinated for the three doses of Hepatitis B with the first two doses of vaccination already completed. In addition, a first phase of training titled Clinical Management of Hepatitis B training was held on 14 March, 2015 in which a group of about 45 health personals participated. Resource persons from PGI, Delek Hospital and Tanda coordinated this workshop. This training was funded graciously by the Tibet Relief Fund.

In early 2015, we had provided Hepatitis B viral load testing free of cost to 175 hepatitis B positive patients residing in 11 settlements in India namely Sataun, Kamrao, Dekyiling, Herpertpur, Poanta, Bir, Ladakh, Kullu, Miao, Tezu, Ravangla, Bandara, Orrisa and Mainpat with funding support of PRM, USA.

Furthermore, we implemented a Hepatitis B needs assessment among the Sonamling Tibetan settlements in Ladakh and Jhangthang region in May, 2014 in collaboration primarily with University of Rochester and secondarily with University of Hawaii. It was aimed to understand the perceptions and level of awareness about Hepatitis B among the local Tibetan population in Ladakh. The project has been successfully completed and the findings will be released very soon. We hope that the findings would give important qualitative understanding about the problems faced by the general public with regard to Hepatitis B which would in turn assist us in evidence based planning of future hepatitis B control program for the Tibetan community particularly in providing assistance for screening and treatment support among the needy people.

In addition to these abovementioned efforts, the most important way to control Hepatitis B among our community is through prevention and better awareness about Hepatitis B. Since last year’s world Hepatitis B, we have launched an awareness campaign titled “Get three hepatitis B vaccines” through posters and an educational video which proved beneficial in motivating the community members to get the three complete doses of Hepatitis B to prevent this illness. CTA Department of Health continues to work towards greater awareness about Hepatitis B through mobile health education, health education sessions by field health workers and publication of educational brochures in both Tibetan and English. Therefore, I would like to request everyone to:

• Get tested for hepatitis B and to seek clinical guidance at your respective health centers in case you need treatment.
• Get the three complete doses of Hepatitis B vaccination at your health center which is the best way to prevent Hepattis B and liver cancer.
• Take precautions like avoid sharing of needles and tooth brushes and to always have protected sex with your partner.
• If you are pregnant and are Hepatitis B positive, your newborn must receive Hepatitis B immunoglobin just after birth to prevent Hepatitis B.
• If someone in your family is hepatitis B infected, it is important for other family members to get screened and vaccinated appropriately.
• urges all institutions and people not to discriminate people living with Hepatitis B at both individual as well as community level
• Lastly, protect yourself, your family and most importantly your children from Hepatitis B by getting vaccinated or get effectively guided and treated if you are infected

I therefore, encourage every Tibetan to commit yourself in knowing more about this disease and ways to prevent it. I am positive that through collective efforts of the health department, general public, monastic communities and school administration; we would be able to strengthen and mobilize the Hepatitis prevention and awareness with the larger goal of total elimination of this deadly Hepatitis B from the Tibetan community.

I seek your genuine support and motivation in fulfillment of a Hepatitis B free Tibetan community on this world hepatitis day. I would like to thank all the supporters and well wishers of the health department who have financially supported the Hepatitis B prevention projects within the Tibetan community so far and we are hopeful about continuing support and collaboration.

I request all the Tibetans to participate actively in Hepatitis awareness events and take responsible steps to prevent the spread of Hepatitis particularly Hepatitis B both at individual and community level.