Hepatitis B is a serious liver infection caused by Hepatitis B virus. Chronic Hepatitis B infection leads to increased risk for liver cirrhosis, liver cancer and consequent death due to these conditions. The major modes of transmission include mother to child during birth, blood exposure and during sexual contact. The Hepatitis B infection can be prevented through three doses of Hepatitis B vaccination given over a period of six months and the control of Hepatitis B infections includes costly antiviral medications. As per World Health Organization (WHO), the regions of the world with hepatitis B prevalence rate less than 2% have low endemicity, those having prevalence rate of 2-7% are of medium endemicity and regions with prevalence rate greater than 7% are categorized as highly endemic. India falls in medium endemic region with Hepatitis B prevalence rate ranging from 2-7%.

In the context of the exile Tibetan population, Department of Health, CTA recognizes Hepatitis B as a major public health problem. High cost of the Hepatitis B screening tests along with costly treatment lead to huge economic burden to the infected individuals within the Tibetan community in addition to loss of lives, associated disabilities and poor quality of life. 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 cross sectional prevalence study of Hepatitis B in 2013 among a sample of 2769 people in a Tibetan settlement in South India. As per the preliminary findings, the prevalence of Hepatitis B has been reported as 8.9 % among the Tibetan population. According to the Health Information system of Department of Health, Liver cancer is one of the most common cancers in our community along with Stomach and esophageal cancer. Since 90% of the liver cancer is due to chronic Hepatitis B infection, hence it is estimated that a large number of Hepatitis B infected Tibetan refugees eventually suffer and die from complications of liver cancer.

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 immunoglobulin. The role of screening for Hepatitis and providing vaccination to children above 6 who might not have received vaccinated is of particular importance because youth who are infected with Hepatitis B are at increased risk for chronic Hepatitis B and liver cancer .Furthermore, we implemented a Hepatitis B needs assessment at Sonamling Tibetan settlement in Leh and Jhangthang areas in Ladakh, India in May 2014, in collaboration with University of Rochester and 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 findings of this study will give important qualitative understanding about the community’s knowledge, attitudes and stigma about Hepatitis B. The findings will also assist the Department of Health 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. The Health education section of the Department of Health continue to work towards awareness and education to the general public about Hepatitis B.

The risk of Chronic Hepatitis B is inversely related to age. Those infected during childhood have significantly greater chance of developing chronic Hepatitis B and eventually liver cancer than those who have been infected during adulthood. Given the high prevalence of Hepatitis B in the community, it is imperative to screen the children and to vaccinate those who have not been previously vaccinated. The Department of Health, CTA have been providing free Hepatitis B vaccination to all children under 5 years old since 2002. Even though the Department of Health, CTA has initiated free vaccination for Tibetan children below 5 since few years, it is expected that a large majority of the population are not vaccinated and are also not aware of Hepatitis B status. Therefore, there is an increasing risk that a large number of children and youths have been infected from Hepatititis B from their household members and during birth. Therefore, we are launching a new pilot project, “Hepatitis B Control Project among School Children” this year to screen, and vaccinate total of 2000 school children between the ages of 6 to 18. However, we are unable to screen and vaccinate all the children and adolescents (who have not been vaccinated in childhood) due to financial constraints.

Therefore, The Department is in need of support to plan and implement mass Hepatitis B screening and vaccination of children above 6 years old, youths and adult population. The other important need regarding hepatitis B is improving access to treatment for those suffering from Hepatitis B. The access to hepatitis B treatment among the Tibetan population is further complicated by the huge cost of Hepatitis B. Majority of the Tibetans are unable to afford quality medications for clinical management of Hepatitis B due to poverty and economic constraints. To facilitate provision of subsidized treatment to Hepatitis B patients, the Health Department is in urgent need of generous support for treatment of needy Tibetans suffering from Hepatitis B. We believe that your support can play an important role in total elimination of hepatitis B from the Tibetan community by saving lives and reducing the burden of Hepatitis B.