India’s efforts to eliminate viral hepatitis have largely centred on hepatitis B (HBV) and hepatitis C (HCV), given their significant contribution to chronic liver disease, cirrhosis and hepatocellular carcinoma. While this focus is justified, achieving the World Health Organization’s 2030 elimination targets will require a broader, health system-driven strategy. Hepatitis A (HAV), D (HDV) and E (HEV) continue to contribute to outbreaks, severe clinical outcomes in vulnerable populations and gaps in disease surveillance, making it imperative to view viral hepatitis as a continuum rather than a collection of individual diseases.
Looking beyond hepatitis B and C
Even though hepatitis B and C are still leading agents of chronic liver disease, cirrhosis, and liver cancer, other types of hepatitis viruses create significant health problems. Hepatitis A and E lead to outbreaks in different parts of the world, especially in places with poor sanitation and lack of safe drinking water. Even though most infections are self-limiting, they can still cause serious consequences for older adults, pregnant women, and people having chronic liver disease.
Hepatitis D is another area that needs more attention. Since it occurs only in people infected with hepatitis B, it is often overlooked unless appropriate testing is performed. Co-infection can accelerate liver damage, making early identification and management especially important.
Why early diagnosis still remains a challenge
One of the biggest challenges in hepatitis care continues to be delayed diagnosis. Many patients remain asymptomatic until significant liver damage has already occurred. While access to hepatitis B and C testing has improved under the National Viral Hepatitis Control Programme (NVHCP), similar attention is needed to strengthen diagnostic pathways and surveillance for other forms of viral hepatitis.
Healthcare institutions can support this effort by adopting risk-based screening practices, strengthening laboratory capacity and ensuring timely referral of patients requiring specialist care. Improved surveillance and reporting systems will also help detect outbreaks earlier and enable more effective public health interventions.
Prevention must remain at the centre of care
A comprehensive hepatitis strategy must embed prevention across healthcare delivery. Maintaining hepatitis B immunization levels, including birth dose, improving infection control measures, ensuring blood safety, and enhancing WASH services are other interventions which work together in preventing transmission of different types of hepatitis.
Equally important is building awareness among healthcare professionals to recognise diverse clinical presentations and identify high-risk individuals who may otherwise remain undiagnosed until advanced liver disease develops.
The road to elimination
Elimination of viral hepatitis is no longer just a case of increasing access to treatment for hepatitis B and C. This involves having an overarching framework that links surveillance, diagnosis, prevention, and clinical care across various disciplines. As India makes progress in its quest for elimination, broadening its focus to cover all types of viral hepatitis is going to help prepare its health system better and make the effort sustainable.
Such an approach is important not just in the fight against liver diseases but also in building a stronger public health system.