He said around 300 million people are living with viral hepatitis around the world, unaware of their condition, according to the World Health Origination (WHO). Without being diagnosed and linking them to treatment and care, millions will continue to suffer, and lives will be lost, the apex health body said on this World Hepatitis Day, observed on 28 July, 2019.

Hepatitis B infection is a contagious liver disease caused by Hepatitis B Virus. The disease is 50 to 100 times more infectious than HIV. There are acute types of the infection where the disease manifests within 6 months for long term, which leads to chronic and life long illness. It becomes serious with liver damage.

While most of the patients are ignorant of their hepatitis status, health experts have warned that those suffering from diabetes mellitus should be extra careful for viral hepatitis. Diabetes mellitus commonly known as diabetics is a metabolic disease that causes high blood sugar. It is one of the most common non communicable diseases in India.

"There is a strong link between diabetes mellitus and Hepatitis B, which leads to cirrhosis of liver and liver carcinoma. Patients from age group of 23 to 59 face two-fold risk than non-diabetics. This is because they have less immunity to fight the virus and clear the infection. Diabetics develop more antibodies to HBV, about 60% as compared to non-diabetics; therefore the fatality rate is much higher in diabetics," said Dr Nagaraj.S, physician and diabetologist at Infilife Healthcare Pvt. Ltd, Bengaluru.

"Hepatitis B can be spread by unprotected sex, using drugs and improper use of needles. Diabetics while availing nursing care in hospitals and nursing homes, especially elderly on assisted living in long term healthcare facilities, are at risk. This is because of the common sharing of blood glucose meters, finger prick device, syringe and insulin pens, contaminated blood glucose monitoring devices, improper sterilization of podiatric equipment, improper disinfection procedures and hand hygiene methods by healthcare professionals and care givers, which leads to spread of the virus," he said.

According to the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommendations (2019 guidelines), more than 60 years of adults as soon as diagnosed, post diagnosed for diabetes should be vaccinated for HBV.

"The effectiveness of vaccine decreases as age advances, partial protection is important, if not full. For children, the CDC and ACIP have included HBV vaccination in routine immunization schedule. Infection of Hepatitis B in diabetics can be prevented with adequate infection control procedures and proper early vaccination. It is important to prevent exposure by avoiding sharing instruments and adopting proper sterilization and disinfection methods," said Dr Nagaraj.S.

"It is important to get 3 shots in 0, 1, 6 months. Check Liver Function Test once in 6 months if positive for HBV and ultra sound scanning for abdomen and pelvic should be done. As people get frightened with word Hepatitis, it is pertinent to note that not all hepatitis positive case progress to active disease. If anyone finds symptoms of loss of appetite and jaundice more than 2 weeks s/he should meet physician," he said.