HEPATITIS C

FACT SHEET FOR HEALTH PROFESSIONALS

Up to 300,000 Canadians have Hepatitis C. As Hepatitis C can be asymptomatic (without symptoms),
most infected individuals are not aware that they are living with the disease.  Get tested! 

Surveillance  June, 2007

To improve surveillance information on Hepatitis C, Health Departments across Ontario will be requesting additional information on acute cases and chronic carriers of hepatitis C.  Previously, little information was gathered.  Starting in 2000, surveillance will collect laboratory information, history of hepatitis, risk factors, possible source, and the need for follow-up information (eg., patient information, counselling, hepatitis vaccination).  

2001 Ontario rate of Hep C positive cases is 40.4/100,000 population.
2002 Ontario rate of Hep C positive cases is 40.1/100,000 population.
2003 Ontario rate of Hep C positive cases is 39.4/100,000 population.

2003 Durham rate of Hep C positive cases is 40.1/100,000 population. As of April 28, 2003, Durham Region Health Department has 1,557 Hepatitis C records in their system, which are based on reports of diagnostic tests performed at the time of "service".  The number of newly diagnosed in Durham Region for 2002 is 221. The number of newly diagnosed in the Province of Ontario in 2002 is 4,771. The populations for Durham and Ontario are respectively:   512,271 and 11,669,344. 

The number of people diagnosed with Hepatitis C in Durham Region:

March 19, 2004 1,762 Hepatitis C records.
April 25, 2005 1,958 cases of Hepatitis C.  Up to the end of 2005, the number was 2, 125.
February 20, 2006 2,142 diagnosed with HCV in Durham Region.
March 16, 2007 2, 345 cases of Hepatitis C have been reported to the Durham Region Health Department.
Stats Source:  Durham Region Health Department.

Re:  Provincial statistics, they are available in the PHERO (Public Health and Epidemiology Report Ontario) publications usually in the February issues. They appear in two versions, the year end number for the year prior, as well as the number for one year before that. Prior to Volume 9 #2 Hepatitis C stats were not listed in PHERO.

Epidemiology

Since the start of reporting in 1990, over 46,000 cases of hepatitis C (HCV) have been reported in Ontario. In the time frame 1990-1998, over 35,000 cases of hepatitis C (HCV) had been reported in Ontario. In 1998, approximately 6,170 new cases were reported in the province. In 2000, approximately 5,000 cases were reported in the province.

Statistics in Canada

Hepatitis C incidence is currently between 10-20 cases per 100,000 /year in Canada. Prevalence was estimated at 250,000 or 0.8% of the Canadian population in 2002.
Reference 2003:
Bloodborne Pathogens Section, Blood Safety Surveillance and Health Care Acquired Infections Division, Health Canada

March 31, 2005
 Modeling analyses suggests that there are about 240,000 to 300,000 hep C carriers in Canada of which 44% live in Ontario i.e., 105,000 to 132,000. The Reportable Disease Information System, (RDIS) database in public health reports a cumulative total of 70,000, the total of all positive test results since reporting began in 1990 up to 2004.  Therefore, it is estimated that there may be 56,000 to 60,000 individuals yet to be diagnosed.  RDIS reports just over 5,000 positive results per year, but it is not yet determined which of these are chronic and which are acute infections (i.e. long time infections or new seroconversions).
Source:  Ontario Hepatitis C Secretariat (Ontario Ministry of Health and Long-Term Care)

Comparison to HIV/AIDS

Dec. 31, 1999- 45,534 Canadians with HIV/AIDS. 
56,523 positive HIV tests reported to the Centre for Infectious Disease Prevention and Control (CIDPC) from November 1985 (when reporting to Health Canada began) up to June 30, 2004.

PHAC Jan. 13, 2005 In May 2004, the Government of Canada increased on-going funding for HIV/AIDS over the next five years, from $42.2 million to $84.4 million annually by 2008-2009.

Canada Takes Action on HIV/AIDS (2005 - 2010) (Oct. 2005)

Funding for Hepatitis C

HCV prevalence was estimated at 250,000 or 0.8% of the Canadian population in 2002.

September, 1998 Health Canada  invested $50 million in a five-year program for  the Hepatitis C Prevention, Support and Research Program and in 2004 provided $10.6 million to help bridge services until the new Public Health Agency of Canada (PHAC) was established.

Feb. 23, 2005  Federal Budget 2005 " In addition, this budget renews the funding for the Hepatitis C Prevention, Support and Research Program for one year, in the amount of $10.7 million."  This HCV funding ends March 31, 2006.

May 12, 2006 One year extension for current federal funded projects ending March 31, 2007.

April, 2007 In Canada, there are currently between 240,000 to 300,000 people infected with the hepatitis C virus, with Ontario accounting for approximately 110,000 cases. Each year, approximately 5,000 Canadians become newly infected with hepatitis C. More than one-third of people with HCV are unaware of their infection, and the majority have never felt unwell due to the virus.
Source URL:
http://www.oma.org/pcomm/OMR/apr/07hepatitis.htm

Transmission

Hepatitis C is transmitted primarily by the parenteral route. Sources of infection include injection drug use, needlestick accidents, and transfusions of blood or blood products prior to 1990.1

Injection drug use

In Canada, injection drug use is associated with at least half of HCV infections but the actual proportion may be much greater.1 The rate of infection among those who have used injection drugs may be as high as 60-80%.2   Often, the use of injection drugs was 20-30 years before the patient is found to have the infection.1

Needlestick injuries

The risk of transmission as a result of a needlestick injury from a known positive source is estimated to be 4% to 10%.1

Infection Control in the Physician's Office, 2004 Edition (PDF at CPSO site)

Previous blood transfusion

The receipt of blood and blood components, especially before 1990, is the second most important risk factor for HCV infection.  Since 1990 with the introduction of tests for anti-HCV, the transmission from blood has decreased substantially. The risk of post-transfusion HCV infection is now approximately 0.001%/unit transfused.3

Sexual transmission

The risk of sexual transmission is estimated to be about 2.5% for prolonged exposure (> 20 years) to infected individuals.1 Both case-control and prospective data indicate that early age of sexual intercourse, lack of condom use, having an infected sex partner, history of other sexually transmitted diseases (STDs), and sex with trauma are each associated with an increased risk of hepatitis C virus infection.6

Men who have sex with men (MSM) do not appear to be at higher risk than the heterosexual population. Although the virus is present in the menstrual blood of infected women, transmission from men to women appears to be more efficient than transmission from women to men.7

Other

Transmission from mother to child (<5%) is uncommon, and the risk associated with breastfeeding is unresolved.3HCV infection has also been associated with organ transplantation, renal dialysis and with unsterile tattooing equipment.5

Hepatitis C can be passed through tattooing by reuse of tattooing needles or dye, inadequate sterilization of tattooing needles between customers, or breaks in sterile technique, such as the artist pricking the back of his or her hand to test the needle's sharpness.

* The Canadian Blood Services website states re: Tattoos/Body Piercing-  Donors must wait one year after having a tattoo or body piercing before donating blood or bone marrow. The reason for this temporary deferral is the increased risk of Hepatitis C and other infections associated with tattoos and piercing. Other similar procedures that may fall under this category include acupuncture and electrolysis.

Clinical Manifestations

Only 5% to 25% of people with newly-acquired HCV infections have symptoms.  Up to 90% of infected persons continue to carry the virus indefinitely. These people are at risk of clinical sequelae such as profound fatigue (50% at 10 years), cirrhosis (25% at 20 years) and liver cancer (5% at 30 years).5

Screening

The diagnosis of HCV infection requires testing for anti-HCV.4  Test results are usually positive approximately 6 to 8 weeks after the patient’s exposure to HCV. Initial testing is by enzyme immunoassay (EIA), and positive results are then confirmed by supplemental testing. The sensitivity of EIA is 98% after the window period. If tested at the appropriate time, only a few cases of hepatitis C will be missed.  The positive predictive value of a confirmed anti-HCV test result is high, therefore, patients with positive results should be considered to have HCV infection.

Viral Hepatitis Serology Training

Management

Patients with chronic HCV can be treated with Rebetron, a combination of alpha interferon and ribavirin.4 The prime indication for treatment in chronic hepatitis C is an ALT level more than 1.5 times the upper limit of normal on three consecutive occasions over more than three months. 7  Consultation with a specialist is recommended prior to the initiation of therapy. Patients with HCV infection need support and counselling with regard to their clinical illness and strategies to prevent transmission to others.  Newly diagnosed cases should be investigated to establish the most likely source of the infection and to prevent transmission to others. Cases of HCV infection should be reported to the local medical officer of health.  Health unit staff will provide additional counselling if requested by a physician.  In managing a patient with HCV infection it is important to discuss hepatitis A and B vaccinations, blood donations and testing for other blood borne diseases.

May 30, 2003 Ministry of Health and Long Term Care (MOHLTC) has officially approved Pegetron (pegylated interferon alfa-2b + ribavirin) for reimbursement under the Individual Clinical Review (Section 8) mechanism for the treatment of chronic hepatitis C in patients previously untreated with interferon monotherapy (naive patients) or failed initial treatment with interferon. Schering Plough's Peginterferon alfa-2b (PEG-Intron) combination therapy withRebetol®  (Ribavirin, USP) Capsules (US site)

February 7, 2005 BC Pharmacare listed Pegasys RBV making it eligible for reimbursement through their Special Authority Program. Pegasys RBV (Peginterferon alfa-2a and COPEGUS (Ribavirin, USP) ) is also currently being reimbursed in Ontario, Quebec, Nova Scotia and Saskatchewan.

Pharmacodynamics of PegIFN alfa-2a and PegIFN alfa-2b in interferon-naive patients with HCV (Aug. 2007)

Hepatitis A and Hepatitis B Vaccinations

Patients with Hepatitis C (HCV) are recommended to be vaccinated against Hepatitis A (HAV) andHepatitis B (HBV) (if appropriate). 

As of September, 1998, people with HCV are eligible for publicly funded HBV vaccines. 

As of September 26, 2003 HAV vaccines are free of charge in Ontario for high risk groups:  people with chronic liver disease, including hepatitis C; IV drug users;  MSM and contacts (for outbreak control).

The use of Hepatitis A vaccine for those with chronic liver disease is aimed at reducing morbidity and further deterioration to the liver.  Hep A vaccine, if given within 7 days of exposure, can prevent the development of disease and is recommended in preference to immunoglobulin (exception: infants <1 year, immunocompromised patients, contraindications to vaccine).  Hepatitis A vaccine is usually given in two injections, at 0 and 6-12 months. 

People who have had previous exposures and hence antibodies already, will not benefit from such immunization.  Local health departments are responsible for distribution of the vaccine to the area physicians.

To obtain the Hepatitis A and Hepatitis B vaccines, HCV sufferers can either attend one of the Durham Region Health Department's Sexual Health Clinical Services in Oshawa, Pickering or Port Perry or contact the Head Office in Whitby
1-800-841-2729 to have the vaccines released to his/her family doctor.  

Durham Region Health Department- Facts about Hepatitis C
1-800-841-2729 for HCV testing, free HAV vaccine and free HBV vaccine

Excerpt < In Durham Region, there were 24 reported cases of hepatitis B from 1994 to 2004, for an average of 2.2 cases per year.  In Durham Region, there was an average of 230.5 reported cases of hepatitis C per year from 1999 to 2004.
The age-standardized prevalence rate of hepatitis C was lower for Durham Region compared to Ontario; 38.6 per 100,000 verses 40.1 per 100,000 respectively, in 2004. Incidence rates for hepatitis B and prevalence rates for hepatitis C were consistently higher in males than females. In Durham Region, 7 deaths were attributed to hepatitis B and 16 deaths were attributed to hepatitis C from 1988 to 2001. >
Source:  Dec. 2005 Snapshot on Hepatitis B  & C -* Link to PDF

Durham Hepatitis C Support Group (Meeting Page)

References

1. Guidelines and Recommendations on the Prevention and Control of Hepatitis C. Canadian Communicable Disease Report. The Laboratory Centre for Disease Control (LCDC) of Health Canada. Ottawa: 1995.

2. Margaret Fearon. Ministry of Health Guidelines for Hepatitis C Testing. Ontario Medical Review, 1999; (Jan.): 24-25.

3. G.Y. Minuk & B.G. Rosser. Counselling of Patients with Viral Hepatitis. Contribution to the Canadian Hepatitis Education Council- Schering Canada Inc. 1997; HepNet

4. P.R. Gully & M.L. Tepper. Hepatitis C. Can. Med. Assoc. J. 1997; 156 (10); 1427-1428.

5. M. Sherman CASL Hepatitis Consensus Group Correspondence. Management of Viral Hepatitis: Clinical and Public Health Perspectives – A Consensus Statement. CMAJ In Press. 1999: Montreal, March 5 & 6.

6. M. Alter: Sexual Transmission of Hepatitis A, B, and C. (Plenary I) Thirteenth Meeting of the International Society for Sexually Transmitted Diseases Research, July 11-14, 1999, Denver, Colorado.

7. The Management of Viral Hepatitis :  Proceedings of a Consensus Conference:  Montreal, Quebec:  March, 1999 by the Canadian Association for the Study of the Liver.

Educational Links

Advances in HCV Therapy  (PDF)

Are you at risk?  (Ontario Gov't site. April, 2007)

Canadian Association for the Study of the Liver  
Link to 2007 (PDF's)
Management of Hepatitis B: Guidelines
Management of Hepatitis C: Guidelines

CMAJ February 28, 2006 Hepatitis C: a review for primary care physicians Correction

HepWeb Study (University of Washington, Seattle, WA)

The Royal College of Physicians and Surgeons of Canada -Locate a specialist

More Pages on Sandi's Site

"HCV- The Taboo Subject" by Sandi  Copyright 1998
Hepatitis C Counselling Guidelines Page
"Hepatitis C" Essay by Sandi's son Copyright 2000
Medical Research Page
Memorial Page
Proclamation -Hepatitis C Awareness
Sandi's Story Copyright 1997 - 2008
Transplant Page

Email Listowner/Moderator Smilin' Sandi for a personal invite to join
 the Yahoo CANHepC list for current Hep C info and private online support.

This personal website is maintained by Smilin' Sandi
providing Education, Support and Patient Advocacy worldwide since 1997.
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Original Page April 13, 2000
Last updated 05/26/08