World Hepatitis Day
World Hepatitis Day is globally recognized every July 28. Local service and health providers are working together to offer the following schedule of events in Thunder Bay:
- Monday, July 22 - Hep C Ask Me Anything (AMA) virtual question and answer event. Participate on reddit.com/r/iama and look for hepnettbay. AMA will be monitored from 12:00 pm—4:00 pm The short film Blood2Blood will also be released on YouTube. https://www.youtube.com/watch?v=abzNKD84mA8
- Tuesday, July 23 – FREE Info fair and Hep C testing, Victoriaville Mall from 11:00am—2:00pm
- Wednesday, July 24 – FREE BBQ, Hep C testing and info, LiverCare Northwest (103-1040 Oliver Rd) from 11:00am— 2:00pm
- Thursday, July 25 – FREE BBQ, Hep C testing and info, Elevate NOW (106 Cumberland St. N.) 12:00pm—2:00pm
OVERVIEW OF HEP C
Hepatitis C (Hep C) affects the liver. Someone can have Hep C and not know it. People can live with Hep C without feeling sick for many years before they have any symptoms. Symptoms often only occur when the damage to the liver becomes severe.
Hep C is passed from person to person through blood-to-blood contact. The only way to know you have Hep C is by taking a blood test. There is no vaccine to protect against Hep C, but treatments are available. Although the body can sometimes clear the virus on its own without treatment, most people will need treatment. New treatments work well and are easier to take with fewer side effects.
“Hepatitis” means inflammation of the liver. Hepatitis can be caused by viruses. There are many different hepatitis viruses, but Hepatitis A, B, and C are the ones most people are familiar with.
In the Thunder Bay District, Hep C infection rates are higher than the provincial average.
The hepatitis virus can damage the liver if left untreated. The liver is an important part of the body that processes things like food, drinks and medications. Learn more by visiting Liver care.
If the liver is damaged by Hepatitis, the whole body is affected. For more information about what happens to the liver when it is infected with Hep C, visit Understanding Cirrhosis of the Liver: First steps for the newly diagnosed.
Click here to watch a short video from the Gastrointestinal Society.
Approximately 250,000 people are living with Hep C in Canada; 110,000 of them live in Ontario. It is estimated that 20% of people with the virus do not know that they are infected.
In the Thunder Bay District, annual rates of Hep C infection are higher than the provincial average. In 2018, more than 175 individuals in the Thunder Bay District were newly diagnosed with Hep C.
To learn more about the rates of Hep C in Canada, visit The Epidemiology of Hepatitis C in Canada.
Hep C is a blood-borne infection; this means it is passed from person-to-person through blood–to-blood contact. Blood-to-blood contact means blood containing the Hep C virus comes into contact with the bloodstream of another person. This can happen through an entry point in the body like a small puncture or tear in the skin.
There are many ways for blood-to-blood contact to happen. Hep C is most commonly spread by sharing drug supplies that have been used by someone who is infected with Hep C.
Drug supplies could be items like needles, swabs, filters, spoons and water, and supplies for smoking or snorting drugs, like crack pipes or cocaine straws. Small amounts of blood from injection sites, cracked lips, or tiny nosebleeds can be found on these items, increasing the risk for transmission.
Hep C can also be passed on to people if tattoo or piercing equipment is re-used or not disinfected properly. In Ontario, businesses that offer tattooing or piercing must be inspected by the local public health unit.
Although the risk is lower, Hep C can also be transmitted through sex, or sharing personal hygiene and grooming supplies, even if a very small amount of blood is present.
Casual contact with a person living with Hep C, like sharing utensils, hugging, or kissing, has no risk for blood-to-blood contact. To learn more about how someone can become infected with Hep C, visit How Hepatitis C transmission happens.
When someone becomes infected, they are considered to have an acute infection; also referred to as phase 1. At this stage about 25% of people clear the virus from their body on their own without treatment.
If the body is able to clear the virus, antibodies, our bodies’ natural infection-fighters, will remain in the blood. Individuals with these antibodies in their bloodstream are not considered infectious (e.g. not able to pass the infection to someone else) as the virus is no longer present.
If the body can’t clear the virus, it will continue to attack the liver and progress to what is known as chronic infection or phase 2. The progression of phase 2 is slow, often lasting over 20-30 years, and a person may not show any symptoms.
If this chronic infection goes undiagnosed, the virus will continue to attack the liver and cause scar tissue to form. This scar tissue is called fibrosis.
Some people who go undiagnosed for many years will develop even heavier scarring called cirrhosis. There are different types of cirrhosis. For more information, visit Understanding Cirrhosis of the Liver: First steps for the newly diagnosed.
In phase 1 (acute infection) a person will likely not show any symptoms. Symptoms can take many years to develop in phase 2 (chronic infection).
Once the virus causes significant damage to the liver, symptoms will begin to show. Common symptoms of chronic Hep C infection are:
- Bleeding easily
- Poor appetite
- Yellow skin and eyes (jaundice)
- Nausea and vomiting
- Itchy skin
- Fluid building up in the abdomen (ascites)
- Weight loss
- Confusion and drowsiness
As Hep C is transmitted “blood-to-blood,” the best way to protect yourself from Hep C is by avoiding contact with another person’s blood.
- Using NEW drug supplies every time
- NOT sharing ANY drug using equipment; this includes all supplies for both injecting and smoking/snorting
- NOT sharing any sharp instruments or personal hygiene items like razors, toothbrushes, nail clippers
- Using the services of a tattoo artist or piercer who has been inspected by the Thunder Bay District Health Unit; ask the artist/piercer if they are inspected
- Having protected sex by using a condom/barrier
Click here to watch a short video from Hepatitis Education Canada (University of British Columbia)
New drug supplies are available for FREE through the Thunder Bay District Health Unit’s Superior Points harm reduction program. Harm reduction programs focus on reducing the harms associated with drug use, like the risk of getting Hep C or other blood-borne infections (e.g. HIV).
Harm reduction programs believe in the right of the individual to make a choice, including the choice NOT to abstain. Abstinence may not be possible or a priority at that point in time for that individual. Harm reduction services are community-based and non-judgemental.
All supplies are offered for FREE and anonymously. Supplies from Superior Points are available at several locations across Thunder Bay and the district. People in Thunder Bay can also call Superior Points if they would like supplies dropped off to them.
There is no limit on the number of needles provided to each client per visit. Clients are not required to return used needles but are encouraged to properly dispose of used needles and syringes; containers are provided and there are several needle disposal bins located in the city.
The program offers a variety of needle and syringe types by gauge, size, and brand. The program also distributes equipment necessary for safer injection (needles, alcohol swabs, filters, cookers, tourniquets, sterile water) as well as the supplies for safer smoking (glass pipes, brass screens and a mouthpiece). Condoms and lube are also available.
Call Superior Points at (807) 621-7861 or (807) 621-7862 for more information. For a list of locations where the supplies are available, visit the Locations section of the Superior Points page.
Learn more about harm reduction by visiting Substance Use and Harm Reduction.
Unfortunately, there is no vaccine to provide immunity to prevent Hep C.
However, there are vaccines for Hepatitis A and B. People who are Hep C-positive should be immunized against Hepatitis A and B as these infections can also damage the liver. It’s important for people who are Hep C-positive to keep their liver as healthy as possible by avoiding other liver infections and injuries.
The vaccines for Hepatitis A and B are free to anyone in Ontario who is diagnosed with or at risk for Hep C.
In the Thunder Bay District, those who are eligible can get the vaccines from any health care provider.
Those who don’t have a health care provider can call the Health Unit at 625-5900 or toll-free at 1-888-294-6630 to learn about other options to get the vaccines.
TESTING & DIAGNOSIS
In Ontario, it is recommended that anyone who has risk factors for Hep C is tested. This includes:
- People who share drug using equipment
- People who have had a piercing or tattoo from a provider who was not inspected by the Health Unit.
- People who have unprotected sex with a person living with Hepatitis C
In 2018, a guideline from the Canadian Association for the Study of the Liver (CASL) recommended screening all “Baby-Boomers,” in addition to people with the above risk factors to address the burden of illness and under-diagnosis in this age group. This screening is also recommended by the United States’ Centers for Disease Control & Prevention (CDC).
After a 2018 review of this guideline, the Ministry of Health and Long-Term Care decided against screening any specific age-group and continues to recommend risk-based screening in Ontario.
It takes two tests for someone to fully know their status; one to test for antibodies and a second to determine if an active infection is present or the person has cleared the virus. Hepatitis C testing must be done using a name. Anonymous testing is only available for HIV.
Click here to watch a short video on testing from Hepatitis Education Canada (University of British Columbia).
The first test determines if someone has been in contact with the Hep C virus and has the antibodies in their blood. If someone is concerned about potential exposure to the Hep C virus, it is recommended they wait about 3 months before testing as it can take 6-9 weeks for antibodies to show up in the blood.
Most health care providers draw blood from a vein to complete the initial test. The health care provider will contact the person with the results and discuss next steps. If no antibodies are present, the person was not exposed to the virus and no further testing is required. If antibodies are present, the health care provider who ordered the test will encourage the person to get the second test to confirm their status.
The only way to know if someone with antibodies has an active hepatitis C infection is with a second test, also called a confirmatory blood test. The results of this test will tell the person if the actual virus is detectable in their bloodstream and if they have an infection that needs to be treated. This test will also determine the genotype or strain of the virus (there are 6 types).
If the virus is not detectable in the second test, it means that the person does not have an active infection and has cleared the virus OR that it’s too early to detect the virus. The health care provider will counsel the person and let them know their next steps; it may be repeating the test again in the future OR moving forward to treatment.
There is a finger prick point-of-care (POC) test that will allow someone to know quickly if they have been exposed to the antibodies and if they need a confirmatory test for a diagnosis. See "Local Resources" section below for a list of organizations in Thunder Bay offering POC testing.
For more information about POC testing, visit Hepatitis C point of care testing: What is its impact on testing and linkage to care?
All health care providers can order the initial test and the confirmatory test. For more information about other organizations that offer testing, click here.
See "Local Resources" section below for a list of organizations in Thunder Bay offering POC testing.
Those who test positive for Hep C will be referred to and followed by health care providers who specialize in infections like Hep C. The health care team will then make a treatment plan together with the individual to manage their infection.
If a person tests positive for Hep C after the confirmation test, they will need to have further tests to monitor how the virus is affecting their body. This information is then used to determine their treatment options.
Hep C infections can cause liver damage which is referred to as fibrosis. Fibrosis causes inflammation and scarring of the liver cells. Different tests will be done to measure an individual’s level of fibrosis and monitor liver function.
Blood tests can monitor liver damage and inflammation as well. Your health care team may order blood tests such as liver function tests. An ultrasound of the liver can check the size of the liver. For more information on these tests, visit Liver Function Tests
A “fibroscan” of the liver is often used to measure the level of fibrosis. A fibroscan uses sound waves to measure the degree of stiffness of the liver. It is a quick and painless procedure. The results from this test help the health care provider to assess treatment options.
There are different factors that health care providers will discuss with a person when they are considering treatment decisions, including their strain of Hep C as well as other test results.
For a long time, Hep C treatment included a combination of two medications. These medications were difficult to take because they have serious side effects.
With new research, there are now medications available in Canada with fewer side effects, a shorter treatment time (1.5-6 months), and a higher cure rate.
Staff at all of the organizations listed under Local Resources section below can help individuals investigate their options and provide assistance in completing the paperwork required to access funding for treatment.
For a list of medications approved for use in Canada, visit Hepatitis C drugs approved for adults in Canada.
Click here to watch a short video on treatment from CATIE.
Hep C can be cured. Getting treatment decreases damage to the liver, lowers the chances of developing liver cancer, and lowers the ability to pass Hep C to other people.
Some individuals may have coverage through their private health insurance.
The Ontario Drug Benefit Program (ODB) and the Trillium Drug Program (TDP) are available to eligible Ontario residents and may be able to help cover the cost of Hep C medications.
Registered First Nations and recognized Inuit people can access coverage for their Hep C medications through the Non-Insured Health Benefits (NIHB) program.
For more information about coverage in Ontario, visit Prescription drug programs.
Staff at all of the organizations listed under Local Resources section below can help individuals investigate their options and provide assistance in completing the paperwork required to access funding for treatment.
A cure is also called a sustained virological response (SVR).
After a person has successfully completed treatment, blood testing is done to determine the amount of the hepatitis C virus left in the blood, if any. This is called the “viral load.” If the viral load is undetectable for 12 weeks in a row after treatment, it’s called a SVR12.
If a person gets to SVR12, they are tested after 12 more weeks. If after the full 24 weeks they are still undetectable, this is called SVR24 and the person is considered cured.
It’s important to remember that a cured person could still become infected with a different strain of Hep C if they engage in activities that increase their risk (e.g. sharing drug supplies).
Once treatment is completed, their health care provider will counsel the person on how to keep their liver healthy in the future.
In Thunder Bay, Elevate NWO offers the following services:
- Case managers help clients who are preparing to go on treatment and who are currently on treatment. The case managers also help reduce barriers to treatment (e.g. inadequate housing, food insecurity and financial instability).
- Counselling services are also provided for other health concerns, such as depression or substance use, or to provide support in dealing with the side effects that clients may experience as a result of treatment.
- Support groups are offered to clients to provide education on treatment and living well with Hepatitis, as well as offer an opportunity to socialize with people who have similar experiences.
Clients can be referred to Elevate NWO by their health care provider. Those who are living with a positive Hep C diagnosis can also self-refer. To become a client, individuals must complete the intake process either by appointment or walk-in during business hours.
The Thunder Bay District Health Unit offers an online toolkit for all diseases of public health significance, including hepatitis C, which contains further information on testing, and treatment. Visit the Infectious Disease Toolkit for Hepatitis C
Elevate NWO offers free in-service educational presentations and capacity building sessions for service providers who work with individuals at risk of or living with Hep C. Presentations can be tailored to the specific needs of the agency and staff, and can cover a range of topics related to Hepatitis C, including harm reduction, HIV, and working with people who use drugs.
CATIE (Canadian AIDS Treatment Information Exchange) offers open online courses through eduCATIE.ca to build knowledge of HIV and hepatitis C science. Courses are free, self-directed and are designed for service providers who prefer to learn on their own time and at their own pace. All participants receive a certificate of completion.
CATIE also offers ongoing professional development through free online webinars. For a list of upcoming webinars visit CATIE Webinars. For a list of archived webinars, visit CATIE Archived Webinars. The Provincial Health Services Authority in British Columbia offers a FREE LearningHub online course called Hepatitis C: The Basics.
SAGE is a resource-sharing community for Canadian HIV and hepatitis C service providers. To learn more about membership and accessing services visit the SAGE website.
CanHepC is a research network funded by Canadian government organizations dedicated to improving Hep C prevention and outcomes and reduce its burden. To learn more visit CanHepC Special Topic Series.
Harm reduction supplies are available from the following organizations. Please contact each organization for details:
Superior Points Harm Reduction Program - Services available Monday – Friday from 11:00 am - 4:00 pm and 5:00 - 8:00 pm. Call 621-7862 or 621-7861; leave a message and your call will be returned. New supplies can be delivered and used supplies can be picked up. Ask about free overdose prevention kits containing Naloxone.
Thunder Bay District Health Unit Offices - Monday - Friday from 8:30am to 4:30pm in Thunder Bay, Geraldton and Marathon
Elevate NWO - Visit their website for contact information and other important details
Nipigon District Memorial Hospital - Contact the hospital for more details about hours of availability; 887-3026.
Norwest Community Health Centres - Supplies are available at both the Thunder Bay and Longlac sites. Visit their website for contact information.
OATC (Ontario Addiction Treatment Centres) - Harm reduction supplies are available at all four locations. Visit their website for details including address, phone number and hours of operation.
P.A.C.E (People Advocating For Change Through Empowerment Inc.) - Supplies are available at both the Thunder Bay and Geraldton sites. Visit their website for contact information.
Shelter House - Supplies are available 24 hours a day at 420 George Street (between May and Simpson).
Hepatitis C testing is available from any health care provider. The following organizations can provide both Hep C tests: the initial test and the confirmatory test:
Sexual Health Clinic - Thunder Bay District Health Unit - Sexual Health Clinic; 999 Balmoral Street (Thunder Bay) or call 625-5900 (toll-free 1-888-294-6630). An Ontario Health Card is NOT needed.
Elevate NWO - An Ontario Health Card IS NEEDED. Visit their website for contact information and other important details.
Liver Care Northwest - Call 767-7211 for details. An Ontario Health Card IS NEEDED.
OATC (Ontario Addiction Treatment Centres) - Testing is available at all four locations. Visit their website for details including address, phone number and hours of operation. An Ontario Health Card IS NEEDED.
Umbrella Clinic - Visit their website for details. An Ontario Health Card IS NEEDED.
The types of treatment support services vary by organization, so please contact each organization directly.
Elevate NWO - Visit their website for contact information and other important details regarding treatment services and other valuable supports. No referral is needed.
Liver Care Northwest - Call 767-7211 for details. No referral is needed
OATC (Ontario Addiction Treatment Centres) - Treatment is available at all four locations. Visit their website for details including address, phone number and hours of operation. No referral is needed.
Umbrella Clinic - Visit their website for details. No referral is needed.
For Further Information
Call the Infectious Disease Program: (807) 625-5900
or toll-free: 1-888-294-6630