Hepatitis C

Reporting Obligations

Laboratory confirmed cases must be reported to the Thunder Bay District Health Unit by fax, phone or mail.

  • Fax: (807) 625-4822
  • Phone: 625-8318 or toll-free at 1-888-294-6630, ext. 8318
  • Mail: 999 Balmoral Street, Thunder Bay, ON P7B 6E7

Epidemiology

Aetiologic Agent:

The hepatitis C virus (HCV) is a small, single-stranded RNA virus and is a member of the Flaviviridae family. At least 6 major genotypes and approximately 100 subtypes exist. There is limited evidence about any differences in clinical outcome between the various types; however, differences do exist in responses to antiviral therapy according to HCV genotypes.

Clinical Presentation:

Approximately 20% to 30% of acute infections are symptomatic. If symptoms develop the onset is slow and insidious and can include anorexia, vague abdominal discomfort, nausea and vomiting, fatigue and jaundice. Without treatment, a high percentage (75%-85%) of infected persons develop chronic infection. About 5% to 20% of those chronically infected will develop cirrhosis over a period of 20-30 years, and 1% to 5% will die from consequences of chronic infection (i.e., cirrhosis and hepatocellular carcinoma).

Modes of transmission:

HCV is primarily transmitted by blood-to-blood contact (parenterally). Parenteral transmission routes include sharing of needles or other injection drug use equipment, exposure to blood contaminating inadequately sterilized instruments and needles used in medical and dental procedures or other activities that break the skin (e.g., tattooing, ear or body piercing), sharing of personal items such as razors and toothbrushes, and accidental needle-stick exposures among health care workers. Sexual and mother-to-child transmission have both been documented but appear uncommon except for instances of HIV co-infection, especially HIV positive men who have sex with men.

Incubation Period:

Ranges from 2 weeks to 6 months, most commonly 6-9 weeks.

Period of Communicability:

Period of communicability is from one or more weeks before onset of the first symptoms and may persist indefinitely among persons with chronic infection. Communicability can be ended with treatment. HCV can remain infectious on inanimate surfaces for up to 6 weeks.

 

Risk Factors/Susceptibility

Medical:

Risk of health care-associated transmission; recipient of blood transfusions, blood products or organ transplant before 1992 in Canada; receiving hemodialysis.

Behavioural/Social:

Injection drug use (includes intranasal and inhalation); incarceration; exposure in a high-prevalence region (born, travelled or resided); needle-stick injuries; higher-risk sexual behaviour, tattoos or body piercing or sharing sharp instruments or personal hygiene materials with someone who is HCV positive and anyone with clinical clues suspicious for HCV infection.

The Canadian Task Force on Preventive Health Care recommends against general screening in the population.

 

Diagnosis & Laboratory Testing

Two serology tests can screen for chronic Hepatitis C infection for patients with risk behaviours or potential past exposures to HCV:

  • Anti-HCV testing to assess for previous exposure (if positive, the patient will have antibodies for life) and
  • HCV-RNA testing to check for active virus.

For HCV RNA Testing, submit a PHO Lab Hepatitis PCR Requisition.

Testing Information & Requisition

 

Treatment & Case Management

The Management of Chronic Hepatitis C: 2018 Guideline Update from the Canadian Association for the Study of the Liver was written to assist Health Care Providers in the management of adult patients with chronic HCV infection.

The Counselling Guidelines for Hepatitis C is a tool for your use when providing information to a newly diagnosed patient.

The patient is eligible for free Hepatitis A and B vaccines. To order, please use the appropriate vaccine order form, located on the Immunization Resources page under "Vaccine Ordering."

 

Patient Information

HepCNWO.com is a new website by the TBDHU which educates the public about Hepatitis C and provides information about local resources and services.

Patient Fact Sheet

 

References

  1. Ministry of Health and Long Term Care, Infectious Diseases Protocol, 2018. Hepatitis C: Appendix A (2019) and Appendix B (2019).
  2. CMAJ. "The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver."

 

Additional Resources

Can J Gastroenterology. "Management of chronic Hepatitis C: Consensus Guidelines, 2015."

Can Association for the Study of the Liver. Online app to access and navigate the "Management of chronic Hepatitis C: Consensus Guidelines, 2015."

Canadian Liver Foundation. "Healthy Living with Viral Hepatitis."

Healthy Canadians, Government of Canada, "Hepatitis C."

Canadian AIDS Treatment Information Exchange (CATIE). "Hepatitis C."

Last Updated: 29/07/2019