As we mark World Hepatitis Day (July 28), it’s important to acknowledge that more than 130,000 British Columbians are hepatitis B and/or C infected. That’s one out of every 33 people.
Enormous strides in hepatitis B prevention have been made through the use of publically funded hepatitis B vaccination. It started with vaccination of Grade 6 students in 1992 and was followed by the adoption of universal infant vaccination in 2001. Last year, less than 15 acute hepatitis B infections were identified in B.C.
In contrast, there is no vaccine for hepatitis C but it can be cured. Current antivirals can cure about 65-75 per cent of infections. Soon, single daily combination pills with few side effects will be able to cure greater than 95 per cent of infections. These new antivirals enable us to begin to dream about hepatitis C elimination.
Hepatitis C touches four major different population groups. People who inject drugs represent the majority of those diagnosed with new hepatitis C infections. For these people, comprehensive harm reduction and a model of Treatment as Prevention needs to be considered.
Dr. Julio Montaner and the Centre for Excellence in HIV/AIDS and his team have shown that Treatment as Prevention for HIV improves the health of those already infected, while simultaneously reducing the risk of HIV transmission to others. Lessons from this approach are relevant for hepatitis C.
The second major group is baby boomers born between 1945 and 1965 or even 1975. This group represents about two-thirds of those infected with hepatitis C in BC. Many were infected in the distant past and are not likely to transmit their infection. However, as they age, they have a 20 times higher risk of developing liver disease and liver cancer.
Curing their infection substantially reduces their risk of developing further liver damage and reduces their risk of dying. However, many boomers don’t know or remember if they were at risk of being infected. Even if they are not treated, knowing that they are infected is still important because they could consider reducing their alcohol intake, which reduces their risk of developing progressive liver disease.
The third major group is immigrants. About 20 per cent of hepatitis C, and most hepatitis B infections occur in immigrants, most of whom were infected in their country of origin and don’t know that they are infected.
The fourth major group is aboriginals. Canada’s indigenous people are disproportionately affected by hepatitis and are important partners in the efforts to prevent, care and treat hepatitis.
Together with the Public Health Agency of Canada we have developed patient materials in English, French, Aboriginal languages and soon in Punjabi to help people understand why to test and what options are available to them. These can be found on the BCCDC website at www.bccdc.ca followed by a search for “Hepatitis C Educational Materials.”
Given the range of new curative hepatitis C antiviral treatments that will soon be available, disease elimination becomes an achievable goal if society is willing. Hepatitis B is next on the radar, currently controllable by treatment and virtually completely vaccine preventable, but we still await a cure. Get tested so you know your treatment options.”
Dr. Mel Krajden
Medical Head of Hepatitis
BC Centre for Disease Control
