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Hepatitis C, viral

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Reporting Obligations

Individuals who have or may have HCV infection shall be reported to the local Health Unit.

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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. 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–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.

Screening/Risk Factors

There is consensus that people with the following risk factors benefit from screening for hepatitis C:

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 and Laboratory Testing

Two serology tests can screen for HCV infection:

  • Anti-HCV antibody testing to assess for previous exposure. If positive, the individual will have antibodies for life
  • HCV-RNA testing to check for active virus

For HCV RNA testing, submit PHO Lab Hepatitis PCR Requisition.

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Treatment and 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 Hepatitis A and B vaccines at no cost as well as Pneu-P-23 vaccine (2–64 years). To order, please fill out the Vaccine Order Form.

Patient Information

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Additional Resources

Canadian Medical Association Journal (CMAJ). “The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver”.

Healthy Canadians, Government of Canada, “Hepatitis C.”

Ontario Hospital Association. “Communicable Disease Surveillance Protocols for Ontario Hospitals”.

Canadian AIDS Treatment Information Exchange (CATIE). “Hepatitis C.”

References

Ministry of Health and Long-Term Care, Infectious Diseases Protocol, March 2019.