Skip to main content
NCBI home page
Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2000 Jul 1;91(Suppl 1):S19–S23. doi: 10.1007/BF03405102

Public Health and Hepatitis C

L’hépatite C et la santé publique

David M Patrick 1,✉, Jane A Buxton 1, Mark Bigham 1, Richard G Mathias 1
PMCID: PMC6979855

Abstract

This paper reviews key public health aspects related to surveillance, transmission and primary prevention of hepatitis C. Hepatitis C is now a reportable disease in all Canadian provinces and territories. Although prevalence in Canada is estimated at under 1%, that associated with injection drug use (IDU) approaches 90%. The epidemiology of new HCV infections in Canada is now primarily defined by IDU behaviour, with annual incidence rates among new drug injectors exceeding 25%. HCV is less efficiently transmitted through other routes of exposure. An effective vaccine against HCV remains elusive. Some jurisdictions offer hepatitis A and hepatitis B vaccine to HCV-infected persons. An array of harm reduction strategies targeting IDU has been implemented but underdeployed across Canada, and has been ineffective to date in controlling the HCV epidemic. Public policy alternatives, such as legalization and regulation of injection drugs, are being debated. Improved HCV preventive strategies are urgently required and need careful evaluation.

Electronic Supplementary Material

Supplementary material is available for this article at 10.1007/BF03405102 and is accessible for authorized users.

French language version/Version en Français

Références

  • 1.LCDC. Hepatitis C–Prevention and control: A public health consensus. CCDR. 1999;25S2:1–23. [Google Scholar]
  • 2.Recommendations for preventioncontrol of hepatitis C virus HCV infectionHCV-related chronic disease. MMWR. 1998;47:RR–19. [PubMed] [Google Scholar]
  • 3.Division de la surveillance des maladies, Laboratoire de lutte contre la maladie, Santé Canada.
  • 4.Remis RS, Group HCW. The report of the expert panel on hepatitis C. Toronto: Secrétariat canadien du sang, Santé Canada; 1998. Estimating the number of blood transfusion recipients infected by hepatitis C virus in Canada, 1960–1985 and 1990–1992. [Google Scholar]
  • 5.Manuel DG, Johnson I, Fearon M, Hockin J. The prevalence of hepatitis C in a community based population, Ontario, 1996. CCDR. 1999;25-23:193–99. [PubMed] [Google Scholar]
  • 6.LCDC. Preventing the transmission of blood-borne pathogens in health care and public service settings. CCDR 1997;23S3.
  • 7.Liou TC, Chang TT, Young K e coll. Detection of HCV RNA in saliva, urine, seminal fluid and ascites. J Med Virol. 1992;37(3):197–202. doi: 10.1002/jmv.1890370309. [DOI] [PubMed] [Google Scholar]
  • 8.Wang JT, Wang TH, Sheu J e coll. Hepatitis C virus RNA in saliva of patients with posttransfusion hepatitis and low efficiency of transmission among spouses. J Med Virol. 1992;36(1):28–31. doi: 10.1002/jmv.1890360106. [DOI] [PubMed] [Google Scholar]
  • 9.Mahajan L, Wyllie R, Steffen R, Kay M. Mother-to-infant transmission of hepatitis C virus and breast-feeding. [comment] J Pediatrics. 1995;127(4):670–71. doi: 10.1016/s0022-3476(95)70145-1. [DOI] [PubMed] [Google Scholar]
  • 10.Zanetti AR, Tanzi E, Newell ML. Mother-to-infant transmission of hepatitis C virus. J Hepatol. 1999;31(Suppl1):96–100. doi: 10.1016/s0168-8278(99)80383-3. [DOI] [PubMed] [Google Scholar]
  • 11.European Collaborative Study. Risk factors for mother-to-child transmission of HIV-1. Lancet. 1992;339:1007–12. doi: 10.1016/0140-6736(92)90534-a. [DOI] [PubMed] [Google Scholar]
  • 12.LCDC . Health Canada, Sentinel Health Unit Surveillance System. 1994. [Google Scholar]
  • 13.Crofts N, Jolley D, Kaldor J e coll. Epidemiology of hepatitis C virus infection among injection drug users in Australia. J Epidemiol Community Health. 1997;51:692–97. doi: 10.1136/jech.51.6.692. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.The VIDUS project update #5, septembre 1999.
  • 15.Can J Infect Dis. 1998.
  • 16.Garfein RS, Vlahov D, Galai N e coll. Viral infections in short-term injection drug users: The prevalence of the hepatitis C, hepatitis B, human immunodeficiency and human T-lymphotropic viruses. Am J Public Health. 1996;86:655–61. doi: 10.2105/ajph.86.5.655. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Frank C, Mohamed M, Strickland G e coll. The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt. Lancet. 2000;355(9207):887–91. doi: 10.1016/s0140-6736(99)06527-7. [DOI] [PubMed] [Google Scholar]
  • 18.Alter MJ. Hepatitis C virus infection in the United States. J Hepatol. 1999;31(Suppl1):88–91. doi: 10.1016/s0168-8278(99)80381-x. [DOI] [PubMed] [Google Scholar]
  • 19.Kleinman SH. Incidence/Window Period Model. Transf Med Rev. 1997;11:155–72. doi: 10.1053/tmrv.1997.0110155. [DOI] [PubMed] [Google Scholar]
  • 20.Committee on Infectious Diseases, American Academy of Pediatrics. 1997 Red Book: Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics, 1997;75.
  • 21.Zanetti AR, Tanzi E, Paccagnini S e coll. Mother-to-infant transmission of hepatitis C virus. Lancet. 1995;345:289–91. doi: 10.1016/s0140-6736(95)90277-5. [DOI] [PubMed] [Google Scholar]
  • 22.Resti M. Mother-to-infant transmission of hepatitis C virus. Ital J Gastroenterol Hepatol. 1999;31:489–93. [PubMed] [Google Scholar]
  • 23.Tovo P-A, Newell M-L. Hepatitis C in children. Curr Opinion in Infect Dis. 1999;12:245–50. doi: 10.1097/00001432-199906000-00015. [DOI] [PubMed] [Google Scholar]
  • 24.Thomas SL, Newell ML, Peckham C e coll. A review of hepatitis C virus (HCV) vertical transmission: Risk of transmission to infants born to mothers with and without HCV viraemia or human immunodeficiency virus infection. Int J Epidemiol. 1998;27:108–17. doi: 10.1093/ije/27.1.108. [DOI] [PubMed] [Google Scholar]
  • 25.Resti M, Azzari C, Mannelli F e coll. Mother to child transmission of hepatitis C virus: Prospective study of risk factors and timing of infection in children born to women seronegative for HIV-1. Tuscany Study Group on Hepatitis C Virus Infection. BMJ. 1998;317:437–41. doi: 10.1136/bmj.317.7156.437. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Lin H-H, Kao J-H, Hsu H-Y e coll. Absence of infection in breast-fed infants born to hepatitis C virus-infected mothers. [see comment] J Pediatrics. 1995;126(4):589–91. doi: 10.1016/s0022-3476(95)70356-x. [DOI] [PubMed] [Google Scholar]
  • 27.Kumar RM, Shahul S. Role of breast-feeding in transmission of hepatitis C virus to infants of HCV-infected mothers. J Hepatol. 1998;29:191–97. doi: 10.1016/s0168-8278(98)80003-2. [DOI] [PubMed] [Google Scholar]
  • 28.Garland SM, Tabrizi S, Robinson P e coll. Hepatitis C - Role of perinatal transmission. Aust NZ J Obstet Gynaecol. 1998;38(4):424–27. doi: 10.1111/j.1479-828x.1998.tb03102.x. [DOI] [PubMed] [Google Scholar]
  • 29.Caporaso N, Ascione A, Stroffolini T. Spread of hepatitis C virus infection within families. Investigators of an Italian Multicenter Group. J Viral Hepatol. 1998;1:67–72. doi: 10.1046/j.1365-2893.1998.00085.x. [DOI] [PubMed] [Google Scholar]
  • 30.Guadagnino V, Stroffolini T, Foca A e coll. Hepatitis C virus infection in the family setting. Eur J Epidemiol. 1998;14(3):229–32. doi: 10.1023/a:1007459626023. [DOI] [PubMed] [Google Scholar]
  • 31.Sagnelli E, Gaeta GB, Felaco F e coll. Hepatitis C virus infection in households of anti-HCV chronic carriers in Italy: A multicentre case-control study. Infection. 1997;25(6):346–49. doi: 10.1007/BF01740815. [DOI] [PubMed] [Google Scholar]
  • 32.Diago M, Zapater R, Tuset C e coll. Intrafamily transmission of hepatitis C virus: Sexual and nonsexual contacts. J Hepatol. 1996;25(2):125–28. doi: 10.1016/s0168-8278(96)80063-8. [DOI] [PubMed] [Google Scholar]
  • 33.Hou CH, Chen WY, Kao J e coll. Intrafamilial transmission of hepatitis C virus in hemodialysis patients. J Med Virol. 1995;45(4):381–85. doi: 10.1002/jmv.1890450405. [DOI] [PubMed] [Google Scholar]
  • 34.Demalia L, Vallebona E, Poima R e coll. HCV transmission in family members of subjects with HCV related chronic liver disease. Eur J Epidemiol. 1996;12(1):45–50. doi: 10.1007/BF00144427. [DOI] [PubMed] [Google Scholar]
  • 35.Papanastasiou DA, Spiliopoulou I, Katinakis S e coll. Lack of transmission of hepatitis C in household contacts of children with homozygous beta-thalassaemia. Acta Haematol. 1997;97(3):168–73. doi: 10.1159/000203675. [DOI] [PubMed] [Google Scholar]
  • 36.Dienstag JL. Sexual and perinatal transmission of hepatitis C. Hepatology. 1997;3(Suppl1):66S–70S. doi: 10.1002/hep.510260712. [DOI] [PubMed] [Google Scholar]
  • 37.Tanaka K, Stuver S, Ikematsu H e coll. Heterosexual transmission of hepatitis C virus among married couples in southwestern Japan. Int J Cancer. 1997;72(1):50–55. doi: 10.1002/(sici)1097-0215(19970703)72:1<50::aid-ijc7>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  • 38.Nakashima K, Ikematsu H, Hayashi J e coll. Intrafamiliar transmission of hepatitis C virus among the population of an endemic area of Japan. JAMA. 1995;274:1459–61. [PubMed] [Google Scholar]
  • 39.Meisel H, Reip A, Faltus B e coll. Transmission of hepatitis C virus to children and husbands by women infected with contaminated anti-D immunoglobulin. Lancet. 1995;345:1209–11. doi: 10.1016/s0140-6736(95)91992-9. [DOI] [PubMed] [Google Scholar]
  • 40.Kumar RM. Interspousal and interfamilial transmission of hepatitis C virus: A myth or a concern? Obstetrics and Gynecology. 1998;91(3):426–31. doi: 10.1016/s0029-7844(97)00684-4. [DOI] [PubMed] [Google Scholar]
  • 41.Akahane Y, Kojima M, Sugai Y e coll. Hepatitis C virus infection in spouses of patients with type C chronic liver disease. Ann Intern Med. 1994;120(9):748–52. doi: 10.7326/0003-4819-120-9-199405010-00005. [DOI] [PubMed] [Google Scholar]
  • 42.Coltorti M, Caporaso N, Morisco F e coll. Prevalence of hepatitis C virus infection in the household contacts of patients with HCV-related chronic liver disease. Infection. 1994;22(3):183–86. doi: 10.1007/BF01716699. [DOI] [PubMed] [Google Scholar]
  • 43.Abildgaard N, Peterslund NA. Hepatitis C virus transmitted by a tattooing needle. Lancet. 1991;338:460. doi: 10.1016/0140-6736(91)91095-c. [DOI] [PubMed] [Google Scholar]
  • 44.Shimokura GH, Gully PR. Risk of hepatitis C virus infection from tattooing and other skin piercing services. Can J Infect Dis. 1995;6(5):235–38. doi: 10.1155/1995/935407. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Vento S, Garfano T, Renzini C e coll. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. N Engl J Med. 1998;338:286–90. doi: 10.1056/NEJM199801293380503. [DOI] [PubMed] [Google Scholar]
  • 46.Comité consultatif national de l’immunisation . Guide canadien d’immunisation. 5e édition. Ottawa, ON: Santé Canada; 1998. [Google Scholar]
  • 47.Weiner AJ, Brauer MJ, Rosenblatt J e coll. Variable and hypervariable domains are found in the regions of HCV corresponding to the fla-vivirus envelope and NSI proteins and the pes-tivirus envelope glycoproteins. Virology. 1991;180:842–48. doi: 10.1016/0042-6822(91)90104-j. [DOI] [PubMed] [Google Scholar]
  • 48.Kato N, Ootsuyama Y, Ohkoshi S e coll. Characterization of hypervariable regions in the putative envelope protein of hepatitis C virus. Biochem Biophys Res Commun. 1992;189:119–27. doi: 10.1016/0006-291x(92)91533-v. [DOI] [PubMed] [Google Scholar]
  • 49.Kato N, Ootsuyama Y, Tanaka T e coll. Marked sequence diversity in the putative envelope proteins of hepatitis C viruses. Virus Res. 1992;22:107–23. doi: 10.1016/0168-1702(92)90038-b. [DOI] [PubMed] [Google Scholar]
  • 50.Weiner AJ, Geysen HM, Christopherson C e coll. Evidence for immune selection of hepatitis C virus (HCV) putative envelope glycoprotein variants: Potential role in chronic HCV infections. Proc Natl Acad Sci USA. 1992;89:3468–72. doi: 10.1073/pnas.89.8.3468. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Minton EJ, Smillie D, Neal K e coll. Association between MHC class II alleles and clearance of circulating hepatitis C virus. J Infect Dis. 1998;178:39–44. doi: 10.1086/515599. [DOI] [PubMed] [Google Scholar]
  • 52.Lechmann M, Ihlenfeldt HG, Braunschweiger I e coll. T- and B-cell responses to different hepatitis C virus antigens in patients with chronic hepatitis C infection and in healthy anti-hepatitis C virus-positive blood donors without viremia. Hepatology. 1996;24:790–95. doi: 10.1002/hep.510240406. [DOI] [PubMed] [Google Scholar]
  • 53.Diepolder HM, Zachoval R, Hoffmann R e coll. Possible mechanism involving T-lymphocyte response to non-structural protein 3 in viral clearance in acute hepatitis C virus infection. Lancet. 1995;346:1006–7. doi: 10.1016/s0140-6736(95)91691-1. [DOI] [PubMed] [Google Scholar]
  • 54.Missale G, Bertoni R, Lamonaca V e coll. Different clinical behaviors of acute hepatitis C virus infection are associated with different vigor of the anti-viral cell-mediated immune response. J Clin Invest. 1996;98:706–14. doi: 10.1172/JCI118842. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55.Tsai SL, Liaw YF, Chen M e coll. Detection of type 2-like T-helper cells in hepatitis C virus infection: Implications for hepatitis C virus chronicity. Hepatology. 1997;25:449–58. doi: 10.1002/hep.510250233. [DOI] [PubMed] [Google Scholar]
  • 56.Diepolder HM, Gerlach JT, Zachoval R e coll. Immunodominant CD4+ T-cell epitope within nonstructural protein 3 in acute hepatitis C virus infection. J Virol. 1997;71:6011–19. doi: 10.1128/jvi.71.8.6011-6019.1997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 57.Choo QL, Kuo G, Ralston R e coll. Vaccination of chimpanzees against infection by the hepatitis C virus. Proc Natl Acad Sci USA. 1994;91:1294–98. doi: 10.1073/pnas.91.4.1294. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 58.Krawcynski K, Alter MJ, Tankersley D e coll. Effect of immune globulin on the prevention of experimental hepatitis C virus infection. J Infect Dis. 1996;173(4):822–28. doi: 10.1093/infdis/173.4.822. [DOI] [PubMed] [Google Scholar]
  • 59.Van den Hoek JAR, van Haastrecht HJA, Goudsmit J e coll. Prevalence, incidence and risk factors of Hepatitis C virus infection among drug users in Amsterdam. J Infect Dis. 1990;162:823–26. doi: 10.1093/infdis/162.4.823. [DOI] [PubMed] [Google Scholar]
  • 60.Fisher DG, Fenaughty AM, Paschane A e coll. Hepatitis C virus infection among Alaskan drug users. Am J Public Health. 1997;87(10):1722–24. doi: 10.2105/ajph.87.10.1722. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61.McCruden EAB, Hillan KJ, McKay I e coll. Hepatitis virus infection and liver disease in injecting drug users who died suddenly. J Clin Pathol. 1996;49:552–55. doi: 10.1136/jcp.49.7.552. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.Romanowski B, Campbell PJ, Preiksaitis JK, Fonseca K. Human immunodeficiency virus sero-prevalence and risk behaviours in patients attending sexually transmitted disease clinics in Alberta. Sex Transm Dis. 1997;24(8):487–94. doi: 10.1097/00007435-199709000-00008. [DOI] [PubMed] [Google Scholar]
  • 63.Garfein RS, Doherty MC, Monterroso ER, et coll. Prevalence and incidence of Hepatitis C virus infection among young adult injection drug users. J Acquir Immune Defic Syndr 1998; (Suppl 1):S11–S19. [DOI] [PubMed]
  • 64.Moyer LA, Mast EE, Alter MI. Hepatitis C: Part II. Prevention, counselling and medical evaluation. Am Fam Phys. 1999;59(2):349–54. [PubMed] [Google Scholar]
  • 65.Leshner AI, Koob GF. Drugs of abuse and the brain. Proc Assoc Am Physicians. 1999;111(2):99–108. doi: 10.1046/j.1525-1381.1999.09218.x. [DOI] [PubMed] [Google Scholar]
  • 66.DuPont RL, Voth EA. Drug legalization, harm reduction, and drug policy. Ann Intern Med. 1995;123(6):461. doi: 10.7326/0003-4819-123-6-199509150-00011. [DOI] [PubMed] [Google Scholar]
  • 67.Schwartz RH. Legalization of drugs of abuse and the pediatrician. Am J Dis Child. 1991;145(10):1153–58. doi: 10.1001/archpedi.1991.02160100085028. [DOI] [PubMed] [Google Scholar]
  • 68.Millman RB. Pharmacology of the drugs of abuse and the development of public policy. Mt Sinai J Med. 1991;58(5):416–20. [PubMed] [Google Scholar]

Articles from Canadian Journal of Public Health = Revue Canadienne de Santé Publique are provided here courtesy of Springer

RESOURCES