Testing key to slowing spread of hepatitis C, doctor says

Dr. Siddharth Kogilwaimath speaks to reporters outside Access Place in Prince Albert ahead of World Hepatitis Day. The theme for World Hepatitis Day 2020, marked on July 28, is ‘finding the missing millions.’ (Peter Lozinski/Daily Herald)

Test, test, test.

That’s not just the mantra of a sound technician, or for doctors and nurses fighting the COVID-19 pandemic. It’s also the message to residents ahead of World Hepatitis Day.

Next Tuesday, July 28, marks World Hepatitis Day, and this year’s theme, as set by the World Hepatitis Alliance, is Finding the Missing Millions.

It’s estimated that 290 million people are living with viral hepatitis and don’t even know it. Without finding those undiagnosed and linking them to care, millions will continue to suffer and lives will be lost.

Hepatitis is an inflammatory condition of the liver, commonly caused by a viral infection. There are five types of hepatitis — A, B, C, D and E. A, B and C are the most common and are usually spread through shared drug equipment or sexual contact.

Hepatitis B through E are the most serious, with Hepatitis A clearing up on its own. Hepatitis D can only be present if there’s also hepatitis B, while hepatitis C is rare.

Vaccines exist for hepatitis A and B, which also prevent hepatitis D.

But there’s no vaccine for the most common form of viral hepatitis — hepatitis C.

Symptoms include fatigue, flu-like symptoms, dark urine, pale stool, abdominal pain loss of appetite, unexplained weight loss and yellow skin and eyes. Patients can also develop cirrhosis, or scarring of the liver, or liver disease.

If caught, it’s treatable.  Hepatitis B and C are treated with antiviral drug therapies. One or two pills are taken every day for one to two weeks, depending on the type of Hepatitis C and liver involvement.

“It’s really, very easy to treat, and it’s really well-tolerated as well, as opposed to previous treatments, said Dr. Siddharth Kogilwaimath.

He’s a visiting doctor who supports the hepatitis C program in Prince Albert. He’s also an assistant professor at the University of Saskatchewan.

“Having a day like this helps us focus our efforts and redouble and engage with people and put out the message,” he said.

That message is that anyone with risk factors for hepatitis C should be tested.

“We take it for granted sometimes that we do have access to medications, but even the simple act of testing and knowing your status relating to the blood-borne pathogens hepatitis and HIV goes a long way,” Kogilwaimath said.

“There’s no reason we can’t test all the people out there and get a sense of how big our epidemic is.”

Providers, patients and people in the community are asking for hepatitis C testing, Kogilwaimath said. That rise in testing is positive, especially since the illness can come with a lot of stigma.

“We do a lot of work to try and address the stigma,” Kogilwaimath said.

“It’s not going to happen overnight, but we do a lot of things to normalize testing, normalize dealing with the results and try and put out the message to help primary care physicians and people who feel comfortable doing the test interpret the test and help them understand where to refer patients.”

Saskatchewan’s rates of hepatitis C are higher than the national average. Since 2008, between 500 and 750 people in the province have been diagnosed each year.

The illness is frequently the product of complex social issues, according to information provided by the Saskatchewan Health Authority. Injection drug use is the most common risk factor, though others also exist.

According to preliminary 2019 data, there were 667 positive cases, a rate of 55.1 cases per 100,000 population. The most recently-available national rate was 31.7 cases per 100,000 population, reported in 2017.

Since 2007, the worst year for positive hepatitis c cases was 2008, when the province had 725 cases for a rate of 70 per 100,000 population, about twice that year’s national average. Of those 725 cases, 101 also had HIV.

According to the most recent, detailed report, published using 2017 data, the most common risk factors were a history of injection drug use (54 per cent) and invasive body art (12 per cent). More men were diagnosed than women (at about a 3:2 ratio), but for women who were diagnosed, 78 per cent were of child-bearing age.

The regions with the greatest number of cases were Regina, Saskatoon and Prince Albert. With 109 positive cases, the former Prince Albert Parkland Health Region had the highest hepatitis C infection rate in the province, at 131.1 per 100,000 population. That was followed by the three northern-most health regions, which combined for a rate of 119 per 100,000 population.

Data isn’t available for the local health region.

A note in the report points out that higher rates in the region may be partly due to the presence of the Saskatchewan Penitentiary.

“Rates of disease are impacted by friends and relatives moving to live in the community to be close to the incarcerated individuals,” the report says.

“This phenomenon has been observed in other areas in Canada where federal penitentiaries are located.”

More recent data isn’t available for the Prince Albert region.

Addressing the high rates of hepatitis C in Saskatchewan will require a multi-pronged strategy, Kogilwaimath said.

While sharing needles might be the most well-known risk factor, the transmission of hepatitis also comes through sharing snorting devices or inhalation devices. While it can be transmitted through sex, that’s not as common as through direct blood exposure through needle using or other drug-related activities, Kogilwaimath said.

Anyone who has a risk of having come into contact with the virus should get tested, he said.

“There are so many people out there in the community who are not tested,” he said.

“The message has to be to test, test, test. You test, we treat. We’re happy to treat the ones who are positive.”