February 18, 2002
People continue to be more and better informed about the diseases and health risks they face. One example of this has been the change in behaviour once we learned about HIV/AIDS — most people today recognize the dangers posed by HIV. Unfortunately, a new disease is thriving and may soon become as well known as AIDS. It is Hepatitis C.
The Hepatitis C virus (HCV) causes inflammation of the liver that may lead to cirrhosis or even cancer. It has neither vaccine, nor cure. Although present for decades, it was not until 1989 that the virus was specifically identified as the cause of what had been called “non-A and non-B hepatitis.”
Many people may be living with Hep C without knowing it. An infected person can experience a range of effects from mild to very serious. Some will recover completely from an infection while others become carriers of the disease, spreading it unknowingly to others. The symptoms vary widely and may include fatigue, jaundice, nausea, muscle and joint aches, abdominal pain and weight loss. Over the long term, chronic disease may set in, leading to serious liver damage. Of 338 liver transplants performed in Canada in 1998, 217 could be attributed to the HCV. There is concern that these numbers could triple by 2008.
Justifiably, people should be concerned about becoming infected with the HCV. The virus is spread through contaminated blood or bodily fluids. Not only is Hepatitis C far more infectious than HIV, about 10-15 times more so, it is also more easily transmitted through blood. This is one of the reasons that the biggest risk factor for infection is among injection drug users sharing needles, syringes or other paraphernalia. In fact, 63% of new cases each year are linked to this group.
Other methods of transmission include sharing razors or toothbrushes, getting tattoos or body piercings with contaminated needles, from a mother during birth, or during sexual intercourse. While the risk from these forms of transmission is quite low, it is not zero. Another source of infection, prior to 1990, was the blood system which did not begin screening for the HCV until then. Today, that risk is quite small as all blood in Canada is tested. Hepatitis C is not spread by casual contact such as hugging, kissing or shaking hands, or by being around someone who is sneezing or coughing. Nor is the virus found in food or water.
Hepatitis C is a complex disease. Much of the difficulty in finding a cure or a vaccine comes from the fact that the HCV is not actually one virus. It has many sub-types and quasi species. Thus, even if a vaccine was created that fought dozens of sub-types, it would not necessarily protect against other variations.
Combating Hepatitis C means placing more importance on programs such as needle exchanges. These programs not only provide clean needles, they also educate, counsel and support those most at risk. This risk-reduction approach is a key strategy for public health. When people are willing to engage in high-risk behaviour irrespective of the consequences, perhaps the place to start is in minimizing the negative outcomes of that behaviour.
Longer term, or until there is a cure or vaccine, the solution to Hepatitis C may not be completely medical.
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