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HEPATITIS C

This information provides a snapshot of the Hepatitis C epidemic in Canada sourced from a fact sheet series on the epidemiology of HIV and Hepatitis C in Canada published by Public Health Agency of Canada (2011). All epidemiological information is approximate, based on the best available data.

What is Hepatitis C?

Hepatitis C is a liver disease caused by the Hepatitis C virus. Some people are able to clear the virus from their body early on in infection; however, in about three-quarters of people, the infection becomes chronic. Chronic infection can lead to severe liver damage (cirrhosis), liver cancer and liver failure (which requires a liver transplant). There are treatments for Hepatitis C, but no vaccine exists to prevent infection.

How is Hepatitis C spread?

Hepatitis C is transmitted when the blood of someone carrying the virus gets into the bloodstream of an uninfected person.

The most common ways a person can get infected with the Hepatitis C virus are through:

Though less common, a person can also become infected with the Hepatitis C virus by:

At the end of 2007, an estimated eight of every 1,000 Canadians were living with Hepatitis C (prevalence).1

Based on national 2007 hepatitis C estimates:

Based on national 2007 Hepatitis C estimates, approximately 50,000 or 21% of people living with Hepatitis C were unaware that they had it.

Hepatitis C is more prevalent among people who inject drugs than in any other group.

Based on national Hepatitis C estimates and a number of Canadian surveillance systems:

In 2007, an estimated three out of every 10,000 Canadians contracted Hepatitis C (incidence).1

Based on national 2007 hepatitis C estimates:

The annual reported rates for Hepatitis C infections are declining.6

Based on 2010 national surveillance data, 10,741 Hepatitis C diagnoses were reported to the Public Health Agency of Canada. This is equal to 31.5 cases of Hepatitis C per 100,000 Canadians. This is a significant decrease from 2005 when 13,017 Hepatitis C diagnoses were reported to the Public Health Agency of Canada, corresponding to a rate of 40.4 cases per 100,000 people.

Most Hepatitis C diagnoses reported in 2010 were in Canadians aged 30 years and older.7

Based on 2010 national surveillance data:

In 2010, most new Hepatitis C diagnoses were reported by Ontario, British Columbia and Quebec.6

Based on 2010 national surveillance data:

The long-term impacts of Hepatitis C can be severe.1

Based on national 2007 Hepatitis C estimates:

Key Definitions

Prevalence—the total number of people who are living with a condition at a point in time. In the case of Hepatitis C, the prevalence rate tells us how many people have hepatitis C in a defined population.

Incidence—the number of new infections in a defined period of time (usually one year). In the case of Hepatitis C, the incidence rate tells us how many people are getting Hepatitis C in a particular year.

Where Are These Statistics From?

All epidemiological information is approximate, based on the best available data. Most of the data in this page comes from national Hepatitis C surveillance data, population specific surveillance studies or national Hepatitis C estimates produced in a modelling exercise.

Routine Hepatitis C case reporting (surveillance)

Healthcare providers are required to report Hepatitis C diagnoses to their local public health authorities. Each province/territory then compiles this information and provides it to PHAC. Sometimes additional information is collected and sent to PHAC, such as information about age, gender and the way the person may have acquired Hepatitis C. At the time this information was published, the most recent data available was from 2010.

Limitations—These data represent the number of cases reported to PHAC by each province/territory. Reported cases do not truly represent the prevalence or incidence of hepatitis C because these statistics represent only those cases that have been diagnosed (excluding those who have yet to be diagnosed). Furthermore, these numbers do not distinguish between acute (new) infections, chronic (more long-term) infections and infections that have been resolved (when a person has cleared the virus from their body). Therefore, it is impossible to know who is recently infected, who has a chronic infection and who no longer has the disease. Other limitations to these data include reporting delays (the time between the diagnosis of Hepatitis C and when it is reported to PHAC) and under-reporting (largely, due to the asymptomatic nature of Hepatitis C virus infection).

Correctional Service Canada (surveillance)

Prisoners in Correctional Service Canada’s institutions can be voluntarily tested for Hepatitis C at admission or at any time throughout their term. The surveillance data is compiled annually. The most recent data available to the public at the time this information was published is from 2006.

Limitations – these data do not truly represent the prevalence of Hepatitis C in the prison population. These statistics reflect only diagnosed cases of Hepatitis C within the correctional setting and self-reported hepatitis C infections at the time of admission. Not all prisoners are tested for Hepatitis C infection, which is the only way to get a true picture of Hepatitis C in any given population. Furthermore, data collected about people in prisons do not distinguish between ongoing and resolved infections.

Use of mathematical modelling in producing estimates of Hepatitis C prevalence and incidence

Mathematical modelling techniques were used to provide an overall picture of the Hepatitis C epidemic in Canada in 2007. A three-stage approach was used to obtain estimates of the population at risk stratified by age and gender: (1) Hepatitis C incidence rate among those born in Canada; (2) prevalence rate among immigrants to Canada at the time of arrival and subsequently; and (3) the projected outcomes of chronic Hepatitis C infection.

Limitation – Mathematical models use a combination of available data and assumptions. They help us to understand the state of the epidemic; however, the findings are only as good as the data and assumptions the mathematical models are based on.

Population-specific surveillance

The Public Health Agency of Canada (PHAC) monitors trends in the spread of a number of infectious diseases, including measures of Hepatitis C and associated risk behaviour indicators among key vulnerable populations identified in Canada through population-specific surveillance systems. These surveillance systems, also known as “Track” systems, are comprised of periodic cross-sectional surveys, which, in addition to collecting information on biological specimens to be tested for HIV and Hepatitis C virus also collect information on behavioural risks at selected sites in Canada. The blood test used does not distinguish between past or present Hepatitis C infection.

I-Track is the national surveillance system of people who inject drugs. The statistics provided in this fact sheet are for the years 2005 to 2008 from participating phase-2 I-Track sites. Because the system only recruits voluntary participants from selected urban sites, the results do not represent all people who inject drugs across Canada.

M-track is the national surveillance system for gay men and other men who have sex with men. The statistics provided in this fact sheet are for the years 2005 to 2007 from participating phase-1 M-Track sites. Because the system only recruits voluntary participants from selected urban sites, the results do not represent all men who have sex with men in Canada.

Enhanced Street Youth Surveillance (E-SYS) is the national surveillance system for street-involved youth. The statistics provided in this fact sheet are for the years 1999 to 2005 from participating E-SYS sites. Because the system only recruits voluntary participants from selected urban sites, the results do not represent all street-involved youth in Canada.

Acknowledgements

Thanks to the Centre for Communicable Diseases and Infection Control and the Public Health Agency of Canada for their expert review of this information.

References

Author(s): L. Challacombe

Published: 2013

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