Academic journal article Canadian Journal of Public Health

Hepatitis A, B, and C in Canada: Results from the National Sentinel Health Unit Surveillance System, 1993-1995

Academic journal article Canadian Journal of Public Health

Hepatitis A, B, and C in Canada: Results from the National Sentinel Health Unit Surveillance System, 1993-1995

Article excerpt

ABSTRACT

Objectives: To estimate the incidence of and to describe the risk factors that were associated with the acquisition of hepatitis A, B, and C in well-defined Canadian populations from the Sentinel Health Unit Surveillance System (SHUSS).

Methods: We used the 1993 to 1995 data on hepatitis A, B, and C infection in Canada, collected by SHUSS, a national surveillance system established by the Laboratory Centre for Disease Control in Health Canada in 1993, through consultation and collaboration with provincial partners. We calculated the rates of, and described and discussed the risk factors that were associated with, hepatitis A, B, and C infection, based on the SHUSS surveillance data.

Results: From 1993 to 1995, SHUSS reported 92 cases of hepatitis A, 89 hepatitis B, and 720 hepatitis C, yielding a rate of 3.9, 3.8, and 30.3 per 100,000, respectively. The reported rates varied substantially among participating health units, ranging from 0.8 to 8.1 per 100,000 for hepatitis A, 0.0 to 9.0 for hepatitis B, and 5.4 to 73.3 for hepatitis C. The most frequently reported risk factor for hepatitis A was a history of street drug use, followed by recent international travel and household contact with a hepatitis A case, household crowding, and a history of raw or undercooked shellfish consumption. The most frequently reported risk factors for the acquisition of hepatitis B included history of street drug use and occupational exposure. The most frequently reported risk factor for the acquisition of hepatitis C was a history of street drug use, followed by health care exposure and occupational exposure. Only 5% of persons with hepatitis B infection had a history of hepatitis B immunization.

Interpretation: Despite the limitations of possible bias due to selective participation of SHUSS and the lack of information on risk factors among controls, the high exposure to known risk factors and the low rate of vaccination among hepatitis patients can provide useful information for the development of public health policies to control hepatitis A, B, and C infection in Canada.

Hepatitis A continues to be a source of disease burden in both developed and developing countries.1-2 The rate of reported hepatitis A in Canada has increased from 4.3 per 100,000 in 1987 to 6.3 in 1997.(3) In Canada, persons at risk for hepatitis A infection include travellers to countries with high disease endemic, injection drug users, and men who have sex with men.4

Hepatitis B virus infection causes a number of clinical syndromes including subclinical disease, acute self-limited hepatitis and chronic infection associated with long-term sequella such as cirrhosis and hepatocellular carcinoma.4-6 Over the last decade, the rate of new hepatitis B virus infection in Canada has reached a plateau, with approximately 2,000 to 3,000 cases reported annually.7 Hepatitis B is a notifiable disease and has been reportable in Canada since 1969. Few studies, however, have been conducted on the prevalence of hepatitis B virus infection in Canada nationally. The most recognized mode of hepatitis B transmission is via unprotected heterosexual and homosexual contact with an infected person, followed by injection drug use and occupational exposure to blood.4,8 Vaccine to prevent Hepatitis B infection has been available in Canada since 1982. Current control measures in Canada include a universal, school-based hepatitis B immunization program which has been implemented in all provinces and territories except Manitoba.

The development of serological tests for hepatitis C infection have shown that this virus is the primary etiologic agent of parenterally transmitted non-A, non-B hepatitis and is an important cause of acute and chronic hepatitis worldwide.9-11 Approximately 90% of infected persons are at risk for chronic liver disease or other hepatitis C virus-related chronic diseases during the first two decades following initial infection. …

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