Public Health and Hepatitis C

L’hépatite C et la santé publique

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.

Résumé

La présente communication passe en revue les principaux aspects de la santé publique liés à la surveillance, à la transmission et à la prévention primaire de l’hépatite C. Aujourd’hui, au Canada, cette infection doit être déclarée dans toutes les provinces et dans tous les territoires. Bien que sa prévalence dans notre pays soit évaluée à moins de 1 %, celle qui est associée à l’utilisation de drogues injectables (UDI) est proche de 90 %. L’épidémiologie des nouvelles infections par le VHC au Canada se définit maintenant surtout par le comportement des UDI et les taux annuels d’incidence parmi les nouveaux utilisateurs de drogues injectables sont supérieurs à 25 %. Le VHC se transmet moins efficacement par d’autres voies d’exposition. La mise au point d’un vaccin efficace contre le VHC paraît impossible à l’heure actuelle. Certaines provinces vaccinent les personnes atteintes du VHC contre l’hépatite A et l’hépatite B. Plusieurs stratégies de réduction des préjudices attribuables à l’UDI ont été instituées au Canada, mais leur portée n’est pas suffisante et elles n’ont pas permis, jusqu’à présent, d’enrayer l’épidémie du VHC. On envisage actuellement des solutions sur le plan de la politique publique, notamment la légalisation et la réglementation des drogues injectables. Il est urgent de trouver de meilleures stratégies de prévention du VHC et de les évaluer soigneusement.

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Correspondence to Dr. David M. Patrick.

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Patrick, D.M., Buxton, J.A., Bigham, M. et al. Public Health and Hepatitis C. Can J Public Health 91, S19–S23 (2000). https://doi.org/10.1007/BF03405102

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