Hepatitis C

“Hepatitis” means inflammation of the liver. Hepatitis can be caused by viruses. There are many different hepatitis viruses, but Hepatitis A, B, and C are the ones most people are familiar with.

In the Thunder Bay District, Hep C infection rates are higher than the provincial average.

The hepatitis virus can damage the liver if left untreated. The liver is an important part of the body that processes things like food, drinks and medications. Learn more by visiting Liver care.

If the liver is damaged by Hepatitis, the whole body is affected. For more information about what happens to the liver when it is infected with Hep C, visit Understanding Cirrhosis of the Liver: First steps for the newly diagnosed.

Watch a short video from the Gastrointestinal Society.

An estimated 250,000 Canadians have Hepatitis C. 

In the Thunder Bay District, annual rates of Hep C infection are higher than the provincial average. In 2021, 138 individuals in the Thunder Bay District were newly diagnosed with Hep C.

To learn more about the rates of Hep C in Ontario, visit Infectious Disease Trends in Ontario, Hepatitis C.

To learn more about the rates of Hep C in Canada, visit The Epidemiology of Hepatitis C in Canada.

Hep C is a blood-borne infection; this means it is passed from person-to-person through blood–to-blood contact. Blood-to-blood contact means blood containing the Hep C virus comes into contact with the bloodstream of another person. This can happen through an entry point in the body like a small puncture or tear in the skin.

There are many ways for blood-to-blood contact to happen. Hep C is most commonly spread by sharing drug supplies that have been used by someone who is infected with Hep C.

Drug supplies could be items like needles, swabs, filters, spoons and water, and supplies for smoking or snorting drugs, like crack pipes or cocaine straws. Small amounts of blood from injection sites, cracked lips, or tiny nosebleeds can be found on these items, increasing the risk for transmission.

Hep C can also be passed on to people if tattoo or piercing equipment is re-used or not disinfected properly. In Ontario, businesses that offer tattooing or piercing must be inspected by the local public health unit.

Although the risk is lower, Hep C can also be transmitted through sex, or sharing personal hygiene and grooming supplies, even if a very small amount of blood is present.

Casual contact with a person living with Hep C, like sharing utensils, hugging, or kissing, has no risk for blood-to-blood contact. To learn more about how someone can become infected with Hep C, visit How Hepatitis C transmission happens.

It is estimated that 20% of people with the virus do not know that they are infected.

When someone becomes infected, they are considered to have an acute infection; also referred to as phase 1. At this stage about 25% of people clear the virus from their body on their own without treatment.

If the body is able to clear the virus, antibodies, our bodies’ natural infection-fighters, will remain in the blood. Individuals with these antibodies in their bloodstream are not considered infectious (e.g. not able to pass the infection to someone else) as the virus is no longer present.

If the body can’t clear the virus, it will continue to attack the liver and progress to what is known as chronic infection or phase 2. The progression of phase 2 is slow, often lasting over 20-30 years, and a person may not show any symptoms.

If this chronic infection goes undiagnosed, the virus will continue to attack the liver and cause scar tissue to form. This scar tissue is called fibrosis. 

Some people who go undiagnosed for many years will develop even heavier scarring called cirrhosis. There are different types of cirrhosis. For more information, visit Understanding Cirrhosis of the Liver: First steps for the newly diagnosed.

In phase 1 (acute infection) a person will likely not show any symptoms. Symptoms can take many years to develop in phase 2 (chronic infection).

Once the virus causes significant damage to the liver, symptoms will begin to show. Common symptoms of chronic Hep C infection are:

• Bleeding easily
• Tiredness
• Poor appetite
• Yellow skin and eyes (jaundice)
• Nausea and vomiting
• Itchy skin
• Fluid building up in the abdomen (ascites)
• Weight loss
• Confusion and drowsiness

As Hep C is transmitted “blood-to-blood,” the best way to protect yourself from Hep C is by avoiding contact with another person’s blood.

• Using NEW drug supplies every time
• NOT sharing ANY drug using equipment; this includes all supplies for both injecting and smoking/snorting
• NOT sharing any sharp instruments or personal hygiene items like razors, toothbrushes, nail clippers
• Using the services of a tattoo artist or piercer who has been inspected by the Thunder Bay District Health Unit; ask the artist/piercer if they are inspected
• Having protected sex by using a condom/barrier

New drug supplies are available for FREE through the Thunder Bay District Health Unit’s Superior Points harm reduction program. Harm reduction programs focus on reducing the harms associated with drug use, like the risk of getting Hep C or other blood-borne infections (e.g. HIV).

Harm reduction programs believe in the right of the individual to make a choice, including the choice NOT to abstain. Abstinence may not be possible or a priority at that point in time for that individual. Harm reduction services are community-based and non-judgemental.

All supplies are offered for FREE and anonymously. Supplies from Superior Points are available at several locations across Thunder Bay and the district. People in Thunder Bay can also call Superior Points if they would like supplies dropped off to them.

There is no limit on the number of needles provided to each client per visit. Clients are not required to return used needles but are encouraged to properly dispose of used needles and syringes; containers are provided and there are several needle disposal bins located in the city.

The program offers a variety of needle and syringe types by gauge, size, and brand. The program also distributes equipment necessary for safer injection (needles, alcohol swabs, filters, cookers, tourniquets, sterile water) as well as the supplies for safer smoking (glass pipes, brass screens and a mouthpiece). Condoms and lube are also available.

Call Superior Points at (807) 621-7861 or (807) 621-7862 for more information. For a list of locations where the supplies are available,  visit the Ontario Harm Reduction Distribution Program (OHRDP) website.

Learn more about harm reduction by visiting Substance Use and Harm Reduction. 

Unfortunately, there is no vaccine to provide immunity to prevent Hep C.

However, there are vaccines for Hepatitis A and B. People who are Hep C-positive should be immunized against Hepatitis A and B as these infections can also damage the liver. It’s important for people who are Hep C-positive to keep their liver as healthy as possible by avoiding other liver infections and injuries.

The vaccines for Hepatitis A and B are free to anyone in Ontario who is diagnosed with or at risk for Hep C.

In the Thunder Bay District, those who are eligible can get the vaccines from any health care provider.

Those who don’t have a health care provider can call TBDHU at (807) 625-5900 (in Thunder Bay) or toll-free at 1-888-294-6630 (ask for VPD) to learn about other options to get the vaccines.

In Ontario, it is recommended that anyone who has risk factors for Hep C is tested. This includes:

• People who share drug using equipment
• People who have had a piercing or tattoo from a provider who was not inspected by TBDHU
• People who have unprotected sex with a person living with Hepatitis C

In 2018, a guideline from the Canadian Association for the Study of the Liver (CASL) recommended screening all “Baby-Boomers,” in addition to people with the above risk factors to address the burden of illness and under-diagnosis in this age group. This screening is also recommended by the United States’ Centers for Disease Control & Prevention (CDC).

After a 2018 review of this guideline, the Ministry of Health and Long-Term Care decided against screening any specific age-group and continues to recommend risk-based screening in Ontario.

Early diagnosis is important to prevent liver damage and disease. When a person is diagnosed with hepatitis C, they can access treatment, care and other supports to improve their health and prevent transmission to their contacts who may be at risk of being exposed.

It takes two tests for someone to fully know their status; one to test for antibodies and a second to determine if an active infection is present or the person has cleared the virus. Hepatitis C testing must be done using a name. Anonymous testing is only available for HIV.

Test 1

The first test determines if someone has been in contact with the Hep C virus. If a person has been in contact with Hep C, or has ever had a Hep C infection, they will have the antibodies in their blood.

If someone is concerned about potential exposure to the Hep C virus, it is recommended they wait about 3 months before testing as it can take 6-9 weeks for antibodies to show up in the blood.

The health care provider will contact the person with the results and discuss next steps. If no antibodies are present, the person was not exposed to the virus and no further testing is required.

If antibodies are present, the health care provider who ordered the test will encourage the person to get the second test to confirm their status.

Test 2

The only way to know if someone with antibodies has an active hepatitis C infection is with a second test, also called a confirmatory blood test. The results of this test will tell the person if the actual virus is detectable in their bloodstream and if they have an infection that needs to be treated. This test will also determine the genotype or strain of the virus (there are 6 types).

If the virus is not detectable in the second test, it means that the person does not have an active infection and has cleared the virus OR that it’s too early to detect the virus. The health care provider will counsel the person and let them know their next steps; it may be repeating the test again in the future OR moving forward to treatment.

More Information

You can find more information on CATIE’s webpage, How hepatitis C testing works: Diagnostic tests.
 

There is a finger prick point-of-care (POC) test that will allow someone to know quickly if they have been exposed to the antibodies and if they need a confirmatory test for a diagnosis. POC testing is only available in some locations in Canada.

For more information about POC testing, visit Hepatitis C point of care testing: What is its impact on testing and linkage to care? 

All health care providers can order the initial test and the confirmatory test. For more information about other organizations that offer testing, visit Testing & Diagnosis below.

See "Local Resources" section below for a list of organizations in Thunder Bay offering testing.

Those who test positive for Hep C will be referred to and followed by health care providers who specialize in infections like Hep C. The health care team will then make a treatment plan together with the individual to manage their infection.

If a person tests positive for Hep C after the confirmation test, they will need to have further tests to monitor how the virus is affecting their body. This information is then used to determine their treatment options.

Hep C infections can cause liver damage which is referred to as fibrosis. Fibrosis causes inflammation and scarring of the liver cells. Different tests will be done to measure an individual’s level of fibrosis and monitor liver function.

Blood tests can monitor liver damage and inflammation as well. Your health care team may order blood tests such as liver function tests. An ultrasound of the liver can check the size of the liver. For more information on these tests, visit Liver Function Tests 

A “fibroscan” of the liver is often used to measure the level of fibrosis. A fibroscan uses sound waves to measure the degree of stiffness of the liver. It is a quick and painless procedure. The results from this test help the health care provider to assess treatment options.

Hep C can be cured. Getting treatment decreases damage to the liver, lowers the chances of developing liver cancer, and lowers the ability to pass Hep C to other people.

There are very effective treatments that cure more than 95% of people of Hep C which prevents further injury to the liver. Being cured also prevents the spread of hepatitis C to other people by eliminating the virus from the body.

Medications used to treat hepatitis C are called direct-acting antivirals or DAAs.

Treatment usually involves taking one to three pills once a day for eight or 12 weeks.

Side effects are usually mild and diminish or go away completely after a few weeks.

For a list of medications approved for use in Canada, visit Hepatitis C drugs approved for adults in Canada.

Watch a short video on treatment from CATIE.

See "Local Resources" section below for a list of organizations in Thunder Bay offering treatment.

Hep C infections can cause liver damage which is referred to as fibrosis. Fibrosis causes inflammation and scarring of the liver cells. Different tests will be done to measure an individual’s level of fibrosis and monitor liver function.
For more information, visit Liver health monitoring tests

A cure is also called a sustained virological response (SVR).

After a person has successfully completed treatment, blood testing is done to determine the amount of the hepatitis C virus left in the blood, if any. This is called the “viral load.” If the viral load is undetectable for 12 weeks in a row after treatment, it’s called SVR12.

If a person gets to SVR12, they are tested after 12 more weeks. If after the full 24 weeks they are still undetectable, this is called SVR24 and the person is considered cured.

It’s important to remember that a cured person could still become infected with a different strain of Hep C if they engage in activities that increase their risk (e.g. sharing drug supplies).

Once treatment is completed, their health care provider will counsel the person on how to keep their liver healthy in the future.

In Thunder Bay, Elevate NWO offers services including treatment and case management. 

You can also call for more information at 807-345-1516.To become a client, individuals must complete the intake process either by appointment or walk-in during business hours.

CATIE (Canadian AIDS Treatment Information Exchange) offers a variety of resources.

1. Self-directed, free courses designed for service providers who prefer to learn on their own time and at their own pace in English and French including Hepatitis C Basics, Hepatitis C Treatment and HIV and Hepatitis C Testing in English and French.
2. Instructor-led courses that combine online education with discussion forums and live training facilitated by knowledgeable CATIE educators. All participants receive a certificate of completion. The courses are offered at different times; visit the website to learn more.
3. Webinars are offered regularly and are FREE. To be notified of upcoming webinars, subscribe to CATIE’s Webinar Updates e-mail list. Recordings of past webinars are also available.

The Provincial Health Services Authority in British Columbia offers a FREE LearningHub online course called Hepatitis C: The Basics.

SAGE is a resource-sharing community for Canadian HIV and hepatitis C service providers. Sage supports the information access of HIV and hepatitis C service providers by providing a centralized, online, community-driven space for the collection and dissemination of Canadian-produced digital information resources relevant to HIV and hepatitis C. To learn more about membership and accessing services visit the SAGE website.

CanHepC is a research network funded by Canadian government organizations dedicated to improving Hep C prevention and outcomes and reduce its burden. A webinar series is held every second year and will run from October 2023 to April 2024.To learn more visit CanHepC Webinar Series. 

Use this map to find locations throughout Thunder Bay and the surrounding district.

Some of the main organizations include: 

• Superior Points Harm Reduction Program -  Services available  Monday – Friday from 11:00 am - 4:00 pm and 5:00 - 8:00 pm. Call 621-7862 or 621-7861; leave a message and your call will be returned. New supplies can be delivered and used supplies can be picked up. Ask about free overdose prevention kits containing Naloxone.
• OATC (Ontario Addiction Treatment Centres) - Harm reduction supplies are available at all four locations. Visit their website for details including address, phone number and hours of operation.
• Shelter House - Supplies are available 24 hours a day at 420 George Street (between May and Simpson).
• Elevate NWO - Visit their website for contact information and other important details
• Norwest Community Health Centres - Supplies are available at both the Thunder Bay and Longlac sites. Visit their website for contact information.
• P.A.C.E  (People Advocating For Change Through Empowerment Inc.) - Supplies are available at both the Thunder Bay and Geraldton sites. Visit their website for contact information.
• Thunder Bay District Health Unit Offices - Monday - Friday from 8:30am to 4:30pm in Thunder Bay, Geraldton and Marathon.

Hepatitis C testing is available from any health care provider. The following organizations can provide both Hep C tests: the initial test and the confirmatory test:

Sexual Health Clinic - Thunder Bay District Health Unit - Sexual Health Clinic; 999 Balmoral Street (Thunder Bay) or call 625-5900 (toll-free 1-888-294-6630). An Ontario Health Card is NOT needed.

Street Nursing (Mobile Unit) - Thunder Bay District Health Unit; call 629-2157 (streetnursing@tbdhu.com). An Ontario Health Card is NOT needed.

Elevate NWO - An Ontario Health Card or any ID IS NOT NEEDED. Visit their website for contact information and other important details. POC testing is available.

OATC (Ontario Addiction Treatment Centres) - Testing is available at all four locations. Visit their website for details including address, phone number and hours of operation. An Ontario Health Card IS NEEDED.

Umbrella Clinic - Visit their website for contact information to make an appointment.

The types of treatment support services vary by organization, so please contact each organization directly.

Elevate NWO - Visit their website for contact information and other important details regarding treatment services and other valuable supports. No referral is needed.

OATC (Ontario Addiction Treatment Centres) - Treatment is available at all four locations. Visit their website for details including address, phone number and hours of operation. No referral is needed.

Umbrella Clinic - Visit their website for contact information to make an appointment