When Karen Robson was about to turn 40 earlier this year, her doctor ordered a battery of tests – including a blood test for hepatitis C. Robson, a Toronto-based sociologist, said she was shocked when the results confirmed that she had antibodies for hepatitis C. "I went into panic mode," she said.
Robson has no idea how she contracted the virus: She has never received a blood transfusion or medical attention in a foreign country, and never experimented with injection drugs, she said. Doctors suggested there was a slim chance she was infected via dental work or sharing a toothbrush. "If I can get this, anyone can," she said.
Hepatitis C is sometimes seen as a drug addict's disease, but recent data suggest the largest group of Canadians carrying the virus consists of average adults born between 1945 and 1975. Last year, evidence of high infection rates among boomers prompted the U.S. Centers for Disease Control and Prevention to recommend that all adults born between 1945 and 1965 be tested and treated for hepatitis C before this latent disease becomes a health crisis.
That testing guideline was supported by the Canadian Liver Foundation, which expanded the birth year to 1975 "due to the prevalence of hepatitis C in the immigrant population," said Dr. Morris Sherman, the foundation's chairman and a liver specialist at Toronto General Hospital.
National health agencies have yet to recommend hepatitis C testing beyond high-risk groups, which include immigrants and active injection drug users. But according to Canadian epidemiologists, hepatitis C is a ticking time bomb. Many predict that without a co-ordinated plan for diagnosis and treatment, large numbers of boomers who have unknowingly carried the virus for decades will develop cirrhosis and liver cancer, or suffer from liver failure.
"I don't want to see government inaction now resulting in an epidemic of end-stage liver disease," Sherman said. He estimates that more than 400,000 Canadians carry hepatitis C, based on data from the U.S. and from British Columbia, which is a North American leader in tracking the disease.
In B.C., for instance, it's estimated that one in 33 boomers has been infected with hepatitis C, said Mel Krajden, medical director of hepatitis services at the B.C. Centre for Disease Control. That means that hepatitis C is at least four or five times more common than HIV, Krajden added.
Hepatitis C is a silent killer, Sherman explained: "The vast majority of patients do not get any symptoms of hepatitis C until their liver fails, usually in their 60s or older."
Infections in the boomer population are largely due to experimentation with recreational drugs, he said. "Injection drug use was really quite common in the 1960s and seventies," he said, adding that one-time use is enough to drive up the risk.
Other sources of infection include tattooing in unhygienic conditions and emergency medical treatment in countries with high rates of hepatitis C, including Egypt, Vietnam, Pakistan, Bangladesh and Somalia. Transfusions of tainted blood account for only a small percentage of undetected hepatitis C infections, Sherman said. The virus can be spread sexually, but it is uncommon since it is transmitted through blood-to-blood contact.
Mark Hull, a physician at St. Paul's Hospital in Vancouver and a researcher with the B.C. Centre for Excellence in HIV/AIDS, estimates the crisis point for hepatitis C-related diseases is about a decade away. Since available treatments can cure about 60 per cent of hepatitis C patients, he added, "I think there's an urgency in moving forward now."
Sherman and others will meet with the Public Health Agency of Canada in October to argue for expanded testing. Without national and provincial guidelines, most family physicians are unaware of the value of one-time testing for hepatitis C in adults over the age of 38, Sherman said. PHAC currently maintains that "in the general population, the risk of contracting hep C is low," said agency spokesperson Sylwia Krzyszton.
Robson's case was unusual. Her doctor was vigilant because he had seen many patients with hepatitis C, she said. Fortunately, a few months after her initial blood tests, Robson discovered from a viral lode test that her body's immune system had eliminated the virus. Studies suggest the phenomenon occurs in roughly a quarter of people with the disease.
Although she will always have antibodies for hepatitis C, Robson is no longer a carrier of the virus or at increased risk of liver disease. She is one of the lucky ones.