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andré picard's second opinion

Hepatitis is the Rodney Dangerfield of the viral world.

With HIV-AIDS, pandemic influenza and even the common cold stealing the headlines, hepatitis doesn't get any respect or attention.

Yet it is estimated that one in 12 people worldwide are infected with a chronic form of hepatitis, a potentially serious liver disease.

Hepatitis is a forgotten epidemic, one whose relentless spread has been greatly facilitated by a combination of ignorance, indifference and stigma.

So one of the most effective tools we have to combat this epidemic is education.

There is an alphabet soup of hepatitis viruses, but the ABCs are the most important in public health terms.

Hepatitis A is mainly a food-borne disease - a virus spread by the fecal-oral route, as they say in the indelicate lingo of public health. It's a nasty bug but it is vaccine-preventable and, if contracted, is self-limiting. Once the patient gets better, the disease is gone; hepatitis A doesn't linger and cause liver damage.

But hepatitis B and C are more stealthy illnesses. An infected person may experience symptoms, but generally speaking the infection is a silent one. The virus can lie low for years while it does damage internally, to the liver; infection is often not discovered until the person has severe disease, such as cirrhosis or liver cancer.

One of the most fascinating and frightening things about hepatitis is that it's a virus that can cause cancer. Conversely, it is a form of cancer that is vaccine-preventable, an idea that was in the realm of science fiction not too long ago.

There are a lot of infectious diseases out there, and many are invisible to residents of wealthy countries such as Canada with ready access to vaccination, sanitation, clean water and prompt treatment.

Unlike many viral diseases, however, hepatitis isn't only a problem in the developing world.

In Canada alone, there are an estimated 600,000 people living with hepatitis B or C, and most don't even know it. But the numbers are guesstimates because there is very little screening and surveillance.

In this country, schoolchildren are vaccinated against hepatitis B. That's because HBV is principally a sexually transmitted disease. It is spread through bodily fluids such as sperm, blood and saliva.

You can contract it from kissing, from sharing a razor or needle, from a blood transfusion, from a tattoo, from inadequately cleaned medical equipment, or during birth if the mother is infected. (Hepatitis is about 100 times more infectious than HIV-AIDS.) Hepatitis B is endemic in large parts of Asia and Africa, the home continents of many immigrants to Canada. About 350 million people in the world are living with chronic hepatitis B.

There is a lot of stigma in some minority communities about hepatitis, which is a barrier to early treatment.

Hepatitis C is also a condition with a lot of baggage. The virus is contracted largely from exposure to contaminated blood - either through transfusion of unscreened blood or from sharing needles.

In Canada, the disease got a lot of attention because of the tainted blood tragedy - in which 10 times as many people were infected with HCV as HIV. More than $2.5-billion in compensation was paid - a sum that could have bought a lot of prevention.

But hepatitis C is often described as a disease of junkies.

There is no vaccine to protect against hepatitis C, so harm-reduction measures such as needle exchanges are a must.

Treatments for hepatitis B and C exist. Interferon and ribavirin are expensive drugs with a lot of side effects. Moreover, they work less than half the time.

For many sufferers, the only recourse is a liver transplant, and the waiting list for livers is very long and growing rapidly.

These limitations mean that prevention is essential: expanding education, immunization and harm-reduction programs across Canada and abroad.

The programs need to be community-driven, and delivered particularly in high-risk communities.

Research is also essential. There was good news on that front this week when a bevy of Canada Excellence Research Chairs were announced, one of them awarded to Michael Houghton, a key member of the team that discovered the hepatitis C virus. There's hope that his high profile will help raise the profile of the disease.

But battling a disease that has already infected one in every dozen people worldwide requires a strategy.

Canada has well-funded strategies to tackle cancer and mental health. It also has a cardiovascular strategy, though it has yet to be funded. It's time to add hepatitis to the list.

Hepatitis is often called "The Silent Epidemic."

It's time to break the silence.