What is Hepatitis?
Hepatitis is a medical word used to describe a liver that is inflamed. A number of things can negatively impact the liver, causing it to become inflamed and impacting its ability to function properly. Generally, Hepatitis is a condition that progresses slowly, but it can become acute and lead to life-threatening effects.
Your liver filters out toxins in your body, and so can become inflamed by an overload of toxins from heavy alcohol or drug use (including prescribed medications). Some medical / health conditions can also cause or lead to hepatitis. The third cause of hepatitis is called viral hepatitis where a virus leads to liver inflammation. The three viruses most commonly known to cause Hepatitis are Hepatitis A (HAV, Hep A), Hepatitis B (HBV, Hep B), and Hepatitis C (HCV, Hep C). There is also a satellite virus called Hepatitis D that is associated with the Hepatitis B virus. This means that only people who have Hepatitis B are able to get Hepatitis D.
What is the difference between Hepatitis A, B, and C?
Hepatitis A, B, and C are in many ways vastly different viruses, they just all cause liver inflammation. Check out the chart below to see some of their key differences and similarities.
| HEPATITIS A | HEPATITIS B | HEPATITIS C | |
| How is it transmitted? | >HAV is spread by ingesting the virus. This means it is spread primarily by contamination of food products. It is resistant to heating and freezing and can survive for a while in food. | HBV is spread through infected blood entering the body of someone without HBV.
Similarly to HCV and HIV, this can include certain sexual acts, improper cleaning procedures during tattooing, skin piercings, or medical procedures, giving birth as a HBV+ person, or sharing drug equipment, especially needles. It also includes any other activities where someone’s blood (even in microscopic amounts) comes into contact with another person’s blood stream. HBV can also be found in the saliva but it is not spread through saliva. |
HCV is spread through infected blood entering the body of someone without HCV.
Similarly to HBV and HIV, this can include certain sexual acts, improper cleaning procedures during tattooing, skin piercings, or medical procedures, giving birth as a HCV+ person or sharing drug equipment, especially needles. It also includes any other activities where someone’s blood (even in microscopic amounts) comes into contact with another person’s blood stream. |
| What short term effects does it have on the body? | HAV usually becomes symptomatic between 2 to 4 weeks after contracting the virus. These symptoms can include jaundice (yellowing of the skin and sometimes eyes), fever, stomach pain, nausea and dark urine. | HBV is often asymptomatic.
If it develops into acute Hepatitis this generally occurs between 8 weeks to 5 months after exposure. |
In about half of people, HCV is a short term illness that the body can fight off on its own. This has similar symptoms to HBV and HAV.
The other half of people develop long term HCV. |
| What long term effects does it have on the body? | HAV normally clears on its own after several weeks leaving no long term health impacts and future HAV immunity.
In rarer cases folks may develop HAV relapses, when this happens they often experience similar symptoms as their first instance of acute hepatitis, and again, it most often clears itself within a month. |
Often, people clear HBV on their own.
If they develop HBV they usually experience some combination of these symptoms: jaundice (yellowing of the skin and sometimes eyes), fever, exhaustion and stomach pain, nausea and dark urine. In severe cases this can lead to death. Some people who contract HBV will develop chronic or long-term HBV. This can go unnoticed and show no symptoms for over 15 years. Long-term HBV can lead to cirrhosis (scar tissue build up on the liver that can eventually lead to liver failure), or the development of liver cancer. Both of these conditions can be fatal. |
Long term HCV often shows no symptoms for a long time – this is part of the reason why testing for HCV is so important. Long-term (also called chronic) HCV can lead to long-term health conditions including life threatening cirrhosis (scar tissue build up on the liver that can eventually lead to liver failure), or the development of liver cancer. Both of these conditions can be fatal. |
| Is there a vaccine for it? | Yes.
In Nova Scotia, vaccines are covered by MSI for certain at risk groups and can be purchased by anyone else. It is encouraged for folks travelling to countries where HAV prevalence is high, and is not available for children under the age of 1. Learn more here. |
Yes.
The HBV vaccine is recommended for most children. Post-exposure Prophylaxis (PEP) is also available for newborns who’s birthing parent has HBV. A combination HBV/HAV vaccine is sold in Nova Scotia and encouraged for folks travelling to countries where HBV prevalence is high. There are also certain at risk populations who can get this combination vaccine covered by MSI. Learn more here. |
No. |
| Is there a cure for it? | There is no specific cure for HAV.
Most cases that result on their own, and for folks that end up leading to hospitalisation treatment often includes managing pain and discomfort and providing fluids to avoid dehydration. |
While there is not a specific cure for HBV there are treatments.
Folks with acute HBV can be treated for pain and discomfort and given fluids to avoid dehydration. There are also medications for folks who develop chronic HBV that can slow down the development of cirrhosis and decrease the likelihood of developing liver cancer. |
There are a number of treatment options available in Nova Scotia for those who test positive for HCV, and this treatment can clear the vast majority of cases. |
| How common is it in Nova Scotia, Canada? | The incidence of HAV is very very low in Nova Scotia.
It has stayed below 1 out of 100,000 people since the year 2000. |
The incidence of HAV is very very low in Nova Scotia.
As of 2020 cases have decreased to about 0.5 cases per 100,000 people. |
HCV is the most common hepatitis virus in Nova Scotia.
Around 25 out of 100,000 (or, 1 out of 4000) people have HCV in this province. |
How can I prevent transmitting Hepatitis?
Since HBV and HCV are carried in the blood, preventing the transmission of these virus’ means avoiding situations where an HV+ person’s blood might enter someone without HV’s body or bloodstream.
In Nova Scotia, there are vaccines protecting against both Hep A and Hep B (TWINRIX), and vaccines protecting against just Hep A or Hep B. Hep B vaccines are often given out to school age children in Nova Scotia (as of 1995). If you went to school in Nova Scotia you can contact your Public Health unit to see if you received the vaccine. If you did not receive the vaccine you can talk to your doctor about if it is right for you. It is only covered for certain at-risk populations.
While very uncommon in Nova Scotia, HCV can be passed through re-using or improperly cleaning tattooing and piercing equipment or medical tools. If you are getting your body pierced or a tattoo by someone outside of a professional setting it is always a good idea to check in about how they are keeping you safe.
More commonly in Nova Scotia HCV is passed on through sharing drug use equipment or through barrier-free sex (sex without condoms or dental dams).
For sexually transmitted HCV most of the activities that are higher risk for passing on HIV (such as anal and vaginal sex) are also more likely to pass HCV since the mode of transmission is so similar. You can check out our section on HIV to learn more. Using preventative measures such as wearing a condom during sex, electing for lower risk sex acts (such as oral sex) with folks who haven’t tested recently for HCV (or whose status you are unsure about), and testing regularly are all great ways to lower your risk. If you have tested positive for HCV it is a good idea to refrain from sex acts that can pass HCV until you have completed treatment. This can be a time to explore other forms of intimacy in your relationships, or get to know your body better!
For HCV transmitted through drug-use, the single most important thing you can do to prevent transmission is not sharing drug-use equipment, especially equipment that comes into contact with your blood. Using new and clean equipment any time you use substances means that HCV has no mode of transmission from one person to another. If you do not have access to new drug use equipment we recommend looking for harm reduction sites near you.
Here is a short list of some of the harm reduction sites we know in Nova Scotia:
Halifax – The Mainline Needle Exchange
Halifax – Refix
Truro – Northern Healthy Connections Society
Cape Breton – Ally Centre of Cape Breton
Mainline Needle Exchange also offers a program called the brown bag program where you can pick up drug use supplies at a long list of pharmacies around the province. Visit this link to learn more.
How do I know if I have/get Hepatitis C?
The only way to know for sure that you have HCV is to get tested. HCV testing involves going to a testing centre and getting a sample of your blood taken. Testing can be done at most places in the province that offer STI testing, including sexual health clinics, and hospitals.
All blood samples in Nova Scotia are then sent to the Hepatitis C clinic at the QEII Hospital in Halifax. Generally, two types of tests are performed on blood samples; anti-HCV and HepC RNA tests. The anti-HCV tests look for antibodies, the defence your body creates against the virus, and HepC RNA tests look for a piece of genetic material that is created by the virus. In simpler terms, the anti-HCV test is looking to see if your body is responding to the presence of the virus, and the HepC RNA test is looking to see if it can find pieces of the virus itself in your body.
If the HepC RNA test comes back positive that means that you have an active Hepatitis C infection in your body. If the anti-HCV test comes back positive, but the HepC RNA test is negative, this most likely means you have had an infection in the past that has either been treated, or that your body fought off without you even realising you had it.
Aside from testing, it never hurts to keep an eye out for these symptoms listed in the chart under the ‘What is the difference between Hepatitis A, B, and C?’ section. That being said, not all cases of HCV show symptoms, and so it is best for your health and the health of your sexual partners to set up a regular testing schedule for yourself – especially if you are having barrier-free sex with multiple partners!
Check out our testing tool to generate a personalised list of tests to get and an idea of how often to get them!
Can Hepatitis C be treated?
Yes, it can!
Hepatitis C treatment is available for anyone over the age of 3 in Canada, and can clear viral infections 95% of the time. HCV treatment usually involves a combination of medications called direct-acting antivirals (DAAs) that are taken for approx. 3 months.
If you know that you have HepC is is best to talk to your family doctor, your local sexual health clinic, or go to your local walk-in to get started on treatment as soon as possible, When you get your tests results back you should be directed to treatment options near you, but if you weren’t don’t hesitate to reach out to us at HEAL NS.
When on treatment, it is a good idea to refrain from activities where you could pass HCV on to other folks.
If you want to learn more about HCV treatment you can look through this resource created by CATIE.
In Nova Scotia, the vast majority of folks are covered through MSI and Provincial Pharmacare. However, the cost of treatment can cost between $60,000 and $120,000 for those who aren’t covered. Additionally, some private insurance plans cover HCV treatment.
You can learn more about where HEAL NS got this information from at:
https://www.who.int/news-room/fact-sheets/detail/hepatitis-a#:~:text=Symptoms%20of%20hepatitis%20A%20range,of%20the%20eyes%20and%20skin)
https://www.cdc.gov/hepatitis-d/about/index.html#:~:text=About%20hepatitis%20D,liver%20damage%20and%20even%20death
https://novascotia.ca/dhw/CDPC/hepatitis-A.asp#:~:text=The%20incidence%20of%20Hepatitis%20A,per%20100%2C000%20population%20since%202000
https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
https://www.cdc.gov/hepatitis/hcv/index.htm#:~:text=Hepatitis%20C%20is%20a%20liver,to%20prepare%20and%20inject%20drugs
https://shns.ca/wp-content/uploads/2021/08/CBRC_NS_8x11-HepAB.pdf
https://mainlineneedleexchange.ca/
https://direction180.ca/our-parterships/
https://nhcsociety.ca/
https://www.allycentreofcapebreton.com/
https://mainlineneedleexchange.ca/brownbag/
https://www.catie.ca/hepatitis-c-an-in-depth-guide/hepatitis-c-treatment
*disclaimer: we do not necessarily endorse all of the information, content, or language used in these references.