Hepatitis A and C "superinfection" tackled in BC
CMAJ 1998;159:643
© 1998 Heather Kent
British Columbia hopes to head off cases involving a deadly combination of 2 viruses by launching a hepatitis A vaccination program for intravenous drug users and others infected with hepatitis C. The program was prompted by a recent Italian study in which one-third of patients infected with both hepatitis A and C died of liver damage (N Engl J Med 1998;338:286-90). The results "were not a surprise," says Dr. Arlene King, director of epidemiology at the BC Centre for Disease Control. Anecdotal evidence had suggested that immunization against hepatitis A should be considered for patients with hepatitis C. One BC resident has died because of the "superinfection" this year, and 6 deaths were reported between 1990 and 1997. By mid-August the centre was tracking 52 reported cases, but under-reporting is suspected.
Because of the overwhelming prevalence of hepatitis C among intravenous drug users in Vancouver's Downtown Eastside, the dual infection could result in "potentially a very explosive situation," says Dr. Liz Whynot, medical health officer for the area. She commends the health ministry for acting before a crisis developed. BC will be the first province to offer the free vaccinations, which cost about $50 per person. Hepatitis A has been spreading at double the normal rate in Vancouver since last fall.
More than 25 000 BC residents are known to have hepatitis C, and up to 10 000 of them are thought to be intravenous drug users. Infection with either virus is reportable, and King says that the province's surveillance system is "one of the best in the country." She predicts 6000 to 8000 new cases of hepatitis A will be reported in 1998. Implementing the vaccination program for people who acquired hepatitis C from differing causes has made the task "one of the most challenging ever put in place."
The effort will be concentrated initially in the Downtown Eastside, where immunization will be available at needle exchanges and through mobile clinics and health units. The BC Centre for Disease Control is still developing promotional strategies to reach eligible people in other parts of the province.
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