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Viral Hepatitis Testing

Last updated on August 29, 2023

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Effective Date: May 26, 2021

Recommendations and Topics

Scope

This guideline provides guidance for the use of laboratory tests to diagnose acute and chronic viral hepatitis in adults (≥ 19 years) in the primary care setting.

Testing related to children or perinatally acquired viral hepatitis infection, or treatment information is outside the scope of this guideline.

Key Recommendations

To avoid duplicate testing, consider the patient’s history, age and risk factors (see Table 1). Check for prior relevant vaccinations and test results before ordering tests for viral hepatitis.

Hepatitis A (HAV) 

  • There are very few acute HAV infections in BC. Cases relate to travel, contaminated food products or close contact with those who are infected. 
  • Self-limited disease not requiring ongoing serological follow-up. Post-vaccination testing is not recommended.

Hepatitis B (HBV) 

  • Although there is currently no cure, treatment is available for chronic HBV infection (see the Management of hepatitis B virus infection: 2018 Guidelines from the CASL and AMMI Canada).1 Patients with chronic HBV infection should be engaged into comprehensive specialist care. Consultation or referral is strongly recommended. 
  • In the absence of risk factors, routine HBV testing is not needed for those born in Canada. 
  • One-time HBV testing for immigrants from endemic areas is recommended (see Appendix 1). 
  • Vaccinate individuals susceptible to HBV infection when risk factors are present (see BCCDC Immunization Manual and Table 1). 
  • Individuals being treated for HCV who are getting worked-up for HIV pre-exposure prophylaxis (PrEP), are immunosuppressed, or who are about to start immunosuppressive therapy, should be evaluated for prior HBV infection to assess the potential risk for reactivation of HBV (see Table 2). 

Hepatitis C (HCV) 

  • Curative treatments (> 95 % effective) are available for those who have HCV infection (see the Management of chronic hepatitis C: 2018 guideline update from the CASL).2 
  • Patients known to have HCV infection, but who have not been previously treated and cured, should be recalled and engaged into care for HCV treatment. 
  • One-time HCV testing for the birth cohort 1945-1965 can be considered (see the Controversies in Care section). 
  • One-time HCV testing for immigrants from endemic areas is recommended (see Appendix 1). 
  • Annual HCV testing for susceptible individuals with ongoing risks for HCV infection or reinfection is indicated (see Table 1 below). 
  • Treatment providers must establish a respectful, trust-based relationship with all patients, and need to consider HCV treatment within a holistic wellness framework.2 
  • Where appropriate, many individuals with HCV infection could benefit from further supports and enrolment into comprehensive care (e.g., opioid agonist therapy, mental health and addiction services, alcohol reduction). 
  • As of 2018, an estimated 28,607 people in BC living with hepatitis C infection (diagnosed and undiagnosed) remain untreated.3

Etiology and Risk Factors

Table 1. Risk Factors, Transmission and Epidemiology for Viral Hepatitis Infection Listed by Etiology

Hepatitis A (HAV) 

Individuals vaccinated for hepatitis A, or who have resolved a natural infection, are protected from subsequent HAV infection.

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Risk Factors

  • Consumption of contaminated food (often raw or undercooked shellfish, raw fruits or vegetables) or water. 
  • Travel to HAV endemic regions. 
  • Contact (including sexual contact) with someone who has HAV infection. 
  • People who use Illicit drugs, who experience homelessness, or who are underhoused, and have gaps in access to care services. 
 

Transmission and Clinical

  • Fecal-oral through person-to-person contact, or exposure to contaminated food or water. 
  • Usually self-limited, but can lead to fulminant hepatitis. It does not lead to chronic disease. 
  • Hepatitis A vaccine is not part of routine immunization schedules, except when at higher risk of exposure (see the BCCDC Immunization Manual). 
 

Epidemiology

  • In 2018, there were 25 reported cases of hepatitis A in BC (0.5 per 100,000).4 
  • Most cases occur in unimmunized persons who have consumed contaminated food products, or who have travelled to endemic countries. 
  • In Canada, recent HAV outbreaks have disproportionately affected gbMSM.5 
  • Low and middle income countries (e.g., areas of  Africa and Asia) have higher rates due to poor sanitary conditions and hygienic practices.6,7 

 

Hepatitis B (HBV) 

Individuals vaccinated for HBV, or who have cleared a natural HBV infection, are protected from subsequent HBV infection. 

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Risk Factors

  • Offspring of HBsAg positive parent who is giving birth. 
  • Family history of HBV or hepatocellular carcinoma (HCC). 
  • Immunosuppression in people with chronic or resolved HBV infection (risk of HBV Reactivation). 
  • Sexual contact with someone who has HBV infection. 
  • Condomless sex with multiple partners. 
  • Born, lived in, or received healthcare in endemic regions (see Appendix 1). 
  • History of, or current illicit drug use (includes sharing equipment used for injection, smoking or snorting). 
  • History of, or current incarceration. 
  • Tattoos and body piercings where infection control practices may have been poor. 
  • HIV infection, particularly in gay, bisexual and men who have sex with men (gbMSM). 
  • Needle stick injury or occupational exposure from an infected person. 
  • Chronic renal failure receiving hemodialysis. 
  • Sharing of personal care items with someone who is infected. 
 

Transmission and Clinical

  • Exposure to blood and body fluids (See the BCCDC Hepatitis B Guidelines for further details). 
  • Efficiently transmitted (except in those who are vaccinated) perinatally, through parenteral contact with blood, and sexual contact with semen or vaginal fluids. 
  • Currently there is treatment available for those with chronic HBV, but there is no cure. 
  • Universal hepatitis B vaccine became available in BC for grade 6 students in 1992, and the infant program was introduced province-wide in 2001. 
  • Routine boosters in immunocompetent persons are generally not necessary. 
  • Prior documented anti-HBs ≥ 10 IU/L after receipt of a full hepatitis B vaccine series is protective, whether or not the anti-HBs is still currently detectable because immune memory persists.1,8 See the National Advisory Committee on Immunization (NACI) statement on hepatitis B vaccine. 
  • With chronic HBV infection, 20-25% can progress to cirrhosis and complications related to end-stage liver disease over decades.9–11 
 

Epidemiology

  • In 2018, there were 12 cases of acute HBV in BC (0.2 per 100,000).4 
  • Acute HBV infection is more likely to occur in persons who inject drugs or through sexual contact. 
  • In 2018, there were 1,035 newly reported chronic/undetermined HBV cases in BC (20.7 per 100,000).4 
  • The majority of chronic HBV infections occurred in persons emigrating from a country where hepatitis B is endemic (see Appendix 1).12 

 

Hepatitis C (HCV) 

Individuals who have cleared a prior HCV infection (whether spontaneously or through treatment) can get reinfected. 

Indigenous peoples continue to be impacted at a significantly higher rate than non-Indigenous people due to historic and present colonial policies and systems that disrupt connection to land, language, and culture, and diminish Indigenous sovereignty. Historical and present intergenerational trauma contributes to the social determinants of health in Indigenous peoples and impacts HCV acquisition risks. Treatment providers must establish respectful, trust-based relationships not only with Indigenous patients, but for all patients, and need to consider HCV treatment within a holistic wellness framework. 

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Risk Factors

  • Born between the years 1945 to 1965 – see Controversies in Care section. 
  • Received a blood transfusion, blood products or organ transplant before 1992 in Canada. 
  • Offspring of a parent giving birth who has HCV infection (approximately 6% risk of perinatal transmission, higher if the parent giving birth is co-infected with HIV).13,14 
  • Sexual transmission is rare, unless there is blood-to-blood contact with someone who has HCV infection or when engaging in condomless sex with multiple partners. 
  • HIV infection, particularly in gbMSM. 
  • Born, lived in or received healthcare in endemic regions (see Appendix 1). 
  • History of, or current illicit drug use (includes sharing equipment used for injection, smoking or snorting). 
  • History of, or current, incarceration. 
  • Tattoos and body piercings where infection control practices may have been poor. 
  • Chronic renal failure receiving hemodialysis. 
  • Sharing of personal care items with someone who is infected. 
  • Needle stick injury or occupational exposure from an infected person. 
 

Transmission and Clinical

  • Blood-to-blood contact. 
  • Percutaneous exposure (e.g., shared needles) is the most efficient means of transmission. 
  • Sexual transmission is uncommon in heterosexual populations.15,16 
  • In some populations (e.g., HIV positive gbMSM) sexual transmission has been reported, and is associated with mucosal trauma (e.g., fisting), presence of genital ulcerative disease and drug use (e.g., ChemSex).17,18 
  • About 75% of HCV infections become chronic and most infected people do not demonstrate symptoms. Over decades, 15-30% can progress to cirrhosis, liver failure, hepatocellular carcinoma, or require liver transplantation.19 
  • HCV antibodies are not protective and do not confirm active infection. 
  • An HCV RNA test is required to confirm active infection. 
  • There is no hepatitis C vaccine. 
  • Acute HCV is typically difficult to recognize because individuals are generally asymptomatic. 
 

Epidemiology

  • In 2018, there were 1,960 newly reported cases of hepatitis C in BC (39.3 per 100,000).4 
  • Around 85% of new infections in BC occur in people who inject drugs. 
  • Chronic infections are most common amongst the 1945-1965 birth cohort,20 who likely acquired the HCV infection through past injection drug use, receipt of contaminated blood products, or poor infection control practices.21 
  • From 1999-2004, the national HCV rate was 6.7 times higher among Indigenous (First Nations, Inuit, and Métis) peoples vs. non-Indigenous people (18.9/100,000 vs. 2.8/100,000).22 

 

Hepatitis D (HDV) 

Rare in BC. Hepatitis B vaccine protects against HDV.

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Risk Factors

  • Risk factors similar to HBV and HCV. 
 

Transmission and Clinical

  • HDV infection can only occur in patients who have HBV infection.
  • Transmission routes same as HBV. 
  • HDV testing is recommended for individuals with chronic HBV infection who have resided in endemic countries or who have a history of injection drug use, and are starting treatment for chronic HBV infection. 
  • Follow-up care for HBV/HDV co-infection is generally limited to specialists.
 

Epidemiology

  • 6 cases in 2018, 0.1/100,000.4 
  • Most countries do not report HDV. HDV endemic areas includes areas of Central and West Africa, Central and Northern Asia, Pacific Islands, Eastern Europe and South America.23,24

 

Hepatitis E (HEV) 

Rare in BC. 

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Risk Factors

  • Consumption of contaminated food or water in HEV endemic regions. 
  • Limited risk of acquisition in Canada.
 

Transmission and Clinical

  • HEV infection is a zoonosis (can be transmitted from animals to humans). 
  • Spread by contaminated water or food products in endemic countries. 
  • Not typically transmitted from one human to another. 
  • Presentation is similar to HAV, but can occasionally cause chronic infection in immunosuppressed people. 
  • Testing and follow-up care is usually limited to specialists. 
 

Epidemiology

  • 5 cases in 2018, 0.1/100,000,4 most travel related. 
  • Endemic countries includes some regions of Asia, Africa, Mexico, the Middle East and South America.25,26 

 

Other 

Viral hepatitis may also be caused by other viruses that are not addressed in this guideline, such as Epstein-Barr Virus (EBV, Mononucleosis), Cytomegalovirus (CMV) and Parvovirus B19 (fifth disease). 

Diagnosis

Applicable to all testing scenarios 

  • To avoid duplicate testing, consider the patient’s history, age and risk factors (see Table 1 above). Check for prior relevant vaccinations and test results before ordering tests for hepatitis. 
  • If HCV infection has been previously established (HCV RNA positive), the patient should be treated. 
  • If prior anti-HCV positive, order HCV RNA to confirm status. 
  • Offer hepatitis B vaccine as appropriate. If previously immunized and anti-HBs < 10 IU/L, refer to the BCCDC Hepatitis B Guidelines (Fig. 5-1; Table 4-2) for post-vaccination serology follow-up. 
  • HIV infection shares the same transmission pathways as HBV and HCV. Offer HIV testing as appropriate. See the HIV Testing Guidelines for BC. 

Table 2. Indications for HAV, HBV and HCV Testing19

Suspect acute hepatitis (jaundice and elevated ALT)

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Initial baseline testing*

  • Anti-HAV Total and anti-HAV IgM 
  • HBsAg, anti-HBs and anti-HBc Total 
  • Anti-HCV

Select the “Acute viral hepatitis undefined etiology” box on the Standard out-patient laboratory requisition.

 

Notes

  • Newly positive anti-HAV-IgM, HBsAg, anti-HBc IgM and anti-HCV results are reported to Public Health by testing laboratories. 
  • ALT is typically elevated, no need to routinely test for AST. 
  • Acute HBV infections in BC are rare. Most HBsAg positive results in BC reflect chronic infection. 
  • Anti-HBc IgM testing is not included in the testing protocol because the sensitivity of current HBsAg assays is such that there usually is no window between the disappearance of HBsAg and serologic evidence of resolved infection. 
  • Symptomatic acute HCV infection is uncommon. 

 

Newly suspected chronic viral hepatitis (risk factors, persistently elevated ALT, cirrhosis or liver cancer) 

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Initial baseline testing*

  • HBsAg, anti-HBc Total and anti-HBs 
  • Anti-HCV 

Select the “Chronic viral hepatitis undefined etiology” box on the Standard out-patient laboratory requisition.

 

Notes

  • Most chronic viral hepatitis infections are asymptomatic. 
  • ALT may or may not be elevated. No need to routinely test for AST. 
  • If HBsAg is positive for > 6 months, this confirms chronic HBV infection. 
  • The presence of anti-HCV can indicate current or past HCV infection. An HCV RNA is needed to confirm active HCV infection. Around 75% of initial HCV infections progress to chronic infection, usually within 6 months. 
  • If already diagnosed with viral hepatitis, see Appendix 7 – Recommended Test for Individuals Already Diagnosed with Viral Hepatitis. Consult with a specialist as needed for HCV infection. Consultation with, or referral to a specialist is strongly recommended for chronic HBV infection. 

 

Illicit drug use – current or ever (includes sharing drug use equipment used for injection, smoking or snorting)

Persons who are, or were incarcerated

Gay, bisexual and men who have sex with men (gbMSM)

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Initial baseline testing*

  • Anti-HCV 
  • If not HBV vaccinated: HBsAg, anti-HBs and anti-HBc Total

If not HBV vaccinated: select the “Chronic viral hepatitis undefined etiology” box on the Standard out-patient laboratory requisition.

  • If HBV vaccinated: no HBV testing (also see Immunosuppressed or undergoing immunosuppressive therapy) 

If HBV vaccinated: write anti-HCV in the “Diagnosis” and “OTHER TESTS” sections on the Standard out-patient laboratory requisition.

 

Notes

Follow-up testing 

  • Offer annual HCV testing for susceptible individuals with ongoing acquisition risk factors. 
  • Offer hepatitis A vaccine where appropriate. 
  • Offer hepatitis B vaccine if HBV serology negative. If previously immunized, refer to the BCCDC Hepatitis B Guidelines (Fig. 5-1) for post-vaccination serology follow-up. 
  • HIV infection shares the same transmission pathways as HBV and HCV. Offer HIV testing as appropriate. See the HIV Testing Guidelines for BC. 
  • Where appropriate, see the: 
    • BC Centre for Excellence in HIV/AIDS PrEP guidelines 
    • BC Guidelines Opioid Use Disorder guideline 

Note: Sexual transmission of HCV is uncommon in heterosexual populations.15,16 In some populations (e.g., HIV positive gbMSM) sexual transmission of HCV has been reported, and is associated with mucosal trauma (e.g., fisting), presence of genital ulcerative disease and drug use (e.g., ChemSex).17,18 

Unless risk factors are present, HCV testing is not recommended as part of routine STI screening. 

 

Birth Cohort (1945-1965) (See the Controversies in Care section)

Immigration from or residence in areas with high prevalence of viral hepatitis

Indigenous peoples (First Nations, Métis and Inuit)

Receipt of health care or tattoos, other injections where infection control practices may have been poor

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Initial baseline testing*

  • One-time offer, regardless of risk assessment: Anti-HCV 
  • If not HBV vaccinated: HBsAg, anti-HBs and anti-HBc Total 

If not HBV vaccinated: select the “Chronic viral hepatitis undefined etiology” box on the Standard out-patient laboratory requisition.

  • If HBV vaccinated: no HBV testing (also see Immunosuppressed or undergoing immunosuppressive therapy)

If HBV vaccinated: write anti-HCV in the “Diagnosis” and “OTHER TESTS” sections on the Standard out-patient laboratory requisition.

 

Notes

  • One-time HCV testing, no need to repeat testing unless ongoing risk factors are present.
  • Refer to Appendix 1.
  • Offer hepatitis A and/or B vaccine series as appropriate.

 

Pregnancy

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Initial baseline testing*

  • Universal HBsAg, syphilis and HIV screening 
  • If HCV risk factors: Anti-HCV 

Select the above tests on the Standard out-patient laboratory requisition for maternity care under “0-14 WEEKS: RECOMMENDED TESTS”. 

 

Notes

 

Immunosuppressed or undergoing immunosuppressive therapy

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Initial baseline testing*

  • HBsAg, anti-HBs and anti-HBc Total 

Write the above tests in the “Diagnosis” and “OTHER TESTS” sections on the Standard out-patient laboratory requisition. 

 

Notes

  • Reactivation refers to an increase in HBV DNA replication in persons who are actively infected or who have a resolved HBV infection. Can occur after initiating immunosuppressive therapy or HCV DAA treatment.29 Reactivation can cause ALT flares, and in some cases, fulminant liver failure and death.1 
  • Offer hepatitis B vaccine where appropriate. 
  • See Appendix 8 – List of Immune Compromising Treatments. 

 

Persons living with viral hepatitis, to identify coinfections and those who can benefit from vaccinations

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Initial baseline testing*

  • If HBV infection: anti-HAV Total and Anti-HCV 

Select the “Hepatitis A (Anti-HAV total)” box
Write anti-HCV in the “Diagnosis” and “OTHER TESTS” sections on the Standard out-patient laboratory requisition.

  • If HCV infection: anti-HAV total, and HBsAg, anti-HBs and anti-HBc Total 

Select the “Hepatitis A (Anti-HAV total)” box
Write the other above tests in the “Diagnosis” and “OTHER TESTS” sections on the Standard out-patient laboratory requisition.  

 

Notes

  • If hepatitis B infection, screen for hepatitis C. Screen for hepatitis A to identify those who should be vaccinated. 
  • If anti-HCV positive, screen for hepatitis A and B to identify those who should be vaccinated. All anti-HCV positive specimens are automatically screened for hepatitis A and B immunity when testing is performed at the BCCDC Public Health Laboratory (BCCDC PHL), and results are forwarded to Public Health and the ordering provider. 
  • See Appendix 7. 

 

Household and sexual contacts with someone with viral hepatitis

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Initial baseline testing*

  • If the case has HAV infection, no serology is indicated for the contact. 
  • If the case has HBV infection, order HBsAg, anti-HBs and anti-HBc Total, regardless of the contact’s immunization status. 
  • If the case has HCV infection, order anti-HCV (if previously anti-HCV positive, order HCV RNA) for the contact. 

Write the above tests in the “Diagnosis” and “OTHER TESTS” sections on the Standard out-patient laboratory requisition.

 

Notes

  • Connect with Public Health, and vaccinate household contacts and the index case for HAV and HBV as appropriate.

 

Exposed to blood or body fluids: occupational needlestick or sexual assault

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Initial baseline testing*

 

* See Appendix 2 for further information on Hepatitis Laboratory Tests and Appendix 3 for Hepatitis B Serology Results and Interpretation.
 

Controversies in Care: Birth Cohort Hepatitis C Testing 

Based on an increased hepatitis C prevalence in certain birth cohorts, a one-time offer of HCV testing has been recommended for those born between 1945-1965. However, there is a lack of agreement with respect to the age-range cut-offs and value of onetime age cohort testing: 

  • In 2020, the US Preventive Services Task Force recommended HCV screening for all individuals 18 to 79 years of age, based upon SVR rates of greater than 95% with new all-oral DAA treatments and associated improved clinical outcomes.20 
  • In 2020, the CDC recommended HCV screening for all adults ≥ 18 years of age, except where HCV prevalence < 0.1%. It was expected that there would be very few settings where HCV prevalence would drop this low in the US. 
  • In 2017, the Canadian Task Force on Preventive Health Care recommended against birth cohort testing.30 However this recommendation was made prior to the wide availability of effective HCV treatments when hepatitis C was not considered routinely curable for everyone, so identification of cases was of limited value. With the dramatic improvements in curability and availability of treatment coverage regardless of fibrosis staging, birth cohort testing is now recommended. 
  • In 2018, the Canadian Association for the Study of the Liver (CASL) recommended birth cohort testing for those born between 1945-1975 based on the estimated prevalence of hepatitis C in Canada.2 

Additionally, concerns had been raised by several B.C. stakeholders that systemic screening of the 1945-1965 birth cohort, which represents 1.3 million people in B.C., may not provide sufficient health care value considering the cumulative costs of testing and the lack of infrastructure to prevent unnecessary repeat testing. It is anticipated that further BC prevalence data and technologies to promote appropriate testing will be available in the future, at which point these recommendations can be re-examined. 

While the BCCDC favours CASL’s 1945-1975 screening recommendations, it is acknowledged that this is based on a relatively low quality of evidence. However, offering one-time HCV testing to this broader age cohort and curing HCV infection in this age group would further prevent both progressive liver disease and reduce transmission of HCV to others. 

Based on BC’s Lifetime Prevention Schedule assessment (2020) and local epidemiology, the best evidence supports the recommendation of the 2013 US Preventive Services Task Force.31 The BCCDC and the GPAC hepatitis working group currently accept the recommendation for a one-time offer of HCV testing for the 1945-1965 birth cohort, regardless of risk factors. 

 

Resources

Appendices 

Associated Documents 

Practitioner Resources 

Patient and Caregiver Resources 

References 

  1. Coffin CS, Fung SK, Alvarez F, Cooper CL, Doucette KE, Fournier C, et al. Management of Hepatitis B Virus Infection: 2018 Guidelines from the Canadian Association for the Study of Liver Disease and Association of Medical Microbiology and Infectious Disease Canada. Can Liver J [Internet]. 2018 Dec 1 [cited 2019 Apr 18]; Available from: https://canlivj.utpjournals.press/doi/abs/10.3138/canlivj.2018-0008 
  2. Shah H, Bilodeau M, Burak KW, Cooper C, Klein M, Ramji A, et al. The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver. CMAJ. 2018 Jun 4;190(22):E677–87. 
  3. Bartlett SR, Yu A, Chapinal N, Rossi C, Butt Z, Wong S, et al. The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of Direct Acting Antivirals. Liver Int. doi: 10.1111/liv.14227. 
  4. Reportable Diseases Data Dashboard [Internet]. [cited 2019 Apr 24]. Available from: http://www.bccdc.ca/health-professionals/data-reports/reportable-diseases-data-dashboard 
  5. Sachdeva H, Benusic M, Ota S, Stuart R, Maclachlan J, Dubey V, Andonov A. Community outbreak of hepatitis A disproportionately affecting men who have sex with men in Toronto, Canada, January 2017–November 2018. Can Commun Rep. 2019;45(10):262–8. 
  6. Centers for Disease Control and Prevention. 2020 Yellow Book Table of Contents [Internet]. [cited 2019 Jul 25]. Available from: https://wwwnc.cdc.gov/travel/yellowbook/2020/table-of-contents 
  7. Hepatitis A [Internet]. [cited 2019 Jul 25]. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-a 
  8. Public Health Agency of Canada. Canadian Immunization Guide: Part 4 - Active Vaccines [Internet]. 2007 [cited 2019 Apr 3]. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines.html?page=7#boost 
  9. Beasley RP. Hepatitis B virus. The major etiology of hepatocellular carcinoma. Cancer. 1988;61(10):1942–56. 
  10. Lai CL, Ratziu V, Yuen M-F, Poynard T. Viral hepatitis B. The Lancet. 2003 Dec 20;362(9401):2089–94. 
  11. McMahon BJ. Natural History of Chronic Hepatitis B. Clin Liver Dis. 2010 Aug 1;14(3):381–96. 
  12. Binka M, Butt ZA, Wong S, Chong M, Buxton JA, Chapinal N, et al. Differing profiles of people diagnosed with acute and chronic hepatitis B virus infection in British Columbia, Canada. World J Gastroenterol. 2018 Mar 21;24(11):1216–27. 
  13. Granovsky MO, Minkoff HL, Tess BH, Waters D, Hatzakis A, Devoid DE, et al. Hepatitis C virus infection in the mothers and infants cohort study. Pediatrics. 1998 Aug;102(2 Pt 1):355–9. 
  14. Zanetti AR, Tanzi E, Romanò L, Zuin G, Minola E, Vecchi L, et al. A prospective study on mother-to-infant transmission of hepatitis C virus. Intervirology. 1998;41(4–5):208–12. 
  15. Vandelli C, Renzo F, Romanò L, Tisminetzky S, De Palma M, Stroffolini T, et al. Lack of evidence of sexual transmission of hepatitis C among monogamous couples: results of a 10-year prospective follow-up study. Am J Gastroenterol. 2004 May;99(5):855–9. 
  16. Terrault NA, Dodge JL, Murphy EL, Tavis JE, Kiss A, Levin TR, et al. Sexual Transmission of Hepatitis C Virus Among Monogamous Heterosexual Couples: The HCV Partners Study. Hepatol Baltim Md. 2013 Mar;57(3):881–9. 
  17. Tohme RA, Holmberg SD. Is sexual contact a major mode of hepatitis C virus transmission? Hepatology. 2010;52(4):1497–505. 
  18. Terrault NA. Sexual activity as a risk factor for hepatitis C. Hepatology. 2002;36(5B):s99–105. 
  19. Krajden M, Cook D, Janjua NZ. Contextualizing Canada’s hepatitis C virus epidemic. Can Liver J [Internet]. 2018 Dec 1 [cited 2019 Apr 3]; Available from: https://canlivj.utpjournals.press/doi/abs/10.3138/canlivj.2018-0011 
  20. Moyer VA, U.S. Preventive Services Task Force. Screening for hepatitis C virus infection in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013 Sep 3;159(5):349–57. 
  21. Janjua NZ, Yu A, Kuo M, Alvarez M, Cook D, Wong J, et al. Twin epidemics of new and prevalent hepatitis C infections in Canada: BC Hepatitis Testers Cohort. BMC Infect Dis [Internet]. 2016 Jul 19 [cited 2019 Apr 3];16. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4952323/ 
  22. Wu H-X, Wu J, Wong T, Andonov A, Li Q, Dinner K, et al. Incidence and risk factors for newly acquired hepatitis C virus infection among Aboriginal versus non-Aboriginal Canadians in six regions, 1999–2004. Eur J Clin Microbiol Infect Dis. 2007 Mar 1;26(3):167–74. 
  23. Hepatitis D [Internet]. [cited 2019 Jul 25]. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-d 
  24. Rizzetto M. Hepatitis D Virus: Introduction and Epidemiology. Cold Spring Harb Perspect Med [Internet]. 2015 Jul [cited 2019 Jul 25];5(7). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4484953/ 
  25. Khuroo MS, Khuroo MS, Khuroo NS. Hepatitis E: Discovery, global impact, control and cure. World J Gastroenterol. 2016 Aug 21;22(31):7030–45. 
  26. Wedemeyer H, Pischke S, Manns MP. Pathogenesis and Treatment of Hepatitis E Virus Infection. Gastroenterology. 2012 May 1;142(6):1388-1397.e1. 
  27. Castillo E, Murphy K, Schalkwyk J van. No. 342-Hepatitis B and Pregnancy. J Obstet Gynaecol Can. 2017 Mar 1;39(3):181–90. 
  28. Boucher M, Gruslin A. No. 96-The Reproductive Care of Women Living With Hepatitis C Infection. J Obstet Gynaecol Can. 2017 Jul 1;39(7):e1–25. 
  29. Shah H, Bilodeau M, Burak KW, Cooper C, Klein M, Ramji A, et al. Appendix to: The management of chronic hepatitis C: 2018 guideline update from The Canadian Association for the Study of the Liver. CMAJ [Internet]. 2019 Jul 24 [cited 2019 Jul 25];190(22E677-E687). Available from: http://www.cmaj.ca/content/suppl/2018/05/29/190.22.E677.DC1
  30. Care CTF on PH. Recommendations on hepatitis C screening for adults. CMAJ. 2017 Apr 24;189(16):E594–604.
  31. Ministry of Health. Lifetime Prevention Schedule - Province of British Columbia [Internet]. [cited 2019 May 13]. Available from: https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/health-priorities/lifetime-prevention 

Abbreviations

AFP

ALT

AMMI
 

AST

BCCDC

CASL
 

CMV 

DAA

EBV

HAV

HBIg

HBV

HCC

HCV

HDV

HEV

HIV

INR

PHAC

PHL

SVR

TNF

Alpha-fetoprotein 

Alanine transaminase 

Association of Medical Microbiology and Infectious Disease 

Asparate aminotransferase 

BC Centre for Disease Control 

Canadian Association for the Study of the Liver 

Cytomegalovirus 

Direct-acting antiviral agent 

Epstein-Barr virus 

Hepatitis A virus 

Hepatitis B immune globulin 

Hepatitis B virus

Hepatocellular carcinoma

Hepatitis C virus

Hepatitis D virus

Hepatitis E virus

Human immunodeficiency virus

International normalized ratio

Public Health Agency of Canada

Public Health Laboratory

Sustained virologic response 

Tumour Necrosis Factor 

 

This guideline is based on scientific evidence current as of the effective date.

The guideline was developed by the Guidelines and Protocols Advisory Committee in collaboration with BC’s Agency for Pathology and Laboratory Medicine and adopted by the Medical Services Commission.

For more information about how BC Guidelines are developed, refer to the GPAC Handbook available at BCGuidelines.ca: GPAC Handbook.

THE GUIDELINES AND PROTOCOLS ADVISORY COMMITTEE

The principles of the Guidelines and Protocols Advisory Committee are to: 

  • encourage appropriate responses to common medical situations 
  • recommend actions that are sufficient and efficient, neither excessive nor deficient 
  • permit exceptions when justified by clinical circumstances 

Contact Information: 

Guidelines and Protocols Advisory Committee 
PO Box 9642 STN PROV GOVT 
Victoria BC V8W 9P1 

Email: hlth.guidelines@gov.bc.ca 

Website: www.BCGuidelines.ca 

Disclaimer 

The Clinical Practice Guidelines (the “Guidelines”) have been developed by the Guidelines and Protocols Advisory Committee on behalf of the Medical Services Commission. The Guidelines are intended to give an understanding of a clinical problem, and outline one or more preferred approaches to the investigation and management of the problem. The Guidelines are not intended as a substitute for the advice or professional judgment of a health care professional, nor are they intended to be the only approach to the management of clinical problem. We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions. If you need medical advice, please contact a health care professional.

 

Keep current on BC Guidelines by signing up for our email notification service.

Interested in contributing to BC Guidelines?

BC Guidelines is always looking for knowledgeable practitioners to chair and serve on our working groups.

Email BC Guidelines at hlth.guidelines@gov.bc.ca and ask for an application package today.

 

Questions, comments or suggestions? We would love to hear from you.

Note: We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions. If you need medical advice, please contact a health care professional.