Health officials working to control hepatitis A outbreak in province

Public health officials are battling a hepatitis A outbreak in Manitoba not seen in decades.

The virus has killed three people and sent 133 to hospital.

“It’s a really difficult virus to control,” Dr. Carol Kurbis said Monday. “You could be spreading the virus before you even know you’re sick.”

Kurbis has served as a provincial medical officer of health in communicable disease control since 2019.

“We are concerned at the number of really severe outcomes that we are seeing,” she said Monday.

Hepatitis A is an acute liver infection caused by the hepatitis A virus. An outbreak was declared more than a year ago, when it initially affected several communities in northern Manitoba. The virus has since spread to more communities, and the number of cases has climbed to 601, as of April 26.

“We haven’t had an outbreak in Manitoba for many, many years, so this is new,” Kurbis said, adding people who typically get the hepatitis A vaccine do so prior to travel abroad.

“This isn’t a virus we routinely immunize for.”

The province is offering free immunization to those most at risk: people in the Island Lake area (Garden Hill, St. Theresa Point, Wasagamack and Red Sucker Lake First Nations), Peguis First Nation, War Lake First Nation (also known as Ilford) and Bloodvein River First Nation.

Anyone travelling to or working in those communities, or hosted household visitors from any of them is urged to get the free vaccine.

Others at risk and eligible include people experiencing homelessness, who use drugs and those with certain high-risk medical conditions. Kurbis said a lack of infrastructure and access to clean water and adequate sanitation exacerbates the spread of hepatitis A. It can spread through contaminated water, food and close contact with someone who has the infection. Those at highest risk include household members, people who spend a lot of time together or share food or utensils.

“If people don’t have access to adequate housing with basic infrastructure in place, we’re going to see ongoing outbreaks and people at risk,” the doctor said. “Part of our jobs is to raise awareness and advocate for everyone to have access to those standards that we have in place for clean drinking water and adequate sewage.”

Indigenous Services Canada, which is responsible for funding First Nations infrastructure, did not respond to a request for comment by deadline.

The outbreak in Manitoba could take months to get under control using immunization campaigns and urging people to wash their hands, Kurbis said.

Public health is identifying communities and those most at risk who may not know if they’ve got hepatitis A and are infectious.

“The symptoms take anywhere from two weeks to up to 50 days after exposure to occur,” Kurbis said. “That’s a really long time to remember where you might have been exposed to the infection.”

Once someone is infected, they’re infectious for two weeks before their symptoms develop and one week after jaundice develops.

“On top of that, there are a number of people who won’t develop any symptoms,” Kurbis said. “Children are known to have more milder cases or to be asymptomatic, but they can still spread the infection to other people.”

Although hepatitis A can be spread through the blood, that’s not how most of the infections have happened in Manitoba, she said. Most involve contact with those known to be sick or infected.

The Winnipeg Regional Health Authority has been trying to engage with community organizations and doing outreach to try to reach at-risk populations and offer them the vaccine, Kurbis said.

“Everyone should be aware of the issue,” she said. “Everyone should be conscious about washing their hands after using the washroom and before they eat. If they had contact with someone who they think had hepatitis A, they should connect with their health-care provider.”

She said the vaccine eligibility criteria may change to include more at-risk populations.

“It’s definitely an evolving situation.” she said.

carol.sanders@freepress.mb.ca