Hepatitis C

Hepatitis C, a lesser-heard variant of the Hepatitis virus umbrella, has been making the waves in the medical circle here. Less than 1% of the Singaporean population is affected by it, in contrast to Hepatitis B, which affects 1 in 35 Singaporeans. To date, 25 patients admitted to SGH between April and June had been diagnosed with the same family of Hepatitis C virus. Eight patients have died, with five deaths linked to the virus.

Hepatitis C is a virus that causes liver inflammation, which can lead to chronic hepatitis, cirrhosis and liver cancer. It is primarily spread through contact with the blood of an infected person. In this saga, it was purportedly spread through multiple-use medical vials, though allegations have not been confirmed. Sufferers of Hepatitis C are vulnerable to other strains of the hepatitis virus like Hepatitis A and B. There is no vaccine for Hepatitis C.

Though the outbreak happened earlier this year in April, SGH told MOH of the news in end-August, and MOH only released news of the outbreak in October. The information lag does raise eyebrows on their response to management of the outbreak. What exactly was done that resulted in the spread? Who are the persons accountable for the way medication is dispensed (multiple-use vials)? Why was news of the causalities held back so long? The consequences could have been mitigated if the situation was dealt with earlier.  Important questions were not addressed clearly. The authorities responded with a string of neutral statements, reiterating their stance on taking the situation seriously through thorough investigative work.

In the aftermath of the outbreak, some measures have been put into place.

An independent review committee has been set up by the government to look into the findings of its investigations but concrete conclusions or statements have not been made known to the public. International experts were too roped in to provide analyses and interpretation of the findings. One of the recommendations include extending the screening to verify if precautionary measures put in place in the wake of the outbreak had been effective. The hospital had originally screened only patients who stayed in the renal wards between January to June. Thus, SGH took further action to screen more patients, 849 of them, for the Hepatitis C virus, of which 777 tested negative and 3 positive, with the remaining 69 test results pending. SGH staff were also screened for the virus, and were given the all-clear.

Kidney dialysis centers across the country were reminded to use dedicated dialysis machines and stations for those with Hepatitis C. Dialysers and bloodlines (dialysis tubes) are not be shared among renal patients and can only be used once and discarded. Some dialysis centres like the National Kidney Foundation (NKF) have also separated Hepatitis B and C patients at separate centres to prevent cross-contamination.

Hepatitis C can be cured with early detection and appropriate treatment. However for 10% of those infected, the virus continues to live in the blood, which could lead to problems like liver cancer or cirrhosis. Hepatitis C if left uncured, is reminiscent of a life sentence, where patients are bound to a lifetime of symptom-regulatory medication to keep afloat relapses.