SINGAPORE: The Singapore General Hospital on Tuesday (Oct 6) said it is investigating a cluster of Hepatitis C infections in its renal ward. In total, 22 patients who were hospitalised between April and June this year were infected and SGH said it cannot rule out that Hepatitis C could be a contributing factor in the deaths of four of the people in the group. One recent death is under review.
Here are answers to some frequently asked questions on the disease, based on information from SingHealth which runs SGH and the World Health Organisation.
1. What is Hepatitis C?
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). It can cause both acute and chronic and chronic Hepatitis infection, ranging from mild illness lasting a few weeks to a serious, lifelong illness. The long-term effect of HCV infection is cirrhosis (scarring of the liver), liver failure or liver cancer, if the patient is left untreated for a prolonged period of time, according to SingHealth. However, it adds that HCV is very rarely associated with acutely life-threatening disease.
“Hepatitis C is a slow progressive disease,” said Dr Desmond Wai, a consultant gastroenterologist and hepatologist at the Mount Elizabeth Novena Hospital. “It takes about 20, 30 years to cause severe liver damage.
“Even in immunosuppressed people, like organ transplant recipients or people on dialysis, it takes about 10, 20 years to have very bad liver damage. The only exception is an organ transplant recipient whereby they’re on immunal suppression so their immune system is down and the Hepatitis C may progress very rapidly. But it’s a very rare syndrome. We call it fibrosing cholestatic hepatitis c. I’ve seen it before but they’re very, very rare.
“In those patients with fibrosing cholestatic hepatitis c, they can die within two to four weeks but that’s very, very rare.”
2. How is HCV transmitted?
HCV infection is not air-borne, unlike Severe Acute Respiratory System (SARS). HCV is largely transmitted by blood and blood products. HCV infections could happen via the following means:
- Intravenous drug abuse
- Receipt of donated blood, blood produces and organs from a HCV carrier
- Accidental needlestick injury in healthcare setting
- Haemodialysis in patients with kidney failure
- From HCV-infected mother to baby during childbirth
- Sex with an HCV-infected person
- Other healthcare procedures that involves invasive procedures, such as injections, according to Centers for Disease Control and Prevention.
While it is a bloodborne virus, Dr Wai said people are not likely to get Hepatitis C through a blood transmission, as Singapore started screening blood donors for Hepatitis C from 1995.
“Any blood donor that goes to the Singapore blood bank to donate blood – they’re asked a whole list of questions,” he said. “They would have screened out any risk factor for Hepatitis B, C, HIV etc.
“The blood bank would then test them for Hepatitis C and that is very, very accurate. So the chances of someone getting Hepatitis C from a blood transfusion in Singapore is almost zero, I would say.”
3. How was the cluster of Hepatitis C infection detected?
In early June 2015, doctors in a renal ward in SGH noted an increased frequency of newly-diagnosed Hepatitis C infections in the ward. There was seven cases found within four weeks. This triggered heightened checks for HCV infection in patients in the ward who had abnormal liver function test results.
4. Who are the patients affected?
The 22 infected patients stayed in the newly-renovated Ward 67 with overlapping periods of stay between April and June while the original renal ward, Ward 64A was being renovated. All the patients had renal disease and a majority had history of end-stage renal failure and/or renal transplant.
5. Who else is being screened?
SGH is proactively contacting all patients who were admitted to Wards 64A and 67 from January to June for screening. Care teams at SGH such as doctors and nurses are being screened as well.
Patients who are uncertain if they are affected can call 65 6321-3356, or leave a message via SMS to 65 8799-2736. They can also email email@example.com with their name and IC number.
6. Is the ward contaminated? Any plan to “clean up” the ward?
As HCV infection is not air-borne like SARS, “cleaning up” the facility is irrelevant, said SingHealth. Nonetheless, SGH has taken steps to tighten its infection control practice by conducting an additional round of environmental cleaning.
7. How sure is SGH that HCV will not affect patients in other wards, as well as their families?
HCV is spread mainly through blood, unlike SARS which is air-borne. In the absence of venous access such as via injections and unprotected open wounds, it should be safe, especially for the patient’s family, said SingHealth.
For patients, strict sterile practices, with no sharing of needles will prevent the spread of HCV. “Such standards are strictly observed,” said SGH. “Nonetheless, we are reviewing all our processes and implementing more stringent measures.”
8. What are the symptoms for HCV?
According to the World Health Organisation, 80 per cent of people do not exhibit symptoms after they are infected. However those who do show symptoms could show signs of fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain and jaundice (yellowing of skin and the whites of the eyes).
9. What is the incubation period for HCV infection?
In people who do develop symptoms for Hepatitis C, the average time period from exposure to symptom onset is 2 to 24 weeks.
Some patients may be asymptomatic (i.e. may not show signs of disease) for years.
10. What is the treatment for HCV infection?
There is no vaccine for Hepatitis C, but treatment is available to prevent the onset of complications, such as cirrhosis. Complications such as cirrhosis typically take years to occur if left untreated for a prolonged period.
Antiviral medicines can cure up to 90 per cent of people infected with Hepatitis C.
The treatment for HCV infection varies depending on the patient’s condition and clinical indication. Hence, the cost of treatment varies and ranges from about S$5,000 to S$90,000 per course, SingHealth said.