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HomeJournal of Viral Hepatitisindex/list_12208_1The Impact of the First, Second and Third Waves of Covid-19 on...

The Impact of the First, Second and Third Waves of Covid-19 on Hepatitis B and C Testing in Ontario, Canada

Abstract and Introduction


The COVID-19 pandemic interrupted routine healthcare services. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are often asymptomatic, and therefore, screening and on/post-treatment monitoring are required. Our aim was to determine the effect of the first, second and third waves of the pandemic on HBV and HCV testing in Ontario, Canada. We extracted data from Public Health Ontario for HBV and HCV specimens from 1 January 2019 to 31 May 2021. Testing volumes were evaluated and stratified by age, sex and region. Changes in testing volumes were analysed by per cent and absolute change. Testing volumes decreased in April 2020 with the first wave of the pandemic and recovered to 72%–75% of prepandemic volumes by the end of the first wave. HBsAg testing decreased by 33%, 18% and 15%, and HBV DNA testing decreased by 37%, 27% and 20%, in each consecutive wave. Anti-HCV testing decreased by 35%, 21% and 19%, and HCV RNA testing decreased by 44%, 30% and 36% in each consecutive wave. These trends were consistent by age, region and sex. Prenatal HBV testing volumes were stable. In conclusion, significant decreases in HBV and HCV testing occurred during the first three waves of the pandemic and have not recovered. In addition to direct consequences on viral hepatitis elimination efforts, these data provide insight into the impacts of the pandemic on chronic disease screening and management. Strategies to make up for missed testing will be critical to avoid additional consequences of COVID-19 long after the pandemic has resolved.


The World Health Organization (WHO) has called for the elimination of viral hepatitis as a public health threat by 2030, a goal that Canada has committed to achieving.[1] Despite the multiple points in the cascade of care for both hepatitis B virus (HBV) and hepatitis C virus (HCV) where patients are lost, Canada was nearly on track to meet these targets prior to the COVID-19 pandemic.[2] The COVID-19 pandemic has had a major impact on healthcare utilization, potentially leading to underdiagnosis and delayed access to monitoring and treatment for HBV and HCV.

We sought to determine the extent of the impact of the COVID-19 pandemic on HBV and HCV testing by comparing testing volumes in 2019 to those in 2020 and 2021. We also evaluated whether the impact on testing volumes varied by age, sex or region, and the indication for testing for HBV DNA and HCV RNA.

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