September 25, 2009: 1 in 10 people in Atlantic Canada have liver disease but even their doctors may not know it

September 25, 2009 – A man shows up at his doctor’s office complaining of being tired, nauseous and achy. The doctor suspects he has the flu and prescribes bed rest, fluids, some over-the-counter pain relievers and sends him home. The symptoms ease — but 5 years later, the same man ends up in the emergency room and is diagnosed with advanced liver cancer from hemochromatosis (a common genetic liver disease that impacts those of Celtic origin resulting in iron overload of the liver). The sad fact is if the doctor had done some additional testing, this liver disease might have been diagnosed in time to prevent these severe consequences. This is exactly the type of scenario that the Canadian Liver Foundation, Dalhousie University Continuing Medical Education and the University of Manitoba Section of Hepatology want to avoid, which is why on September 25, 2009, they will be giving Atlantic Canada’s primary care physicians, specialists, residents and nurses a ‘crash course’ in liver healthcare. Led by some of Canada’s leading liver specialists (hepatologists), the Primary Care Hepatology one-day Continuing Medical Education (CME) Program will equip these front-line health professionals with the knowledge and tools to identify patients within their practice that may be at risk for, or suffering from, liver disease. “Since the liver is a very resilient and long-suffering organ, it won’t necessarily trigger any obvious symptoms, even when it’s under assault,” says hepatologist Dr. Kevork Peltekian, co-chair of the Primary Care Hepatology program and an Associate Professor at Dalhousie University. “As a result, primary care physicians have to be able to assess a patient’s risk factors, consider all the possible causes of their symptoms, test accordingly and interpret the results. Unfortunately, time pressures and lack of liver health training can leave these doctors ill-prepared to identify liver issues at the earliest stages. Through this CME program, we want to show them how to screen, diagnose, and where necessary refer, treat or manage, various liver diseases for the benefit of their patients and ultimately for the benefit of the communities in Atlantic Canada.” Fatty liver disease, one of the most prevalent forms of liver disease in Canada today, is a prime example of a condition that can often be reversed if it is identified before permanent damage is done to the liver. Fatty liver disease, or non-alcoholic steatohepatitis (NASH), is caused by fat build-up in the liver which results in inflammation and can eventually lead to scarring (cirrhosis). As fatty liver disease is most often related to obesity, the condition can be treated through nutrition and exercise. “The public still sees liver disease as being caused solely by alcohol or drug abuse,” says Gary Fagan, President of the Canadian Liver Foundation and fellow co-chair of the Primary Care Hepatology program. “And unfortunately, health care professionals are not immune to these prevailing stereotypes. As a result, physicians may not perceive their patients as being at risk and may not recognize the signs and symptoms of liver disease if and when they present themselves. If liver disease is overlooked or misdiagnosed at an early stage, the consequences can be severe.” Primary Care Hepatology is part of the Canadian Liver Foundation’s ongoing efforts to promote professional education as a critical step in reducing the incidence of preventable and/or treatable forms of liver disease. Together, the Foundation, Dalhousie University and the University of Manitoba Section of Hepatology want to provide primary care physicians with timely and relevant liver health information covering topics such as hepatitis, fatty liver disease, immunization and hepatoxicity and that can be applied within an office-based practice. The goal of the CME program is to equip physicians with the knowledge they need to recognize the signs the symptoms of liver disease, to respond to the situation (by ordering tests, interpreting results) and to resolve the issue (through prevention, treatment, continued monitoring or referral). Primary Care Hepatology has been made possible by the generous support of Schering-Plough Canada Inc., GlaxoSmithKline Inc., Gilead Sciences Canada Inc., Novartis Pharmaceuticals Canada Inc., the Canadian Institutes of Health Research, Bristol-Myers Squibb Canada Inc., Cangene Corporation and Hoffmann-La Roche Limited. Primary Care Hepatology takes place from 7:00am to 4:00pm, Friday, September 25, 2009 in the Admiral’s Room at the Four Points by Sheraton Halifax Hotel. For more information on how to register, the program agenda, speakers and interview opportunities, please contact Melanie Kearns at 1-800-563-5483 ext. 4923 or email mkearns@liver.ca. Canadian Liver Foundation Founded in 1969, the Canadian Liver Foundation was the first organization in the world devoted to providing support for research and education into the causes, diagnoses, prevention and treatment of liver disease. In this tradition, the CLF is committed to increasing public awareness of the importance of liver health, providing funds for much-needed liver research, and creating opportunities to advance the healthcare response by providing liver health education and support at various levels within the medical community. University of Manitoba Section of Hepatology As the first and only Section of Hepatology in Canada, the University of Manitoba (UM) is well poised to help deliver up-to-date and relevant liver health information to primary healthcare physicians and other allied healthcare providers. The UM Section of Hepatology is a multi-disciplinary section composed of three full-time hepatologists, an epidemiologist/statistician and scientists in many fields (such as immunology and molecular biology). Dalhousie University Continuing Medical Education Dalhousie Faculty of Medicine has been meeting the continuing medical education needs of physicians in the Maritimes for over 75 years, and the CME unit was formally established in 1957. Their mission is to enhance the provision of quality health care through research and the facilitation of life long learning. Canadian Liver Foundation Media Contact: Melanie Kearns mkearns@liver.ca  Toll-free: 1-800-563-5483 ext: 4923

September 23, 2009: A career fair for the liver

Local specialist joins with University of Manitoba and Canadian Liver Foundation to recruit young doctors from across the country to become tomorrow’s liver specialists September 23, 2009 – Young doctors finishing their internal medicine education have their pick of organs and bodily systems to specialize in – some more glamorous than others. On September 23 and 24, some of Canada’s leading liver experts will gather in Halifax to give a talented crop of medical residents their best sales pitch to convince them to choose the liver as their area of specialty. Created in 2006 in response to the critical shortage of liver specialists in Canada, the ‘Discover the World of Hepatology’ program has become a much-anticipated annual event within the medical schools and has helped increase interest in a career in clinical liver healthcare or research. Dr. Gerald Minuk, head of the Section of Hepatology at the University of Manitoba and one of the founders of the Discover the World of Hepatology program, was the first practicing hepatologist in Canada 27 years ago. “I chose hepatology almost three decades ago because it was a rapidly emerging field of medicine, “ says Dr. Minuk, “so little was known about the liver at that time and many treatments for conditions such as hepatitis B and C, had yet to be identified. We’ve come a long way since but there are still too few cures and much that remains to be discovered. That’s why I’m still here.“ Despite the fact that fatty liver disease, hepatitis B and C and liver cancer are being diagnosed in increasing numbers, Dr. Minuk and his colleagues are a limited resource. And no one knows this better than fellow Discover of the World of Hepatology faculty member, Dr. Kevork Peltekian who spent years as Atlantic Canada’s only practicing hepatologist. “According to my research, there is currently the equivalent of one full-time practicing hepatologist for every 65,000 people with liver disease,” says Dr. Peltekian. “And with some of my colleagues looking toward retirement in the next five to 10 years and with gastroenterologists seeing fewer liver patients due to increasing demands for scoping and other procedures, we are in desperate need of new doctors to help fill the gap today and in the future.” Gary Fagan, President of the Canadian Liver Foundation and co-chair of the Discover the World of Hepatology program, is worried about the consequences of the shortage of talent in the liver health field. “We are already seeing long waiting lists, delayed diagnosis which can limit treatment options, increased acute care costs and less research to find better treatments and cures,” says Mr. Fagan. “1 in 10 Canadians – that’s over 3 million people – has some form of liver or biliary tract disease but many have yet to be diagnosed. The need for hepatologists is only going to increase. Now is the time to try and do something about it.” The University of Manitoba Section of Hepatology partnered with the Canadian Liver Foundation to establish the first dedicated ‘career-oriented’ hepatology program for medical residents as an innovative approach to the problem. The program soon became so popular that medical schools were forced to hold a lottery for the two available spots allocated to each institution. According to a survey of past participants, 14 doctors have decided upon or are considering a career in hepatology after attending the program. One of those doctors is Edward Tam, a first year fellow at the University of Manitoba who is currently doing an elective in liver transplantation at Dalhousie University. Dr. Tam attended Discover the World of Hepatology in 2008 and is returning this year as one of its success stories – and guest speakers. The two-day symposium will give participants an opportunity to hear first-hand the exciting challenges, opportunities, training options and personal career paths of some of Canada’s leading hepatology experts. Special guest Adam Moir, a liver transplant recipient and medical resident, will also present his unique perspective as both a patient and a peer. At the conclusion of the program, the attendees have a chance to see hepatology ‘knowledge translation’ in action when they participate in a one-day continuing medical education session for Atlantic Canada’s primary health care professionals. Discover the World of Hepatology is sponsored by Schering-Plough Canada Inc., the Public Health Agency of Canada, GlaxoSmithKline Inc., Gilead Sciences Canada Inc., Novartis Pharmaceuticals Canada Inc., the Canadian Institutes of Health Research, Bristol-Myers Squibb Canada Inc., Cangene Corporation and Hoffmann-La Roche Limited The symposium kicks off at 6:00pm on Wednesday, September 23 in the Admiral’s Room at the Four Points Sheraton Hotel, Halifax, and continues throughout the day Thursday, September 24. For more information on the program agenda, speakers and interview opportunities, please contact Melanie Kearns at 1-800-563-5483 ext. 4923 or email mkearns@liver.ca. Canadian Liver Foundation Founded in 1969, the Canadian Liver Foundation was the first organization in the world devoted to providing support for research and education into the causes, diagnoses, prevention and treatment of liver disease. In this tradition, the CLF is committed to increasing public awareness of the importance of liver health, providing funds for much-needed liver research, and creating opportunities to advance the healthcare response by encouraging more doctors to specialize in hepatology and to provide liver health education and support at various levels within the medical community. University of Manitoba Section of Hepatology As the first and only Section of Hepatology in Canada, the University of Manitoba (UM) is well poised to help deliver innovative programs to attract new doctors to the field of hepatology and provide up-to-date and relevant liver health information to primary healthcare physicians and other allied healthcare providers. The UM Section of Hepatology is a multi-disciplinary section composed of three full-time hepatologists, an epidemiologist/statistician and scientists in many fields (such as immunology and molecular biology). Canadian Liver Foundation media contact: Melanie Kearns mkearns@liver.ca Toll-free: 1-800-563-5483 ext: 4923

September 16, 2009: Canadians Hungry For Healthy Food, But What Are They Biting Into?

New Canadian Liver Foundation poll finds Canadians concerned about food-related illnesses, yet majority are not taking proper steps to avoid them September 16, 2009 – Whether it’s through fresh foods, a food handler at a grocery store, or even a local restaurant, you can unknowingly pick up unwanted viruses right here in Canada. A new survey from the Canadian Liver Foundation (CLF) reveals more than half of Canadians over the age of 25 (57 per cent) are concerned about contracting food-related illnesses like hepatitis A, but many are unaware that their everyday food preparation and consumption habits may put them at risk for this liver disease. It is a common misconception among the public that hepatitis A and B are just travellers’ diseases. Canadians are nearly twice as likely to recognize they could be exposed to hepatitis A when eating on holiday (65 per cent), versus only 35 per cent who recognize this same risk here in Canada. As we head into the winter months, locally grown food is less available and we rely even more on fresh foods imported from around the world. In the winter months Canadian imports of fresh produce nearly double, and some foods may hail from areas where hepatitis A is endemic or where sanitation practices may not be up to Canadian standards. In fact, 84 per cent of hepatitis A cases in Canada are not directly linked to travel. “Hepatitis A and B are global liver diseases, and know no borders. While many may consider hepatitis A and B to be travel diseases, it is important to recognize that it can affect you right here at home,” says Dr. Morris Sherman, Chairman of the Canadian Liver Foundation. “While the risks may be lower in Canada versus other parts of the world, there are still risks, and it is key to know what they are and how to help protect yourself.” Canadians mistakenly believe common myths about the risks for contracting food-related illnesses and may have a false sense of security about their foods’ safety. Almost two-thirds of Canadians (63 per cent) incorrectly believe going to a “reputable” restaurant means they are safe from food-related illnesses. A further 58 per cent think that visiting a “reputable” grocery store would be enough to help them avoid a food-related illness. Knowing the risks There are several ways in which food can become contaminated. – From a food service worker: Hepatitis A virus can be passed along by infected food service workers in a restaurant or grocery store, or by those who handle produce along the supply chain. You may be at risk when a food service worker with hepatitis A fails to wash his or her hands properly after going to the bathroom and then touches the food you eat. – From the food itself: Contamination can occur during irrigation, harvesting, sorting, shipping, or processing. Food can be grown in or washed with contaminated water from areas with poor sanitation standards. For example, green onions, lettuce or strawberries have been the source of hepatitis A outbreaks in the past. “Whether you’re getting your food from a big grocery chain, a local market or a five star restaurant, you have no idea how the food was grown, where it was processed or even how many people touched it along the way,” says Dr. Sherman. “If an infected worker is not doing a good job of washing his or her hands before touching your food, or the food was grown in contaminated soil, you could be at risk of contracting hepatitis A.” Here are some general food safety tips on how to properly wash fresh fruits and vegetables: o Always wash your hands before preparing food and after going to the washroom o Soak all fruits and vegetables for one to two minutes in clean, fresh water o Clean your countertop, cutting boards and utensils with hot, soapy water after each use o Don’t forget that pre-packaged or frozen fruits and vegetables should also be well washed Getting Protected More than half of Canadians (51 per cent) believe they are safe from food-related illnesses as long as they wash their food before eating it. While proper hygiene and food handling can help protect against one of the risk factors for contracting hepatitis A, getting vaccinated is the best way to help protect yourself against both the known, and more importantly, the unknown and uncontrollable risks for exposure to this form of viral hepatitis. Only one in three Canadians (35 per cent) believe they are vaccinated for hepatitis A. Hepatitis A, however, is not the only vaccine-preventable form of viral hepatitis Canadians can contract at home. Hepatitis B is spread through direct contact with blood or bodily fluids. Risk factors include: having unprotected sex, getting a tattoo or piercing, and getting a pedicure, dental or medical procedure where inadequately sterilized instruments are used. Just over a third of Canadians (37 per cent) believe they are vaccinated against hepatitis B. “Canadians should consider getting vaccinated against both hepatitis A and B to reduce the risk of contracting these liver diseases here at home,” says Dr. Sherman. “Children in Canada are now vaccinated for hepatitis B in grade school, so it just makes sense for adults to consider vaccination as an effective way to help protect themselves as well.” About Hepatitis A and B in Canada Hepatitis A and B are serious liver diseases with potentially serious consequences. Hepatitis A can last a few weeks to several months and typical symptoms include loss of appetite, nausea, fatigue, fever, and jaundice. The disease can be quite debilitating, causing missed days or weeks of work in healthy adults. Severe cases of hepatitis A may require hospitalization and serious complications can include death in the elderly or those whose immune system is compromised. In Canada, between 1990 and 2004 the number of reported hepatitis A cases varied from over 3,500 to less than 400. Due to asymptomatic infection, underdiagnosis and underreporting, the actual number of hepatitis A cases in Canada is estimated to be 10 times higher than the reported cases. Hepatitis B is significantly more infectious than HIV and hepatitis B-associated liver disease kills more than one million people worldwide each year. There are two forms of hepatitis B: acute and chronic. Chronic hepatitis B infections can lead to cirrhosis (scarring) of the liver, liver cancer, or liver failure, all of which can lead to death. Many people who become infected don’t experience symptoms right away, so they may unknowingly pass the virus on to others like friends and family. Common symptoms include fatigue, nausea, loss of appetite and jaundice. There are approximately 250,000 Canadians with chronic hepatitis B, and approximately 1,100 new hepatitis B cases were reported in 2007 . Hepatitis B is the world’s leading cause of primary liver cancer, causing up to 80 per cent of liver cancer worldwide. Canadians don’t realize it, but we make decisions every day that can have positive or negative effects on our liver. Getting educated about liver disease is a good first step to being liver healthy. For more information, visit the Canadian Liver Foundation at www.liver.ca, or talk to your healthcare provider to find out about vaccination options and other preventative measures. About The Canadian Liver Foundation The CLF is a national charity committed to promoting liver health and reducing the incidence and impact of all forms of liver disease by supporting education and research into causes, diagnoses, prevention and treatment. Through its LIVERight campaign, the CLF wants to make liver health a priority for each and every Canadian – including individuals, health care professionals, government and industry. The CLF has contributed over $10 million dollars to liver research and education in Canada. Survey Methodology Leger Marketing surveyed 1,521 adult Canadians aged 18 and older about contracting Hepatitis A and B in Canada. The online survey was conducted from August 17 – 20, 2009, with a confidence level of +/- 2.5 %, 19 times out of 20. The survey was supported through an educational grant from GlaxoSmithKline. For more information please contact: Melanie Kearns Canadian Liver Foundation (416) 491-3353 or 1-800-563-5483 mkearns@liver.ca

January 30, 2009: Michael Chan M.P.P. and the Canadian Liver Foundation urge Ontarians to talk more openly about hepatitis B

More than 100,000 Ontarians are living with hepatitis B  MARKHAM, ON – January 30, 2009 – Today, the Canadian Liver Foundation was joined by Michael Chan, M.P.P., Markham-Unionville at a press conference held at Markham Stouffville Hospital to promote their effort to raise awareness and encourage open discussion about hepatitis B. Chronic hepatitis B affects an estimated 230,000-300,000 Canadians. Canada is home to many people who come from countries with high endemic rates of hepatitis B. For example, people born in Asia, sub-Saharan Africa, southern and eastern Europe are at a much higher risk of being impacted by this disease. They may be battling the disease in silence and may not know where to go to for information and resources. “The Canadian Liver Foundation is doing important work to educate Ontarians about the issues surrounding hepatitis B,” said Michael Chan, M.P.P., Markham-Unionville. “The importance of talking about the disease, and encouraging our families and friends to do likewise, cannot be emphasized enough.” Today’s discussion focused on raising awareness and educating the public to help reduce misconceptions around the disease and encourage diagnosed patients to speak to their health care provider about the disease, its consequences and its management. Ontario has one of the highest rates of hepatitis B in Canada. It is estimated that more than 100,000 people with chronic hepatitis B are living in the province. “My hope is that this effort to educate the communities directly impacted by hepatitis B will help to lessen the social stigma and shame that prevents sufferers from seeking treatment and will drive people to take action to protect themselves against the disease’s potentially devastating long-term impacts,” said Canadian Liver Foundation President, Gary Fagan. “The CLF is grateful for M.P.P. Chan’s support in our effort to promote awareness about hepatitis B. He is a strong advocate for the community and we look forward to continuing our work with him on this very important initiative.” Hepatitis B is a serious liver health issue in Canada and a type of hepatitis that is frequently overlooked. Often called a “silent” disease, hepatitis B can cause severe liver damage for several years without showing any symptoms. In fact, chronic hepatitis B is the leading cause of liver cancer worldwide and while death rates have declined for most forms of cancer in Canada, liver cancer is unfortunately on the rise. In addition to hearing about the risks associated with the disease and not knowing if you are affected, attendees at today’s press conference also learned about new developments and treatment approaches for the management of hepatitis B. “As physicians, we continue to see the harmful effects of chronic hepatitis B,” said Dr. Morris Sherman, Medical Advisor for the Canadian Liver Foundation. “Recent advances in the area of hepatitis B mean that we can now fight it better than in the past. The first step is early diagnosis, so it is extremely important for people to learn about the risks for hepatitis B and to talk to their doctors about getting tested. Coupled with education efforts, the use of new and very effective treatments will help protect against these effects by controlling the virus and preventing progression of the disease.” About the Canadian Liver Foundation The Canadian Liver Foundation is a national organization whose objective is to promote liver health, reduce the incidence and impact of all liver diseases, and improve the quality of life of the adults and children living with liver disease. This year marks the Foundation’s 40th anniversary of championing the battle against liver disease through research and education into the causes, diagnoses, prevention and treatment of liver disease in all its forms. To date, it has invested more than $10 million in liver research, $3 million of that in the last three years. For more on hepatitis B, click here Media contact: Melanie Kearns mkearns@liver.ca 416-491-3353 ext 4923

January 23, 2009: Immunizing infants against hepatitis B is the most effective way of preventing long-term health complications and costs

January 23, 2009: When you have a vaccine that can prevent a chronic illness or cancer, it makes sense to immunize the most vulnerable at the earliest opportunity. That is why the Canadian Liver Foundation supports the recommendations of Dr. Christopher Mackie and his McMaster and University of British Columbia colleagues published in this week’s Canadian Medical Association Journal that universal neonatal (newborn or infant) hepatitis B immunization be implemented in all provinces. “Chronic hepatitis B affects an estimated 300,000 Canadians and over 350 million people world-wide,” says Dr. Kevork Peltekian, Canadian Liver Foundation Chairman and hepatologist at the Queen Elizabeth II Health Centre, Halifax. “Once an effective hepatitis B vaccine became available, the debate focused on determining the best time to vaccinate. While provinces implemented immunization programs for elementary school children in the 1990s, it still left newborns, who carry the highest risk of becoming chronic carriers, without universal protection. We applaud the provinces like New Brunswick who have led the way in implementing neonatal immunization programs and we encourage all provinces to follow suit.” Hepatitis B is an insidious disease which is easy to prevent but very difficult to treat. A person with acute hepatitis B may be ill for weeks with flu-like symptoms and jaundice but eventually clear the virus. A person with chronic hepatitis B however may not display symptoms until years later after the liver has already become severely damaged. There are many hepatitis B drugs available on the market but none can effectively ‘cure’ this disease and often come at a very high cost. The Canadian Liver Foundation has advocated for universal neonatal immunization programs since hepatitis B vaccines first came on the market in the 1980s. The Foundation took its lobbying efforts to the National Advisory Committee of Immunization (NACI) in the early 1990s but the Committee ultimately recommended the school-age program which was eventually adopted by each province. In their 2007 Hepatitis B Consensus Guidelines, the Canadian Association for the Study of the Liver identified universal neonatal hepatitis B immunization with a catch-up program for adolescents (for those born outside of the country or who missed out on vaccination earlier) as a the ‘ideal’ vaccination policy for Canada. According to their findings, 13 health care jurisdictions administer infant and/or adolescent immunization programs across Canada – and yet no two programs are alike. As a result, children moving from province to province run the risk of missing the vaccination program in their home and their destination province.¹ In their study, Dr. Mackie and his colleagues pointed out that universal neonatal hepatitis B immunization might actually be more cost effective than adolescent programs because they could be combined with other vaccines and incorporated into the standard childhood vaccination schedule. ² “At a time when economic concerns are high on everyone’s priority list, we should be looking at the most cost-efficient yet effective long-term solutions to our health care issues,” says Dr. Peltekian. “The Canadian Liver Foundation and this country’s liver specialists have been recommending for years that neonatal hepatitis B immunization is the most effective way to prevent both acute and chronic hepatitis B. I’m pleased that CMAJ review article has provided additional proof that this is the ideal strategy to reduce the incidence of this disease amongst the Canadian population. I would recommend that the provinces who have yet to implement a neonatal program take a serious look at these findings.” About the Canadian Liver Foundation In 2007, the Canadian Liver Foundation launched its LIVERight initiative as a call to action to all Canadians to learn how to care for their livers to positively impact their overall health. Immunization is one way that Canadians can LIVERight to protect themselves from serious forms of liver disease like hepatitis A and B. Founded in 1969 by a group of doctors and business leaders concerned about the increasing incidence of liver disease, the Canadian Liver Foundation (CLF) was the first organization in the world devoted to providing support for research and education into the causes, diagnoses, prevention and treatment of all liver disease. In 2009, the Foundation is celebrating 40 years of commitment to nurturing and protecting the liver health of Canadians. Through its chapters across the country, the CLF strives to promote liver health, improve public awareness and understanding of liver disease, raise funds for research and provide support to individuals affected by liver disease. For more Information  Click on the following links for more information on hepatitis B, or the CLF’s LIVERight program, or contact the Canadian Liver Foundation. References:  1 Sherman, M. Shafran, S. Burak, K. et al. Management of chronic hepatitis B: Consensus Guidelines. Can J Gastroenterol 2007; 21 (Suppl C): p. 8C. Available online here. 2 Mackie, C., Buxton, J., Tadwalkar, S., Patrick, D. Hepatitis B immunization strategies: timing is everything. Canadian Medical Association Journal, 20 Jan 2009; 180 (2), p. 200. Available online at http://www.cmaj.ca/cgi/content/full/180/2/196  Media contact: Melanie Kearns, Canadian Liver Foundation 1-800-563-5483 ext. 4923 mkearns@liver.ca