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Hepatitis E: Virus spreads faster during conflicts

 A patient, treated for Hepatitis E at MSF hospital, with her family. 

An outbreak of Hepatitis E, which is more fatal in pregnant women, has been reported in South Sudan. Hepatitis E is transmitted by ingesting the virus, either in contaminated water or food. Of interest is that outbreak of the virus occurs when there is conflict, like a war situation, which causes displacement of people and provides conducive environment for the spread of the virus as currently experienced in South Sudan.

The most infected with Hepatitis E are pregnant women, but experts have reassured Kenyans not to worry about the outbreak in South Sudan so long as there is proper sanitation and supply of clean drinking water.

Areas that risk outbreak in Kenya include Kakuma Refugee Camp and slum areas that have challenges in the supply of water and poor sanitation.

To control the virus, the South Sudan government is administering Hecolin vaccine (Hepatitis E) though “the fight against Hepatitis E has been long and frustrating,” said Dr Monica Rull, Medical Director, Médecins Sans Frontières (MSF), which in the last two decades has been responding to the Hepatitis E outbreak in displacement camps.

 “With the experience of this vaccination campaign, we hope to change the way we tackle hepatitis E in the future,” said Dr Rull.

 There are five types of hepatitis viruses: A, B, C, D and E and Prof Julius Oyugi, director of research, University of Nairobi Institute of Tropical and Infectious Diseases, lists Hepatitis B as the commonest in Kenya, followed by Hepatitis A and E.

“Improving hygiene and supply of water will save us from Hepatitis E. But for Hepatitis B, I encourage individuals to pick up the jab as there is high possibility of developing liver cancer that is fatal,” explained Prof Oyugi.

Hepatitis B is spread through unprotected sex with an infected person, and when blood, semen, or other body fluids from a person infected with the virus enters the body.

People infected with Hepatitis B and C are likely to suffer from liver cirrhosis, which causes cancer of the liver.

The Hepatitis E outbreaks came at a time the country joined the globe to celebrate the World Hepatitis Day.

 Health experts are thus calling on the Ministry of Health to revamp surveillance on Hepatitis, as Kenya largely relies on research data, which is not adequate to give a clear picture of the disease burden.

Prof Julius argues that surveillance will also map endemic areas with the disease. “We need to put in a surveillance system to be able to know if we are seeining an increase or decrease in the number of Hepatitis. The data is not countrywide,” said the virologist.

The surveillance, he said, can be done through blood transfusion.

Prof Oyugi, alongside a team of scientists, conducted a Hepatitis study at Moi Teaching and Referral Hospital and Kenyatta National Hospital, five years ago.

The study identified prevalence of Hepatitis in Baringo and Nairobi, and “more studies should be done to know why we have more cases in Baringo and prevention measures in respective regions.”  

Large outbreaks reported in South Sudan are attributed to poor sanitation and shortage of water.

However, there is no specific treatment for Hepatitis E, which as a fatality rate of up to 25 percent, among pregnant women, and also increases the risk of spontaneous abortions and stillbirths.

Clinical trials have shown that Hecolin is highly effective at preventing disease. The WHO recommended that the jab should be considered for use, in outbreak responses, in 2015.

The vaccine efficacy was 100 percent after the first 12 months and 93.3 percent, after 4.5 years post-vaccination.

However, until now it has only been used on an individual basis in China, where it is licensed and used to vaccinate travelers.

“Administering the vaccine is a significant milestone in global efforts to tackle hepatitis E,” said Melanie Marti, Medical Officer, Immunization, Vaccines and Biologicals, at WHO.

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