Forces join to address Hepatitis E Outbreak in Namibia

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A Hepatitis E virus (HEV) epidemic was declared to have started in Namibia on 14 December 2017. It started in informal settlements in Windhoek and has since spread to all 14 regions.

Recently, the Ministry of Health and Social Services (MoHSS), the Embassy of Japan, and the World Health Organization (WHO) have renewed efforts to address this outbreak. On 13 August 2020, there was a ceremony held at the Namibian COVID-19 Communication Centre, and there the project was launched. The goal is the “Improving [of] national preparedness and response capacity to contain infectious disease outbreaks and other drought-related public health events in Namibia”.

The WHO, in partnership with MoHSS, will implement a four million Namibian dollar project in the Khomas, Erongo, Omusati, Ohangwena, Kavango East and Kavango West regions for 12 months. The funding will strengthen the national and regional capacity—essential components required to implement effective response intervention (ERI). This is central when containing infectious diseases, particularly with the ongoing HEV outbreak. Dr Charles Sagoe-Moses, Namibia’s WHO representative, emphasized the need for sustaining essential health services even while attending to the urgency of the current COVID-19 outbreak.

HEV is a virus that causes liver disease that is self-limited and acute. Only in very rare cases does it become chronic and then usually in those that have received organ transplants. The virus is most common in developing countries that have inadequate water supply and poor sanitation. Those living in crowded camps and informal settlements are at particularly high risk – which has been the case in Namibia. Cases from informal settlements in Windhoek (62%) and Swakopmund (21%) make up the majority. There have been 65 deaths reported, of which 26 were maternal.

The virus is usually spread by the faecal-oral route, but may also be spread by the consumption of uncooked/undercooked meat of certain mammals. HEV has been extracted from pork, boar, and deer meat.

Most cases are amongst men with 4 167 men testing positive, compared to 2 896 women. Infections are likely to, in part, stem from street vendors. Men are more likely to buy food from street vendors and are less likely to wash their hands before eating. It was also found that most of the cases are in people in the age group 20-39. Children under one year are the least affected, representing only 0.11%.

When they occur, the signs and symptoms of Hepatitis E are similar to those of other types of acute viral hepatitis and liver injury. They include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Jaundice
  • Dark urine
  • Clay-coloured stool
  • Joint pain

Symptoms appear 15-60 days after exposure. How long an HEV-infected person is infectious has not been determined. In the event of chronic infection, the person sheds the virus continuously.

Luckily, most people with Hepatitis E recover completely. During Hepatitis E outbreaks, the overall case-fatality rate is about 1%. However, pregnant women may become seriously ill. Mortality is as high as 30% among women in their third trimester. Hepatitis E can also pose serious health threats to people with preexisting chronic liver disease and organ-transplant recipients on immunosuppressive therapy.

Screening of HEV is done with an antibody test—and that is only done after many other possibilities have been excluded—for example, Hep A, B, and C and any liver injury. HEV usually resolves without treatment. There is no specific antiviral therapy. Supportive therapy is offered with patients typically being advised to rest, get adequate nutrition and fluids, avoid alcohol, and check with their physician before taking any medication. Medication such as acetaminophen may damage the liver. However, hospitalization is sometimes required and will be considered, especially for pregnant women.

Of course, prevention is better than cure. The prevention of HEV is primarily reliant on proper sanitation and the availability of clean drinking water. Travelers to developing countries can reduce their risk of infection by not drinking unpurified water. Boiling and chlorination of water will inactivate HEV. Also, avoiding meat such as raw pork and venison can reduce the risk of infection.