Battle to stop hepatitis E turning endemic

JANA-MARI SMITH



With more than 6 500 suspected cases of hepatitis E detected in 13 of Namibia’s 14 regions since the outbreak began two years ago, health officials are working hard to stop the disease from becoming endemic.

“The outbreak has not yet reached a point where we can refer to it as being endemic in Namibia, but the threat of it becoming endemic remains,” Dr Bernard Haufiku, the national coordinator leading the response against the outbreak, told Namibian Sun last week.

Haufiku explained that once endemic, the disease would be present in the general population in all regions, with more people at risk of contracting the disease. Women of reproductive age are most at risk of becoming infected and dying.

He stressed that if it does become endemic, it would add additional strain on the health system, which is already burdened with other diseases, such as tuberculosis, malaria and HIV.

“In addition, we face an onslaught of non-communicable diseases such as high blood pressure, diabetes, cancer and mental health.”

To save lives and resources, the outbreak has to be contained and stopped from becoming endemic, he added.

“This will mean knowledge of, and availability of sanitation, clean water and personal hygiene by everyone, everywhere at all times.”

Haufiku said the response team remained optimistic that “if we aggressively address the issues of sanitation and deliver clean water to affected and at-risk populations, we can still contain the outbreak.”

By 6 October, the number of deaths attributed to hepatitis E remained at 55, with no new fatalities reported since August.

Rising slowly

The latest situation report showed that cumulatively a total of 6 527 suspected cases linked to the hepatitis E outbreak have been reported, of which 1 585 were laboratory confirmed.

Laboratory-confirmed and suspected cases have been reported in all regions except Zambezi, and deaths linked to hepatitis E have been reported in all regions except Oshikoto, Otjozondjupa, Kunene, Karas and Zambezi.

The report notes that of the 6 527 suspected cases of hepatitis E countrywide, 60% of the cases were male.

Men are more likely to eat food from street vendors than women and “are also less likely to wash their hands before eating,” the report states.

The majority of cases were in the age group 20 to 39.

The latest report shows that over the past four weeks, new hepatitis E cases have been decreasing compared to the weeks prior.

The Khomas Region’s informal settlements remain the epicentre of the outbreak, with 4 101 cases reported mainly in the Havana and Goreangab informal settlements.

The DRC informal settlement in Swakopmund has reported the second highest number of cases.

The US Centers for Disease Control’s Namibia country director, Dr Eric Dziuban, explained that an endemic disease is one that is always present and infections occur at a predictable rate.

So, while hepatitis E is a significant problem in Namibia, the infection rate is not predictable and whether it is becoming endemic is not certain yet, he said.

Moreover, Dziuban underlined that an endemic disease “can still be eradicated, and malaria is also a good example of an endemic disease that Namibia is trying to eradicate.”

The major challenge is to “break the cycle of transmission and stop new infections. This is harder when the number of new cases is high and widely spread. In Namibia especially the challenge for hepatitis E is upgrading sanitation. If poor sanitation conditions continue, the widespread number of cases will continue.”

Part of efforts to improve awareness and sanitation in affected areas is through the roll out of Community-Led Total Sanitation (CLTS) programmes.

This approach encourages communities to work together to eradicate open defecation and to work towards identifying and implementing community-led sanitation initiatives to create a clean and hygienic environment that benefits everyone.