Hepatitis ravages Namibia's poorest

14 August 2019 | Health

Urgent and fresh interventions are needed to help curb Namibia's drawn-out hepatitis E outbreak, which is approaching its two-year milepost next month and shows no signs of abating.

The outbreak has killed 53 Namibians and infected almost 6 000 of Namibia's poorest since September 2017.

“I have said it time and again, that hepatitis E and even A are diseases of poverty and low socio-economic status, where there is a lack of clean water and poor personal hygiene,” Dr Bernard Haufiku, who heads the national health emergency management committee, told Namibian Sun.

Haufiku emphasised that the outbreak is not an issue confined to the health sector alone but cuts across many sectors, including environment, housing, education, communication and agriculture.

He said although relevant bodies have implemented several strategies to curb the outbreak, there is a strong push to consider alternative, additional strategies, “as our current intervention seem not to take us anywhere”.

“We are basically looking at all potential and available options including considerations for a vaccine against hepatitis E, because we simply cannot allow the situation to continue as it is now,” he said. He warned that a vaccine is “not something one can just pull from the shelf or lab and administer to people”, and that there are a myriad of critical issues to consider, with strict emphasis on safety and efficacy.

“I am personally of the view that we must now consider other available measures and options, and perhaps to do so rather fast, if we really want to bring hepatitis E under control,” he said.

Haufiku said in 2017 an offer for a vaccine developed in China was made but it was declined, partly because of strict international guidelines. He said the Namibian authorities were fairly optimistic that the outbreak could be brought under control.

“The current situation has proven us wrong, as it is now clear that we have not managed to bring the outbreak under control,” he admitted.

He repeated that in his personal view, he would not “exclude considerations for the introduction of an anti-hepatitis E vaccine,” albeit under strictly controlled conditions.

Poorest hardest hit

The most recent situation report indicates that the majority of the 5 940 Namibians infected by hepatitis E to date, namely 77%, or 4 563, are unemployed and live in informal settlements.

Moreover, 4 550 of those infected don't have indoor plumbing but depend on communal taps.

Haufiku emphasised that three underlying issues are driving the outbreak: lack of access to clean water, lack of sanitation and poor personal hygiene.

He said these issues must be addressed not only by the health teams battling the outbreak, but everyone in Namibia, including the private sector, media and others.

He stressed that the response teams' two main objectives are to prevent loss of life and to ensure the disease does not become endemic.

“More people are getting infected and more are losing their lives to the disease, especially pregnant mothers,” Haufiku warned.

“If the current situation is allowed to continue unabated, hepatitis E will become endemic in Namibia and Namibia will struggle to get rid of the virus in the community and we may actually never get rid of it at all.”

The latest situation update shows that five people died of hepatitis E in the two weeks between 14 and 29 July, bringing the death toll to 53.

A year ago, on 29 July 2018, a total of 2 435 suspected cases and 20 deaths had been reported.

Haufiku explained that the response teams are still pushing the water, sanitation and hygiene (WASH) campaign, along with the Community Led Total Sanitation approach, in an effort to slow down the outbreak.

Among the alternative strategies is a small project in the DRC informal settlement at Swakopmund, where a German company is distributing antiseptic products in a controlled environment, as this is the first time the products are being used in Africa.

The team has also been talking with representatives of the organisation Doctors Without Borders who are currently in Namibia to offer their help.

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