Hepatitis torrent

Unless the outbreak is stopped, hepatitis E could become endemic and Namibia might never get rid of it.

25 September 2019 | Health

The relentless tide of hepatitis E that struck residents in poverty-stricken informal settlements near the end of 2017 has seen a 17 000% increase in new infections and a 5 400% rise in deaths over the past two years.

Since the start of the outbreak in 2017, the total number of infections rose from 37 in late December that year, to 6 407 by 8 September this year.

Over the same period, the number of people who died increased from 1 in December 2017 to 55 total fatalities now.

In August, health authorities confirmed that since the outbreak erupted the hepatitis E virus has become the leading cause of maternal deaths in Namibia.

To date, the majority of deaths have been female, many of whom were either pregnant or had recently given birth.

Over the past year the number of total infections increased by close to 80%, from 3 571 by 30 September 2018 to 6 407 this month.

Deaths between September last year and this year rose by 77.4%, from 31 to 55 by 8 September.

Since January this year, new infections continued to spike, from 4 227 by 6 January to 6 407 this month - a 51.6% increase.

By 6 January, the virus had claimed the lives of 40 people, which has increased by 37.5% to a total of 55 fatalities this month.



Ruthless

Analysis of the statistics from the past two years show that the number of infections rose from fewer than 40 to over 1 000 over four months, from 37 infected in December 2017 to 1 030 infected people by 25 March 2018.

By July 2018, infections increased to more than 2 400.

By September, infections had risen by more than 1 000, totalling 3 571 cases by the end of September 2018.

Between December 2018 and January 2019, the biggest spike in fatalities was recorded over a short time period, from 34 deaths in mid-December to 40 by 6 January. By April this year, infections had increased to more than 5 000, and by August, to more than 6 200.



Hard hit

Of the 6 407 cumulative cases recorded by 8 September, the Khomas Region's poorest neighbourhoods remain most impacted, accounting for 63%, or 4 006, of the total cases.

The Erongo Region accounts for 1 467 (23%) of cases, while the remaining regions, including Omusati, Ohangwena, Oshana, Oshikoto, Kavango, Otjozondjupa, Omaheke, Hardap, //Karas and Kunene, account for the rest. Of the 55 fatalities, 23 were maternal deaths. Of the total 55 deaths recorded since 2017, 35 were female and 20 men. Of the 6 407 cases recorded, 1 967 persons said they were unemployed, while 75% of those who tested positive for hepatitis E use communal taps.







Fifty-five per cent of those infected ate food from street vendors, records show.





This year, increased awareness and testing found an increase of hepatitis A and hepatitis B cases too.

A total of 168 hepatitis A and 181 hepatitis E cases have been reported to date.



Critical gaps

Major challenges remain in the fight to end the outbreak and prevent it from becoming endemic.

The latest report states that the ongoing active transmission of the virus continues countrywide, while the response teams struggle with “limited staff and capacity” at the public health emergency centre.



Additionally, a lack of a senior outbreak response focal person, required to enforce accountability and implementation of the outbreak interventions, poses a challenge.

Insufficient water and sanitation facilities, the main drivers of the virus, continue to hamper efforts to stop the outbreak.



Major threat

Dr Bernard Haufiku, who heads the National Health Emergency Management Committee, warned last month that the outbreak, unless stopped, could become endemic in the country.

In that case, Namibia will struggle to get rid of the virus “and we may actually never get rid of it at all,” he said.

He further warned that the chain of transmission has not yet been broken, stressing that the outbreak “begins with sanitation, water provision and personal hygiene. And it will end with us addressing those three challenges. Those are the three fundamental challenges we are facing.”

Haufiku underlined that the outbreak is more than just a health issue, but is linked to the country's socio-economic challenges, including poverty, unemployment and other factors plaguing informal settlements.





JANA-MARI SMITH

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