Stubborn Hepatitis E still soaring

07 January 2020 | Health

Namibia's hepatitis E outbreak shows no signs of abating since it first erupted more than two years ago.

Nineteen people were killed by the disease in 2019 and a 65% rise in new infections saw close to 7 000 reported cases by the end of last year.

At the start of January 2019, a total of 40 deaths had been recorded, which increased to 59 by 15 December.

Moreover, between January and December last year, the total number of infections rose by 2 747, increasing from 4 227 reported cases on 6 January to 6 974 cases reported by mid-December 2019.

The latest report on hepatitis E warns that the primary obstacle hampering efforts to stop the outbreak continue to be limited sanitation facilities and poor access to water.

The report states that the number of toilets and latrines available to communities “remains low and many people are still practicing open defecation”.

Furthermore, a serious concern is the financial barrier to access to clean water.

“Available water at communal taps is not accessible to everyone, because one has to buy the water and most of the community members cannot afford to buy the water, hence the use of water from riverbeds,” the report states.

Last year, Dr Bernard Haufiku, who heads the emergency team tackling the outbreak, stressed that hepatitis E is more than a health sector issue.





“I have said it time and again that hepatitis E is a disease of poverty and low socio-economic status where there is a lack of clean water and poor personal hygiene.” He stressed the outbreak “begins with sanitation, water provision and personal hygiene. And it will end with us addressing those three challenges.”



Impact

The report confirms the majority of the 6 974 infected persons are men (59%), while 72% of all reported cases were persons aged between 20 and 29 years old.

Amongst the 59 deaths reported since the outbreak erupted in September 2017, 24 involved pregnant women or women who had recently given birth.

Dr Lilliane Kahuika-Crentsil, a former member of the national response team to the outbreak, last year confirmed that “since the onset of the outbreak, the leading cause for maternal deaths was found to be viral hepatitis E”.

The December report further notes that most of the reported hepatitis E cases were recorded amongst unemployed persons, while 74% of those infected are dependent on communal taps.

The report highlights that there was a 'drastic decrease' in new infections between 2 and 15 December, compared to the prior two weeks.

A total of 51 hepatitis E cases were reported during that time, compared to 92 cases between 18 November and 1 December.

The Khomas region's poorest informal settlements, including Havana and Goreangab - where the outbreak first erupted - remain the hardest hit, with 4 311 (62%) cases reported in the Khomas region, followed by 1 551 in Erongo and the remaining cases reported in most other regions of the country.



Far and wide

The widespread reach of the disease is a notable feature of Namibia's outbreak.

Last year, Dr Eric Dziuban, Centres for Disease Control and Prevention (CDC) country director to Namibia, said the outbreak is the “only instance of a nationwide outbreak of hepatitis E. Usually outbreaks are contained in the geographic areas where they occur.”

While the disease has not yet become endemic, experts have warned that unless the cycle of infection is broken through urgent and wide-scale sanitation upgrades in vulnerable areas, the outbreak will continue unabated.

Amongst the progresses noted in the latest report is a protocol for a hepatitis E vaccination intervention response, which was submitted to the health ministry in December.





PIC







JANA-MARI SMITH

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