Outbreak of Hepatitis E in Ouaddai Province, Chad.

An outbreak of Hepatitis E has resulted in seven deaths and over 2000 people becoming sick in Ouaddai Province, Chad, according to a press release issued by the World Health Organization on 8 May 2024. The outbreak was first detected on 2 January 2024 when to cases of Acute Jaundice Syndrome were reported by medics from Médecins Sans Frontières who were operating a clinic at a temporary high school at a refugee camp in the Adré Health District of Ouaddai Province.

Between 2 January and 15 February 2024 the number of reported cases of Acute Jaundice Syndrome in Adré Health District rose to 113, of which 28 were confirmed as being Hepatitis E using rapid diagnostic test kits. On 19 February a case was reported at the Allasha Refugee Camp in the Hadjer-Hadid Health District, also Ouaddai Province.

Between 1 and 19 March 2024 forty blood samples taken from Acute Jaundice Syndrome sufferers in Ouaddai Province were sent to the Institute Pasteur of Dakar, Sénégal, where they were tested for Hepatitis E, Yellow Fever, Dengue, West Nile Fever, Zika, Chikungunya, Rift Valley Fever and Crimean-Congo Haemorrhagic Fever. Of these, 36 tested positive for Hepatitis E.

A refugee camp in eastern Chad in January 2024. Médecins Sans Frontières.

Between 2 January and 28 April 2024 a total of 2092 suspected cases of Hepatitis E were reported in Ouaddai Province, with seven fatalities. One hundred and three of these cases were members of the local conflict, while the remaining 1989 were refugees from the conflict in neighbouring Sudan, with the Lycée d'Adré, Aboutengué, and Metché refugee camps being particularly badly hit. 

Hepatitis E is caused by a single-stranded, nonenveloped, RNA Virus, and is usually a self-limiting infection, causing fever, nausea, loss of appetite, vomiting, jaundice, abdominal and joint pain and discolouration of the urine and stool, which typically passes within 2-6 weeks. However, in some cases the disease can cause acute liver failure (hepatitis) which is often fatal. Pregnant women are considered to be at particular risk from this disease, with a fatality rate of about 30%, compared to about 1% for the general population.

The Hepatitis E Virus. Centers for Disease Control and Prevention/Wikipedia.

Hepatitis E is spread through faeces and contaminated water, and thrives in unsanitary and crowded conditions. This makes it a particular problem in settings like refugee camps, where large numbers of people fleeing conflict situations arrive over short periods of time, overwhelming local sanitation systems. 

A queue of water containers at the Metché Refugee Camp in Ouaddai Province, Chad, where Médecins Sans Frontières is providing clean water. Médecins Sans Frontières.

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Sharp rise in the number of Hepatitis E cases in South Sudan in 2021.

Cases of Hepatitis E have been consistently reported in South Sudan since 2014, with recurrent outbreaks occurring in Bentiu, Rubkona County, Unity State (central-north part of South Sudan), where a camp for internally displaced persons is located. In 2021, the number Hepatitis E cases have risen significantly in the country, increasing from 564 reported during the three years 2018-2020, to 1143 suspected cases with five deaths in 2021 (as of 29 November), according to a press release issued by the World Health Organization on 23 December 2021. In the two years 2020-2021, a total of  1420 suspected cases were reported, of which 47 have been laboratory confirmed by polymerase chain reaction at the Uganda Virus Research Institute.

The outbreak is occurring in Unity State, with cases mainly being reported from Bentiu Internally Displaced People Camp. This led the Ministry of Health to declare a Hepatitis E outbreak in the camp in August 2021. A proportion of cases (323; 28.3%) has been reported from outside the camp, in Bentiu and Rubkona towns, suggesting ongoing transmission in the surrounding community.  Males aged 15-44 years are being reported as the most affected group, followed by male children 1-4 years, and females aged 15-44 years. There are no cases currently hospitalised, with clinical management implemented in outpatient departments.

Bentiu Internally Displaced People Camp hosts over 107 000 people and is divided into five sectors. Hepatitis E cases are reported from all sectors, highlighting widespread transmission. Unity State, is also currently affected by a flood that has caused a massive displacement and the development of new internally displaced persons sites, which has resulted in 30 000 more internally displaced people being moved to the Bentiu camp.

 

The Bentiu Internally Displaced People Camp in Rubkona County, South Sudan. Jacob Zocherman/The Guardian.

Hepatitis E is caused by a single-stranded, nonenveloped, RNA Virus, and is usually a self-limiting infection, causing fever, nausea, loss of appetite, vomiting, jaundice, abdominal and joint pain and discolouration of the urine and stool, which typically passes within 2-6 weeks. However, in some cases the disease can cause acute liver failure (hepatitis) which is often fatal. Pregnant women are considered to be at particular risk from this disease, with a fatality rate of about 30%, compared to about 1% for the general population.

 

The Hepatitis E Virus. Centers for Disease Control and Prevention/Wikipedia.

Hepatitis E is spread through faeces and contaminated water, and thrives in unsanitary and crowded conditions. This has become a problem in South Sudan since the country gained independence from Sudan in 2011, as a civil war broke out between different factions of the country's former independence movement, resulting in a conflict that lasted from 2013 till 2020, which resulted in about 400 000 deaths, and the displacement of about four million people from areas affected by the conflict; about 2.5 million of these now reside outside the country, with the remainder displaced internally, most of whom are residing in camps such as Bentiu.

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