Hepatitis E outbreak sparks concern in Lake Chad Basin

A woman holds up a poster showing good hygiene practices in Nigeria. Photo by: Isabel Coello / ECHO / CC BY-NC-ND

ABIDJAN — The hepatitis E virus has become the latest menace in West Africa’s ongoing Lake Chad Basin crisis, compounding major challenges already impacting the region, including the threat of violent militant group Boko Haram, food insecurity and limited access to remote and vulnerable populations. Even more troubling, the virus seems to be circulating among displaced populations who frequently uproot and migrate, making it that much harder to contain.

Following a recent visit to northeast Nigeria, Dr. Philippa Easterbrook, a senior scientist for the World Health Organization’s global hepatitis programme, spoke to Devex about a recently-developed WHO response plan created to reduce the number of new cases of the virus and provide training to local health workers as a means of improving case management and diagnosis.

MSF to aid actors: 'Step up' efforts against hepatitis E outbreak in Chad

International medical humanitarian organization Médecins Sans Frontières has declared the hepatitis E situation in Chad an epidemic.

This water-borne infection was first reported last August in Chad’s Samalat region, to the country’s southeast. As of last month, the country had reported more than 1,600 suspected or confirmed cases, and 18 deaths. The virus then surfaced in neighboring Niger this January, in the Diffa region, an area near the Chad and Nigeria borders. Hepatitis E cases here spiked dramatically in mid-April, and decreased before then increasing again. Now approximately 1,450 people are suspected to have been infected, more than half of those women, with 38 fatalities.

With the frequent movement of internally displaced populations, the infection eventually arrived in Nigeria this May, in Damasak, a town near the Niger border, and has since seen 696 cases total — mostly at the Ngala internally displaced people’s camp, near the Cameroon border in Borno state.

Currently, all cases of hepatitis E in the Lake Chad region have been among displaced persons and refugees, Easterbrook explained. “This led us to the working hypothesis that these outbreaks are all linked and related to large population movements,” she said.

Without immediate attention, humanitarians are concerned that the virus could spread even further within impacted countries and even into unaffected areas, such as neighboring Cameroon or the Central African Republic. Even more so, this outbreak is highlighting the unsanitary water conditions affecting those impacted by conflict in the Lake Chad Basin.

Controlling the outbreak

Hepatitis E is most dangerous in pregnant women, and has an incubation period of two to 10 weeks where the infection remains asymptomatic and undetected in most people. Usually symptoms include flu-like symptoms such as: Low-grade fever, loss of appetite, nausea, vomiting, and most notably jaundice. Because the virus carries symptoms also seen in hepatitis A, yellow fever and malaria cases, diagnosing patients and managing cases can be a challenge.

Roughly 5 percent of cases develop more serious complications, according to Easterbrook, however the biggest risk is developing acute liver failure, or in pregnant women, post-partum hemorrhaging which can be fatal.

In Nigeria — where an estimated 1.9 million people are internally displaced — a hepatitis E containment plan has been outlined, and includes a five-part response of surveillance; case management; education and social mobilization; WASH; and coordination with state and humanitarian partners. A major component of the rapid response plan is to sensitize local communities by providing training to health care workers and community volunteers.

“We spent quite a bit of time speaking to frontline workers, conducting interactive training, optimizing the laboratory network and improving transport of collected [blood] samples,” Easterbrook said about her recent visit. However, this remains a challenge due to security constraints and the start of rainy season.

The most pressing agenda in the response plan is the improvement of water and sanitation hygiene in the region. As the virus spreads via contaminated water, Easterbrook cited that the improvement of WASH conditions would not only support the reduction in new hepatitis E cases, but could also reduce the prevalence of other infectious diseases, namely hepatitis A, cholera, and typhoid.

To date, roughly 200 restrooms and 100 showers have been constructed in Ngala camp. WHO has also worked with local partners to rehabilitate water points and distribute hygiene kits, which include items such as sanitary napkins and water purification tablets, to women and households. However, cultural barriers impede the progress of these initiatives.

“Some people would rather have low-level restroom facilities rather than walk some distance to a more modernized latrine,” Easterbrook explained.

Weekly meetings between local government, United Nations agencies, key partners and

WHO are aimed at improving coordination and cross-border collaboration with Niger and Cameroon.

Though there is a vaccine available, which Easterbrook said has been deemed highly effective, it has not yet been seen as the most appropriate response during these outbreaks.

“To date, the priority has leaned more toward improving WASH conditions and building latrines and focusing more energy on that, because it has a wider impact on other infectious diseases.”

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About the author

  • Christin Roby

    Christin Roby worked as the West Africa Correspondent for Devex, covering global development trends, health, technology, and policy. Before relocating to West Africa, Christin spent several years working in local newsrooms and earned her master of science in videography and global affairs reporting from the Medill School of Journalism at Northwestern University. Her informed insight into the region stems from her diverse coverage of more than a dozen African nations.