21 August 2008

Hepatitis E virus (HEV) outbreak: Uganda

Since January 2008, several districts in Uganda have reported an increase in cases of HEV [1]. As of 17 August 2008, 7,123 cases of HEV and 114 deaths were reported in northern Uganda [2]. Ninety-five percent of the cases have occurred in the district of Kitgum, including the sub-districts of Madi Opei, Paloga and Agoro [1,3]. Many cases (1,642) have been in the internally displaced persons  camp of Potika, in the sub-district of Agoro [4].  Small numbers of verified cases have also been reported in the neighbouring districts of Gulu and Pader (17) [1,3].  

Although the outbreak in Kitgum district has declined since July [1], cases have recently been reported from Amidi, Lagoro and Omiya Nyima, bringing to 19 the number of sub-districts reporting cases [2]. Verified and some unverified outbreaks of HEV in Uganda are detailed on the NaTHNaC Outbreak Surveillance database.

District authorities and non-governmental organisations are working together to improve sanitation and drinking water supplies; an educational programme is underway in affected areas [4].

Hepatitis E

HEV is transmitted by the faecal-oral route, usually following ingestion of contaminated food or water. Direct person-to-person transmission is uncommon. The disease has an incubation period of four to six weeks and usually results in mild or asymptomatic illness, particularly in young children.  Adults are more likely to have symptomatic disease, and in pregnant women, illness can be severe and rarely fatal. Symptoms include jaundice, dark urine, pale stools and nausea.

Advice for travellers

Hepatitis E is endemic in parts of the world where standards of hygiene are poor. Infection reported in the UK is usually associated with travel to endemic areas [5]. The risk of acquiring hepatitis E can be reduced by following common sense guidelines on food and water hygiene and by ensuring good personal hygiene. There is no vaccine to prevent hepatitis E.

References

1. United Nations Office for the Co-ordination of Humanitarian Affairs (OCHA). Uganda Humanitarian Situation Report 1 -31 July 2008. [Accessed 21 August 2008]. Available at: http://www.reliefweb.int/rw/rwb.nsf/db900sid/ASAZ-7HHFWN?OpenDocument&query=hepatitis%20E

2. Uganda Red Cross Society. Red Cross purifies 2,800,000 litres of water. [Accessed 21 August 2008]. Available at: http://www.redcrossug.org/?jc=Hepi

3. World Health Organization. Kitgum District Surveillance Report on Hepatitis E: Update of hepatitis E epidemic in Kitgum district 30 June 2008. [Accessed 21 August 2008]. Available at: http://www.who.int/hac/crises/uga/sitreps/uganda_hepatitis_e

_30june2008.pdf

4. Uganda Red Cross. Hepatitis intensifies kills 72 people. Uganda Red Cross Society. Hepatitis E. [Accessed 21 August 2008]. Available at: http://www.redcrossug.org/?jc=more%20death

5. Health Protection Agency. Foreign travel-associated illness in England, Wales and Northern Ireland: 2007 report. London: Health Protection Agency; 2007. [Accessed 21 August 2008]. Available at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPA

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Links

NaTHNaC Health Information Sheet on Hepatitis E

NaTHNaC Health Information Sheet Prevention of food and water-borne diseases

Health Protection Agency website: hepatitis E