During the coming monsoon season, survivors of the recent earthquake that destroyed parts of Nepal face a "very high" risk of a hepatitis E outbreak that could be especially deadly to pregnant women, according to a consensus statement from a group of infectious disease experts from around the world.
The document, published in the Lancet June 16 and signed by the Johns Hopkins Bloomberg School of Public Health's Alain Labrique and six others, states that the conditions in the April tremor that killed 8,800 people and injured more than 23,000 have left conditions ripe for hepatitis E virus (HEV), which is primarily spread from feces to mouth via contaminated water. The researchers say that 500 pregnant women could die from the virus in the coming months and many more could be sickened.
"Earthquake-affected areas are faced with a 'perfect storm' of risk factors: large displaced populations with limited access to clean drinking water, lack of sanitary facilities, the approaching monsoon, overburdened healthcare infrastructure, large amounts of circulating HEV, and an at-risk population that mostly lacks protective antibodies," the researchers write.
There are an estimated 20 million hepatitis E infections in the world annually. While the virus can lead to liver disease, it mostly runs its course with few long-term complications. Yet pregnant women have a mortality rate of 25 percent when infected by the virus.
There is a safe and effective vaccine available, the researchers say, but it is currently only licensed for use in China. The World Health Organization has not recommended its routine use because there is a need for additional safety and efficacy data, particularly in pregnant women. They have also said, however, that its use should be "considered" in outbreaks such as this. The researchers estimate more than 400 pregnant women could be saved if the vaccine were used in Nepal during monsoon season, which runs from July to September.
The group recommends that Nepalese health authorities actively work to identify cases of the disease where pregnant women are being treated; that the Nepalese Ministry of Health should initiate a request for the vaccine and build a stockpile; and develop targeted deployment strategies for the use of the vaccine, based on identification of high-risk populations and the available organizational capacity for safe implementation and monitoring of outcomes.
"Hepatitis E is a neglected virus that isn't well understood but we are now seeing that it is likely a major cause of maternal deaths in countries where it is common," says Labrique, PhD, an associate professor in the Bloomberg School's departments of international health and epidemiology. "We are compelled to advocate for measures that reduce the risk of preventable mortality."
"Nepali Earthquakes and the risk of an epidemic of Hepatitis E" was written by Buddha Basnyat, Harry R. Dalton, Nassim Kamar, David Rein, Alain Labrique, Jeremy Farrar and Peter Piot. Collaborating institutions include Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Kathmandu, Nepal; University of Exeter; Université Paul Sabatier; University of Chicago; Wellcome Trust; and the London School of Hygiene & Tropical Medicine.
Other Johns Hopkins Bloomberg School of Public Health researchers who signed the consensus statement include Lisa J. Krain, Brittany L. Kmush, Christopher D. Heaney and Kenrad E. Nelson.