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Wednesday, March 13, 2013

Hepatitis E in Sudan Refugee Camps

A ProMED-mail post
Archive Number: 20130308.1577420
Date: Mon 4 Mar 2013
Source: Radio Tamazuj [edited]

Over 88 cases of hepatitis E have been reported in Doro Camp of Upper Nile State, according to a medical source. The health worker reported that in a period of 27 days the camp has reported 88 cases of hepatitis E virus infection, explaining that 5-6 cases per day are reported to various units in the camp. "We have 88 cases with 3 death cases," he said. The officer added that the 3 deceased were all women, 2 of whom were pregnant. The medical officer said that patients suffering from the disease display signs like yellow urine and eyes, joint pains, and general body weakness.

There has been much confusion in the camp because many people want treatment but there is no medical treatment available for the disease; it is a preventable but not treatable disease. One camp resident told Radio Tamazuj: "We resort to traditional treatment because there is no treatment available to us." He described the traditional treatment as involving the use of fire to burn the affected part, which exposes the victim to more pain.

The medical aid organisation Medecins Sans Frontieres has embarked on an awareness campaign in Doro since last year [2012] when hepatitis E broke out in other nearby camps in Maban County inhabited by refugees from Blue Nile State. The affected camps are Jammam, Jandrassa, Yusif Batil, and Doro. The outbreak spread to the latter camp, the largest one, as a result of contact of the residents with affected people from the other camps.[A hepatitis E death toll of 88 cases was recorded on 1 Feb 2013 by Medecins Sans Frontieres and was reported subsequently to have risen to 11 cases (ProMED-mail postings Hepatitis E - South Sudan (02): refugee camps, 20130216.1545704) and may now have increased further. This report is posted because it contains additional information regarding the refugee camps affected and the responses to the outbreak.

Hepatitis E virus is transmitted mainly through the faecal-oral route due to faecal contamination of drinking water. Other transmission routes include foodborne transmission from ingestion of products derived from infected animals and vertical transmission from a pregnant woman to her fetus. Currently, there is no vaccine available for control of hepatitis E virus infection. Hepatitis E virus infection is self-limiting in normal conditions, and fulminant hepatitis is rare, with only pregnant women being at increased risk. In environments such as the refugee camps in South Sudan, the outcomes are much more serious, especially for pregnant women.

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