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Archive Number 20080304.0894
Published Date 04-MAR-2008
Subject PRO/EDR> Hepatitis E virus - Uganda
HEPATITIS E VIRUS - UGANDA
**************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 3 Mar 2008
Source: ReliefWeb, The International Federation of Red Cross And Red 
Crescent Societies [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db900SID/ASAZ-7CDJED?OpenDocument>


Hepatitis E Virus Epidemic in Uganda
------------------------------------
The Ugandan Ministry of Health (MoH) and the World Health 
Organization (WHO) in Uganda have confirmed an outbreak of Hepatitis 
E in Madi Opei Sub-county in Lamwo County, Kitgum District of 
Northern Uganda neighbouring the South of Sudan. A total of 314 cases 
with 11 deaths have been registered since the epidemic began to 
spread in November 2007 and the outbreak in Madi Opei has shown 
minimal reduction in its trend of progression. About 75 percent of 
the cases are between the age group of 15 and 44 years. Meanwhile, 
about 60 percent (186/314) of the cases are females. The risk factors 
responsible for this continued transmission of HEV have been 
discovered to be extremely low latrine coverage, contamination of 
water at household levels and poor hygiene practices in the affected 
IDP camps.

According to findings of a situational analysis carried out in 25 
villages located in Madi Opei, an average of 112 people share one 
latrine facility within the IDP camp. This is almost 6 times above 
the standard requirement of 20 people per latrine facility. 
Furthermore, most villages are lacking latrines and thus the 
communities have formed the habits of open defecation. Most of the 
available latrines are not being maintained, making their use 
difficult. This also encourages open air defecation.

Hygiene practices at household levels such as routine washing hands 
with soap after visiting the toilet or before meals are hardly 
practiced. Despite the fact that soaps were distributed to the 
community, there are no indications to show that soap was being used 
for hand washing at all. Water samples (from pots and buckets) 
collected from households showed heavy presence of coli 
micro-organisms giving the indication that contamination of water is 
taking place at household levels, attributed to the use of pots and 
poor personal hygiene practices.

Madi Opei IDP camp has a total of 19 functional boreholes that supply 
optimal amount of water to the community. Bucket chlorination is 
being conducted at all water sources in Madi Opei and the 
surrounding. It was established that there were occasional 
interruption in the supply of chlorine tablets, resulting into 
erratic discontinuation in chlorination of water at source. This was 
largely attributed to weak supervisory/oversight role provided to the 
chlorination activity.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Hepatitis E is a liver disease caused by hepatitis E virus (HEV) 
which is transmitted in much the same way as other enteric viruses. 
Hepatitis E outbreaks have occurred world-wide in recent years (see 
references below). The signs and symptoms of HEV infection are loss 
of appetite, nausea, vomiting, discoloured urine, jaundice and 
abdominal pain. However, there is no chronic (long-term) infection. 
Hepatitis E is more severe among pregnant women, especially in the 
3rd trimester. HEV is found in the feces of persons and animals with 
hepatitis E. HEV is spread by eating or drinking contaminated food or 
water. Transmission from person to person may occur.

It seems likely in view of the deficiencies in basic sanitation 
pertaining in rural Uganda that other enteric agents in addition to 
HEV are contributing to the epidemic situation described above.

The map of Uganda accompanying this report is available at
<http://www.un.org/Depts/Cartographic/map/profile/uganda.pdf>. - Mod.CP]

[See also:
2007
----
Hepatitis E virus - Europe (02)  20070920.3120
Hepatitis E virus - Europe  20070918.3093
Hepatitis E - India (Kashmir)  20070806.2556
Hepatitis E - Afghanistan (Laghman)  20070226.0695
Hepatitis E - Nepal (03): background  20070220.0637
Hepatitis E, porcine carriers - UK (England)  20070218.0615
Hepatitis E - Nepal (02): background  20070216.0576
Hepatitis E, porcine carriers - Spain  20070215.0561
Hepatitis E - Nepal  20070214.0554
2006
----
Hepatitis E - Congo DR (Equateur)  20061018.2994
2005
----
Hepatitis E - Chad (Eastern)  20050822.2477
Hepatitis - India (Maharashtra): hepatitis E conf.  20050329.0908
Hepatitis E - India (Mumbai)  20050107.0044
2004
----
Hepatitis E virus, fatal - Japan (Hokkaido)  20041128.3183
Hepatitis E virus, wildlife to humans - Japan (02)  20041127.3172
Hepatitis E - Sudan (Darfur)(06)  20040929.2689
Hepatitis E - Chad (Goz Amer)(05)  20040927.2667
Hepatitis E, waterborne - Iraq (02)  20040924.2642
Hepatitis E - Chad (Goz Amer)(04)  20040915.2570]
...........................ccp/ejp/lm

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