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HEV outbreak affected more than 5,000 in South Sudan
There were 5,080 cases of acute jaundice syndrome in four Maban County refugee camps in the Upper Nile state of South Sudan during a 2012-2013 outbreak, and hepatitis E virus was confirmed in samples from cases in each camp, according to a report in Morbidity and Mortality Weekly Report.
In a cross-sectional serosurvey of the Jamam refugee camp, 54.3% of the population was found to be susceptible to hepatitis E virus (HEV) infection. Across all four camps — Jamam, Doro, Gendrassa and Yusuf Batil — the fatality rate related to acute jaundice syndrome was 10.4% among pregnant women.
The outbreak was first identified when two pregnant women and one child in the Jamam camp died during the week of July 2, 2012. All three reportedly had yellow eyes before death. From July 27 to Aug. 3, 2012, three men were admitted to a Jamam camp hospital with acute onset jaundice, and two died within 4 days.
According to the report, refugees from the state of Blue Nile in Sudan began setting in the camps in late 2011, and by mid-July 2012, the population in the Maban County refugee camps was more than 110,000. This population surge coincided with heavy rains and flooding. After the initial cluster of acute jaundice syndrome cases in July 2012, active surveillance was implemented in all four of the camps. HEV was confirmed as the cause of the outbreak in August 2012.
Among the 5,080 cases, 52.5% were women. Among pregnant women, there were 211 cases and 22 deaths. The risk for death in pregnant women was estimated to be 4.8 times higher than the risk for nonpregnant women in the three most affected camps. The overall attack rate in these three camps was 7.4%.
“Large hepatitis E virus outbreaks have occurred among crowded displace populations,” the researchers wrote. “These outbreaks result in appreciable morbidity and mortality, particularly among pregnant women. Despite enhancing water, sanitation and hygiene control measures, outbreaks often are prolonged and necessitate a sustained prevention and control response. The role of vaccination in the context of outbreak control urgently needs to be examined.
Disclosure: The researchers report no relevant financial disclosures.