Viral Hepatitis E (HEV) series & Nepal - Where are we in its understanding? (Part 2)

Viral Hepatitis E (HEV) is a public health problem, which has caused havoc in many parts of the country. Among these, let me share with you two outbreaks that will provide clear perspective into the gravity of HEV problem in our country. One was the confirmed HEV outbreak in the premises of prime ministerial official residence in the year 2007, where then prime minister himself, cabinet minsters and other staffs caught this viral illness. The second HEV outbreak is very recent in the month of May and April, 2014, which occurred in the heart of Biratnagar municipality in eastern part of the country. This outbreak was national headline, where thousands of municipality residence were taken ill and some of them died. In both outbreaks, the root cause for the disease outbreak was found to be the fecal contamination of drinking water. These two recent examples could provide us with a sense of urgency as to the extent of public health problem in Nepal that need to be addressed with available preventive tools. 

Before going into preventive measures available for this illness, let us try to delve into following discussion. I did a quick review of paper in PubMed and was fortunate to find series studies re; to HEV in Nepal since early 1980s. For our convenience, let us try to dissect these studies as below:

1. Literature pre - 2000: Almost all studies were conducted and reported from Kathmandu valley from early as 1980s. Majority of the studies are hospital based done among admitted inpatients supplemented with serological test for its diagnosis. Few studies are also conducted among travellers or expatriate in the valley, Nepalese army in UN mission - Haiti and notably among pregnant women. One study was non human done among local swines in the Kathmandu valley. The findings from these studies suggested that HEV is endemic in Kathmandu valley of significant public health importance and directly relates to poor water, sanitation and hygiene practices. Also, one study reports that local swine population is the host for this disease and suggest HEV as zoonotic illness. Another implication that these studies brings to our notice are that travellers / expatriates visiting Nepal are at risk, thereby this could affect tourism business. Also, there is every likely that the disease could spread to other geographical locations.
2. Literature post - 2000: All the studies post 2000 add to HEV knowledge that have been gathered from studies in Kathmandu valley. What stands out in these studies is most of them are molecular in nature. These studies have clearly outlined the genotypic profile of HEV circulating in Kathmandu valley. Also, other studies done among pregnant women diagnosed with HEV infection adds to our knowledge that HEV remains serious threat to the health of mother and unborn child. Additionally, one study add that HEV has been detected to rodents in Kathmandu so adding to knowledge that some of the genotypes are zoonotic in origin, which later has implication in designing measures to control and prevention of this illness. Most important is that there was a conduct of HEV vaccine trial among Nepalese army. The vaccine tested in this controlled trial was Hecolin - which is licensed for use in China. 

One contention I would like to bring out and be vocal outright with this background of long history of HEV studies with yearly outbreaks in Nepal, how long do we have to wait for this HEV vaccine? This question will be discussed in next journal entry. Also, I will try to elaborate on following points:

• Review data regarding the incidence and burden of disease caused by hepatitis E virus infection in Nepal.
• Review issues related to hepatitis E surveillance and its diagnosis

     ABC
19 Jan, 2015