Hepatitis B is a virus that causes irritation and swelling of the liver. It can be spread through having contact with blood, semens, vaginal fluids, and other body fluids of an infected person.

 

Hepatitis E Breaks Out in Kabong

http://ugandaradionetwork.com/a/story.php?s=24060

Sep 17, 2009

By Frederick Womakuyu

FOLLOWING an outbreak of Hepatitis E in northern Uganda on October 25 last year, doctors and the public could not understand what they were dealing with. Many people have been infected and affected and more are dying, despite a 26% reduction in the number of cases, according to district surveillance focal teams in northern Uganda. But, how did Hepatitis E break out in the region and how did it manage to spread to 17 out of 19 sub-counties of Kitgum district and then later to Pader and Gulu?


It was at Padibe Health Centre IV lies, surrounded by one of the largest internally displaced people's camps, Padibe West and East, about 40kms from Kitgum town, that the first victims of Hepatitis E were treated.


“In October, we began witnessing unusual deaths,” says Charles Oyoo, the in-charge officer at the health centre. “People were coming in with headache, high fever, vomiting, general body weakness and yellow eyes. We thought they were suffering from malaria, yellow fever or hepatitis, but we couldn’t establish the exact disease or be sure of what we were dealing with.”


Oyoo and his colleagues continued treating the patients, most of whom came from the nearby Madi Opei area — at least eight of the first patients.


How did Hepatitis E break out?
Officials, including Oyoo, believe the outbreak can be traced back to a family in Madi Opei that hosted a Sudanese national.


According to Obote Odwar, the district Hepatitis surveillance person for Kitgum, a 40-year-old mother came to Madi Opei seeking antenatal care at the health centre.
“After receiving the treatment, she stayed around with her Ugandan relatives for about one month. That was in September 2007,” he explains.
The current relative peaceful atmosphere after 20 years of war, has attracted some people back to the villages, but basic things like toilets and water are none existent.


“Due to this, the family of her relatives was defecating in the nearby bush. So when she stayed around, she too defecated in the bush,” Obote said.


Prior to this, a Hepatitis E outbreak was killing people in Southern Sudan and because she had been infected, she carried the virus in her fecal matter, says Obote. “In Kitgum, conditions like poor sanitation in both villages and camps with toilet coverage at 17%, leaving many people defecating in bushes favoured the virus. In addition, a number of factors accelerated its spread in 90% of the district.”


One such factor is that Padibe Health Centre IV, like most health centres in the district, with its small staff and 12 beds, handles as many as 1,000 malaria cases each month.
The staff is used to treating serious medical conditions with limited resources. The Hepatitis E outbreak overwhelmed them because there was inadequate laboratory testing gear.


Oyoo says when they discovered that they were dealing with a mysterious disease, they alerted the Ministry of Health. They were instructed to take samples of the infected patients for testing at the Uganda Virus Research Institute (UVRI).
“But UVRI failed to establish what it was and sent the samples to Kenya and South Africa, both UVRI collaborative centres,” Oyoo says.


“The results were not clear, but they suspected Hepatitis, malaria and yellow fever. That was towards the end of October and the disease was spreading fast,” Oyoo says.


Dr. Charles Okot, the head of the World Health Organisation (WHO), Kitgum sub-office, says it was not until WHO investigators arrived in late October that blood samples of patients were flown to the Atlanta Centre for Disease Control for testing. By that time, the health centre had 17 patients suffering from the mysterious illness. Hepatitis E was found in the blood sample of 13 of them.


How does the disease spread?
Okot adds that samples of water sources which were tested showed that wells and household water was heavily contaminated with fecal coli forms.


“Shallow boreholes were also contaminated, while the deep ones were not. At this time, we embarked on health education and advised the people to use pit latrines and consume water from protected boreholes,” he says. “But because people are still in camps with little latrine coverage and less drinking water, the virus continued spreading.”


Hepatitis E is a viral disease transmitted through fecal matter. It is found in the stool of infected persons and animals, and is spread by drinking contaminated water or eating contaminated food.


The disease has an incubation period of 3-8 weeks, making it hard for the victims to realise the symptoms early enough and seek medical help.
“The disease has no cure, however, some patients (about 85%) may recover without visiting a health centre. About 15% will die. We can’t explain why, but what is plausible is that some people have strong immunity.”


How is it that people who have lived in camps for two decades, never experienced anything like this before?
Dr. Okot says Hepatitis E is a new strain in Uganda and with the poor sanitation and personal hygiene at its lowest in the camps, the epidemic has already killed 126 people and left 8,060 people ill.


Okot adds that when the people in the camps realised that the disease was spreading rapidly and killing people, they fled to the villages.


“It is in then that the virus spread to other people, finding its way to the neighbouring districts of Pader and Gulu,” he says.


Government action