CDC Partners to Battle Hepititus E Outbreak in Northern Uganda

In October 2007, the largest hepatitis E epidemic ever reported in Africa hit northern Uganda’s IDP camps.  As of November 2008, there are 8,879 cases and 139 deaths. A disproportionate number of deaths were among pregnant women and children under the age of 2 years.

In response to the outbreak, the Ministry of Health invited CDC to investigate the cause of the outbreak, assess its magnitude and impact, identify potential risk factors associated with infection and disease and make recommendations on interventions to help prevent and control the continued transmission of hepatitis E.  In addition, CDC developed laboratory capacity at the Uganda Virus Research Institute in order to confirm HepE infection and through genetic sequencing, showed that the epidemic was caused by HepE genotype 1, the genotype normally associated with epidemics in humans.
 
HepE is a viral disease transmitted via fecally-contaminated drinking water and is characterized by severe jaundice. Like other communicable diseases it can cause an epidemic in locations like IDP camps that struggle with sanitation and clean water supply systems. This epidemic is likely the result of a combination of poor infrastructure due to the prolonged war in the North, the influx of IDPs returning to their homes and poor sanitation and personal hygiene practices.
 
To determine the magnitude and impact of the epidemic, CDC conducted a door-to-door census, seroprevalence surveys, a case-control study, and environmental investigations between May and June 2008. 
 
Results of the CDC investigation show that two sub-counties in Kitgum District were heavily affected by the epidemic.  In Madi Opei sub-county where the outbreak started, 68% of the population had been exposed to the virus with approximately one-third of the population reporting clinical signs of acute hepatitis E infection.  In Paloga, 61% of the population showed exposure to the virus with approximately one-fifth of the population reporting clinical signs of acute hepatitis E infection. 
 
Kitgum District Chairman Komakech John Ogwok told IRIN, "The biggest challenge we have is the attitude of the population." He says many people preferred to visit traditional healers first and only go to health centres as a last resort.
 
On the positive side, the PEPFAR mandate has been expanded to include activities to address safe water and sanitation issues and this will compliment what the Uganda government and development partners have already initiated. Although the numbers of cases has decreased substantially, new cases continue to be reported from Kitgum and Pader Districts.

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