… As nation intensifies war against Hepatitis E
By Elvis Muraranganda
IT has been exactly three months since the first identified case of Hepatitis E infection was identified at a Windhoek public health facility, and since then, close to 300 possible cases has been recorded at the nation’s hospitals.
However, global health authorities say Namibia is a still a safe place to travel to and trade with.
In December last year, the Health and Social Services Ministry made a public announcement about the outbreak, and in the same breath, issued a strong warning against unhygienic tendencies, which are a breeding ground for Hepatitis E.
At press conference at the time, the ministry further indicated that most of those, who had reported to various health centres in the capital with symptoms of the virus, were residents of Windhoek’s informal settlements.
These patients had reported particularly to the Katutura Intermediate Hospital, with symptoms suggestive of liver disease.
Hepatitis E is caused by the Hepatitis E virus (HEV) and is spread by contaminated water within endemic areas, or through the consumption of uncooked or undercooked meat.
Despite authorities continuing to arrest the outbreak and preventing new infections, Namibia has received a clean bill of health from the World Health Organisation (WHO), as a travel destination and a trade partner.
In a statement this week, the WHO said it will at this stage not recommend any restriction on travel and trade to Namibia, “based on the information available on the current event”.
The global body, however, advised the implementation of general hygiene practices and other preventive measures, which it believes should be sufficient to prevent the disease.
In its risk assessment, the WHO indicated that although hepatitis A, B, and C are common in Namibia, Hepatitis E is rarely diagnosed in the country.
“As a result, the country has limited capacity for Hepatitis E laboratory diagnosis. Additionally, the majority of Hepatitis E cases have been reported from informal settlements within the capital district, Windhoek, where living conditions are poor. These areas are overcrowded, and have limited access to safe drinking water, sanitation, and hygiene.
“Moreover, the holiday season will likely increase the movement of people within the country. All of these could be major contributing factors to this outbreak,” the WHO report said.
According to the WHO, during the rainy season, people often use rainwater or other surface water for drinking and domestic uses. This, it says, is likely increases the risk of Hepatitis E infection.
“Therefore, the above-mentioned factors might lead to the propagation of the cases from this area to other informal settlements and its distribution to other towns or districts, with similar poor environmental health conditions. Thus, the overall risk is assessed as high at the national level and low at regional and global levels.”
In their advice to Namibia, the WHO recommends the improvement of access to safe water and proper sanitation, through different methods, including at home water purification techniques.
It further indicated that the water quality should be regularly monitored in the affected areas, while the number of latrines in the different settlements should be increased, to address the issue of open defecation.
“In addition, the waste management and the overall hygiene practices should be improved.”
Furthermore, the WHO advises that the ongoing interventions should be target the at risk population, through the establishment of antenatal counselling for pregnant women, improving housing conditions for those living in informal settlements and supporting the improvement of health facilities and patient care.
“The local and national reference laboratory capacities should be improved, for timely confirmation of suspected cases.”
The WHO also recognised ongoing efforts by Namibian authorities in curbing Hepatitis E, and noted that already in December last year, the national, regional, and district health emergency management committees were activated, and that the City of Windhoek was informed of the outbreak.
According the world body, five different working groups have been formed to strengthen coordination, and plan response activities under the following thematic areas: surveillance and laboratory, case management, coordination and logistics, WASH, environmental health and social mobilisation.
“The ministry of health is currently leading the case management teams and all suspected cases have been referred to hospitals for treatment.
“To further strengthen surveillance and laboratory response activities, data collection and reporting tools have been distributed to health facilities. Case reporting and investigation, and line listing of cases, have been enhanced.
“An environmental health team from the Ministry of Health and Social Services and the City of Windhoek are currently conducting environmental investigations, to identify exposures that led to the outbreak,” the WHO said.
It also took note of the ongoing national radio campaign, to sensitise the affected communities to the risk of Hepatitis E, as well as the regular briefing of the public, regarding the outbreak, while the City of Windhoek has tested the water quality of the affected areas and continues to monitor, routinely.
“The ministry of health has deployed a field epidemiologist to support the community engagement teams, to ensure active case search and coordinated targeting of areas with active transmission.”
Other efforts include community sensitisation and mobilisation activities in areas at high risk of Hepatitis E, by Red Cross volunteers and community health workers.
Confidente. Lifting the Lid. Copyright © 2015