Reported by Epicentre, a group “embedded” in Médecins sans frontières (MSF), progress is being made in a joint vaccination effort in South Sudan. Alongside this vaccination campaign is an Epicentre study to “evaluate the effectiveness in real conditions” of the vaccine that has demonstrated promise in clinical trials. It has been recommended for use in outbreak responses by the WHO since 2015.
Hepatitis E
The WHO describes hepatitis E as an inflammation of the liver caused by infection with the hepatitis E virus (HEV). An estimated 20 million HEV infections each year cause around 3.3 million symptomatic cases of hepatitis E. The WHO also estimates that hepatitis E caused around 44,000 deaths in 2015.
The virus is transmitted through the faecal-oral route, largely through contaminated water. It is prevalent in East and South Asia but exists worldwide. Large outbreaks occur in situations where water and sanitation are inadequate, such as in mass displacement camps. With no specific treatment for hepatitis E, it has a fatality rate of up to 25% among pregnant patients and increases the risk of spontaneous abortions and stillbirths. Although there is a vaccine in China, it is not yet available elsewhere. The vaccine, Hecolin, has been shown highly effective in clinical trials.
Dr Monica Rull, Medical Director of MSF, describes the fight against hepatitis E as “long and frustrating”. In recent decades MSF has responded to outbreaks in displacement camps, attempting to “control the disease in challenging conditions”. It is made harder by seeing the “devastating impact on extremely vulnerable communities”.
“With the experience of this vaccination campaign, we hope to change the way we tackle hepatitis E in the future”.
Bentiu camp
Bentiu camp is in Unity State, South Sudan. It was established in 2013 and has around 112,000 people. Hepatitis E outbreaks began in 2015 and worsened in 2021 due to “extreme flooding” and an increase in displaced people. MSF has a hospital in the camp and has seen 759 confirmed cases, with the unfortunate deaths of 17 patients.
The Ministry of Health of South Sudan requested that MSF help efforts to control the outbreak through a large-scale vaccination campaign. Although Hecolin has been recommended for outbreak responses by WHO, this is the first time it has been used in response to a public health emergency.
Real time, real conditions
Alongside the mass vaccination programme, Epicentre is studying “coverage and acceptance” as well as the effectiveness and safety of the vaccine. Dr Robin Nesbitt, an epidemiologist at Epicentre, suggests that 91% of the target, 24,469 people, received the first dose of the vaccine in March 2022. 95% received the second dose in April 2022. It is hoped that generating this additional data through ongoing studies will “allay some fears associated with the introduction of newer vaccines”. Furthermore, Epicentre aims to contribute to the “relatively sparse data” on the vaccine in pregnant women, who “suffer the most serious consequences” of infection.
Dr John Rumunu of the South Sudan Ministry of health observed the “successful implementation and the community’s enthusiastic response”.
“I hope the vaccine will help reduce infections and deaths from hepatitis E in Bentiu and beyond.”
The collaboration between the Ministry of Health and MSF will complement outbreak control measures, such as improving water and sanitation services. Additionally, MSF hopes the campaign will “encourage other countries to use the vaccine” in the future to address any further outbreaks.
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