WHO EMRO Weekly Epidemiological Surveillance: Volume 14; Number 48; November 28, 2021 – Sudan

Big event in progress

Update on hepatitis E virus in Sudan

Sudan’s Federal Ministry of Health continues to report cases of acute jaundice syndrome caused by hepatitis E virus (HEV) infection, mainly in the camps. As of Friday, November 12, 2021 (week 45), 1,831 HEV infections, including three associated deaths, have been reported with an attack rate (AR) of 0.6 / 1000 and a case fatality rate (CFR) of 0.16 %

Editorial note

HEV is endemic in many African countries and has caused multiple epidemics. In Sudan, several outbreaks of HEV have been recorded in the past, particularly in camps for internally displaced persons in the Darfur region. As of week 45 of 2021, 1,831 cases of HEV infection, including three associated deaths, were reported in Sudan (AR 0.6 / 1000; CFR 0.16%). Gedarif state reported 78.6% of the total cases, followed by South Darfur with 17.4%.
In week 45 of 2021, eight new suspected cases of HEV were reported without fatalities in the eastern locality of Jabal Marra, South Darfur (see table). In addition, UNHCR reported 87 suspected cases of HEV in “Village 8” refugee camp and Om Rakouba camp in Gedarif, as well as 13 other cases in Hamdayet refugee camp in Kassala. Five suspected cases of HEV have also been reported in Tawela, in North Darfur. In addition, an outbreak of HEV is currently being reported in an IDP camp in Bentiu, South Sudan, near the border with Sudan where there are migratory routes.

Hepatitis E is an acute viral hepatitis caused by infection with HEV with an incubation period of two to 10 weeks after exposure.
The disease usually begins with an acute viral syndrome with mild fever, marked loss of appetite, aversion to food, upper abdominal discomfort, nausea and / or vomiting.
Jaundice can appear a few days after symptoms and usually persist for one to six weeks, then gradually go away. Most HEV infections occur without any symptoms or only as mild illness without jaundice, and most people affected will make a full recovery.

A small proportion of infected people (0.5 to 4.0%) progress to acute hepatic failure (ALF), normally within a week of symptom onset, this phenomenon being more common in pregnant women. ALF is characterized by altered mental status (encephalopathy) and bleeding (coagulopathy) due to a decrease in clotting factors. HEV mortality rates are higher in pregnant women (19.3–63.6%). All people with ALF have a high death rate (up to 50%). HEV is excreted in the stools of infected people, passes through the fecal-oral route, and enters the human body through the intestine. Transmission occurs primarily through contaminated drinking water.

The response activities to the HEV epidemic in Sudan focused on the application of water, sanitation and hygiene (WaSH) strategies. Water quality monitoring is ongoing in the affected areas. Water chlorination protocols have been strengthened in all refugee and IDP sites, while hygiene promotion messages on the drinking water chain, proper food handling, washing of hands, consumption of chlorinated water and use of latrines are ongoing. Routine solid waste cleaning was carried out and hygiene products, including soap, were distributed to the camps. Surveillance and laboratory capacities have been strengthened in all affected areas.

WHO continues to work with the ministry and its partners to support the implementation of prevention and control strategies to contain the epidemic in Sudan.