By guest contributor Diyani Dewasurendra
According to WHO’s Hepatitis Report 2024, hepatitis, a viral inflammation of the liver, has become the 2nd leading infectious cause of death globally (same as tuberculosis), leading to 3500 deaths per day! Hepatitis B and C are commonly recognized as the most prevalent forms of viral hepatitis with approximately 83% of hepatitis-related deaths associated with hepatitis B, while the remaining 17% are linked to hepatitis C.
63% of the new hepatitis B infections affect the African region, and yet only 18% of newborns in the region receive the hepatitis B birth-dose vaccination. Without interruption of vertical transmission of hepatitis B, elimination of hepatitis B will remain unattainable.
Recently WHO updated its guidelines for treating hepatitis B in March 2024. The new guidelines prioritise simplifying its treatment criteria for adults and adolescents, as well as expanding eligibility for antiviral prophylaxis for pregnant women to prevent mother-to-child transmission of HBV. As a result, hepatitis B diagnosis and care are now more accessible on a global scale.
While this is a step forward, hepatitis E, which is estimated to affect 20 million individuals worldwide, is often neglected. Hepatitis E is a faecal-orally transmitted infection, primarily transferred through contaminated water which has the potential to impact several thousand individuals leading to outbreaks. Many of these outbreaks have taken place in regions experiencing conflict and humanitarian emergencies, such as war zones and camps for refugees or internally displaced persons, where ensuring proper sanitation and access to safe water presents significant challenges.
The WHO has recently announced a hepatitis E outbreak in Chad’s eastern province of Ouaddai which has reported over 2000 suspected cases as of April. MSF personnel working in the refugee camps in the Sila region are addressing and responding to this outbreak.
Access to clean water is a valuable means to combat this outbreak, demonstrating that Hepatitis E hits the most vulnerable populations in precarious situations. MSF is addressing the limited access to clean water, we have surveyed nearby water points, donated supplies, trained health workers in chlorine use at Koukou Hospital, engaged with the water committee to promote hygiene practices, and repaired hand-powered pumps to improve access to safe water. Currently, a total of 97 mass sensitization sessions have been conducted, reaching over 1600 individuals. A special focus has been placed on pregnant women who are at high risk and have been identified and registered in Daguessa, Awine Rado, and Goz Achiye camps.
Due to the distinct taste of chlorinated water, local populations may be hesitant to accept the taste. Therefore, it is necessary to engage with the community before any chlorination begins. Strong coordination and advocacy for bucket chlorination is also a must moving forward. Bucket chlorination involves stationing a community member near a water source to add a known dose of chlorine directly into the water collection container, ensuring the water is safe to drink. Additionally, flocculants, used to remove suspended solids from water are not readily available in local markets and must be sourced from outside the country.
In addition to outbreak response, MSF is also actively vaccinating vulnerable populations. During the hepatitis E outbreak in Bentiu, South Sudan in 2022, MSF conducted a mass vaccination campaign to demonstrate the safety and efficacy of the vaccine HEV 239 (Hecolin). As the first-ever hepatitis E vaccination outbreak response campaign, participants included adults, adolescents and even pregnant women who are often regarded as the most vulnerable. Pregnant women can have case-fatality rates as high as 25% and infection during pregnancy poses substantial risks of miscarriage, stillbirth, and neonatal death
Overall, MSF played a pivotal role in reducing the price of hepatitis C antiviral treatment, increasing access to affordable, quality-assured generics in low- and middle-income countries. Simplified and decentralized models of HCV care were developed by MSF, supporting global policy changes and impacting lives much beyond our projects. However, there is still a significant lack of access for the most affected populations; for instance, despite the fact that vaccination against Hepatitis B is very effective and evidence-based PMTCT and hepatitis C is curable, we are still facing gaps in access to basic diagnostics and treatment for those most in need.
Humanitarian organizations need to strengthen our advocacy even more to ensure access to care and treatment for all vulnerable populations. We must also work to narrow the gap and reduce the obstacles in accessing treatment and care for people affected with hepatitis infection.
About the author
Diyani Dewasurendra has worked with MSF as a doctor focusing on infectious and chronic diseases in various settings with a focus on refugee health.
Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.
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