Investigation of Hepatitis E Outbreak Among Refugees — Upper Nile, South Sudan, 2012-2013

Investigation of Hepatitis E Outbreak Among Refugees — Upper Nile, South Sudan, 2012-2013

Morbidity and Mortality Weekly Report (MMWR)  
Weekly July 26, 2013 / 62(29);581-586

This is a good overview of HEV worldwide and especially in displaced populations. —AF

During the week of July 2, 2012, the deaths of two pregnant women and one child were reported by household mortality surveillance in Jamam refugee camp, Maban County, Upper Nile State, South Sudan. All were reported to have yellow eyes before death. During July 27–August 3, 2012, three adult males with acute onset jaundice were admitted to the Médecins Sans Frontières (MSF) hospital in Jamam camp; two died within 4 days of admission. The Republic of South Sudan Ministry of Health, United Nations High Commissioner for Refugees (UNHCR), CDC, and humanitarian organizations responded through enhanced case surveillance, a serosurvey investigation, and targeted prevention efforts. As of January 27, 2013, a total of 5,080 acute jaundice syndrome (AJS) cases had been reported from all four Maban County refugee camps (Doro, Gendrassa, Jamam, and Yusuf Batil). Hepatitis E virus (HEV) infection was confirmed in a convenience sample of cases in each camp. A cross-sectional serosurvey conducted in Jamam camp in November 2012 indicated that 54.3% of the population was susceptible to HEV infection. Across all camps, an AJS case-fatality rate (CFR) of 10.4% was observed among pregnant women. The outbreak response has focused on improving safe drinking water availability, improving sanitation and hygiene, conducting active case finding, and optimizing clinical care, especially among pregnant women. Sustaining these improvements, along with strengthening community outreach, is needed to improve outbreak control. Further investigation of the potential role for the newly developed HEV vaccine in outbreak control also is needed (1).

Refugees began fleeing armed violence in Blue Nile State, Sudan, in late 2011, initially settling in Doro, the oldest camp. By July 2012, the Maban County refugee camp population surged to 110,000, coinciding with the onset of heavy rains and flooding. Flooding disproportionately affected large sections of Jamam camp, forcing refugee relocation to Gendrassa camp, 12 miles (20 kilometers) away. Yusuf Batil camp, 2 miles (3 kilometers) from Gendrassa, also was rapidly settled during the 2012 population displacement. An acute humanitarian emergency ensued, with crude mortality rates exceeding the emergency threshold of one per 10,000 per day in July and August; diarrheal disease was a leading cause of morbidity and mortality.

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