Acute hepatitis E – Nigeria
On 18 June 2017, the Nigerian Ministry of Health notified World Health Organization (WHO) of an outbreak of hepatitis E located in the north-east region of the country. The first case was detected on 3 May 2017 in Damasak, a locality at the border with the Republic of the Niger. Samples were collected from the case and sent to laboratory for confirmation. Cases were later reported in Ngala, one of the local government areas in Borno State that borders Cameroon. As of 2 July 2017, 146 confirmed and suspected cases were reported including 21 confirmed cases.
In Ngala, 25 infected pregnant women (21%) were reported, including two deaths (case fatality rate = 8%). Cases were reported from three local government areas: Ngala (112), Mobbar (19), and Monguno (14). The number of hepatitis E cases is highest in Ngala with 29 cases reported from 19 June to 2 July 2017. Twenty-seven samples were shipped to the virology laboratory in Lagos for further diagnosis. Among the samples collected and tested, 21 tested positive (10 in Ngala, seven in Mobbar, four in Monguno) and six tested negative. Twenty-three samples have been collected and are pending laboratory tests.
This hepatitis E outbreak can propagate rapidly due to the ongoing humanitarian crisis in the region which arises from the volatile security situation in north-eastern Nigeria and continues to persist. This crisis in Nigeria has been ongoing for eight years and as a result 1.9 million people are internally displaced. The region has been facing intense movements of population coming from refugee camps or displaced populations in the areas bordering Chad and Niger. In addition, the fresh wave of returnees from neighbouring countries is overwhelming the current humanitarian capacity. Returnees began entering the town in January 2017 and so far the town has an estimated population of 90 000, according to International Committee of the Red Cross (ICRC) and immigration officials. The town has one unofficial camp hosting returnees considered as strangers or people not affiliated to any of the indigenous communities who have settled in the town. As a result there is overcrowding which is overwhelming the already weak systems in place. Lack of access to essential water, sanitation, hygiene, and health services may lead to propagation of this disease at a very rapid rate.
Public health response
Coordinating partners in this response include WHO, United Nations Children’s Fund (UNICEF), Oxfam (representing the Water, Sanitation and Hygiene (WASH) sector), Médecins Sans Frontières (MSF), FHI 360, ICRC (working with Nigerian Red Cross) and North East Regional Initiative (NERI). Response activities for this outbreak include the following:
WHO and MSF are supporting case management at no cost to patients and this includes hospitalization of those in need, availability of drugs, and health personnel. Symptomatic case management is supported by MSF at the district level.
Epidemiological surveillance system at health facilities exists with the support of local partners.
Technical support is being provided from WHO and other partners.
As of 15 June 2017, WASH assessed and mapped the current water sources and established contacts for a rapid response in the chlorination of water.
A multisectoral approach needs to be emphasized and coordinated between the State Ministry of Health, Nigeria Centre for Disease Control, and Ministries of Water and Environment.
Public health awareness through sensitizations and announcements in mosques and other public places by local government area health educators is taking place. In addition, local health personnel are being sensitized, eight Volunteer Community Mobilizers (VCMs), the health care staff, MSF, UNICEF and FHI 360.
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