Hepatitis E is probably the commonest cause of adult jaundice in Nepal.Outbreaks are common in the summer in Nepal. This viral disease is transmitted through the fecal- oral route. In Kathmandu this act is not difficult to envision. Vegetables washed in the Bishnumatiriver are brought to wedding parties and restaurants and served up as fresh green salad. If they were properly cooked or soaked in adequately iodinated water for at least 20 minutes, there would be less of a problem; but uncooked, these vegetables pose a threat of acquiring hepatitis E and other interesting organisms. Most people that suffer from this disease eventually recover, but if you are pregnant and acquire hepatitis E, things could easily be life threatening( see below).
A potentially life-saving vaccine for our part of the world hasjust recently been approved by China’s State Food and Drug Administration.The world’s first commercial hepatitis E vaccine (Hecolin) is now available in China, and the Chinese are targeting the vaccine on their vulnerable population (women of child-bearing age and patients with chronic liver disease) who, if affected by hepatitis E often suffer life-threatening complications of this viral disease.
Hepatitis E like typhoid fever is a water-borne infection that has caused epidemics in Asia, the Middle East, Africa, and Central America. According to the WHO, one third of the global population may have been infected by the virus, and an annually estimated 14 million people have the symptomatic disease with 300,000 deaths and 5200 stillbirths. Doctors who look after pregnant women in Nepal know full well the possibly tragic outcome ( by some estimates 30 %) in pregnant women who are affected by this virus who may go on to suffer fulminant hepatic failure and death. Hence the drive in certain parts of China to vaccinate women of child-bearing age.The other well- known group predisposed to suffering from severe hepatitis E are patients with chronic liver disease. Often a patient with cirrhosis (an example of a chronic liver disease) who has been stable will suddenly take a turn for the worse and succumb to their illness when infected by this virus.
Chinese vaccines have been used in Nepal with excellent success.The administration of the Japanese encephalitis ( JE) vaccine which is made in Chengdu, China has been instrumental in decreasing Japanese encephalitis rates in Nepal, especially in the Terai region. Unlike its Western counterpart, the Chinese JE vaccine is very cost-effective, and importantly side-effects have been minimal.
The Chinese don’t do things in small numbers. The hepatitis E vaccine trial which was published in the prestigious medical journal Lancet in 2010 revealed that a total of 112, 604 healthy adults participated in the trial with 100 % effectiveness and good tolerance to the vaccine. Even women who became pregnant during the course of the trial had no adverse effects of the vaccine. The US Army working together with the Nepal Army and GlaxoSmithKline did work on another effective hepatitis E vaccine almost eight years ago, but unfortunately this vaccineis unavailable. An exercise in futility.
As they did with the successful use of the Japanese Encephalitis vaccine, Nepal’s health ministry will hopefully strongly considermaking this vaccine available to the vulnerable population in Nepal.