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Simple hygiene can prevent Hepatitis E

By Vision Reporter

Added 13th July 2008 03:00 AM

MOST people think poor sanitation can only cause diarrhoreal diseases and worms. To many, Hepatitis E, caused by a contagious virus through poor sanitation, is a surprise. The epidemic has claimed over 67 people and left over 4,000 bed-ridden in Kitgum district in recent weeks.

MOST people think poor sanitation can only cause diarrhoreal diseases and worms. To many, Hepatitis E, caused by a contagious virus through poor sanitation, is a surprise. The epidemic has claimed over 67 people and left over 4,000 bed-ridden in Kitgum district in recent weeks.

By Arthur Baguma

MOST people think poor sanitation can only cause diarrhoreal diseases and worms. To many, Hepatitis E, caused by a contagious virus through poor sanitation, is a surprise. The epidemic has claimed over 67 people and left over 4,000 bed-ridden in Kitgum district in recent weeks.

Health experts say simple day-to-day observance of proper hygiene, like drinking clean water, sinking latrines and washing hands after visiting the toilets, can prevent the epidemic.

“The major remedy to the epidemic is sensitising people on good sanitation and improving the latrine coverage in the country. The Hepatitis E virus (HEV) has no vaccine,” says Dr Charles Mukisa, a medical practitioner.

HEV causes acute (non-chronic) hepatitis. It is spread via the fecal-oral route through contamination of water supplies.

Mukisa says like Hepatitis A, hepatitis E is an acute and shortlived illness that can sometimes cause liver failure.

Large outbreaks (epidemics) have occurred in Asian and South-American countries with poor sanitation. No outbreaks have been reported in the United States and Canada, but persons travelling to endemic areas may return with the virus.

To contain the situation, the health ministry has embarked on increasing latrine coverage in the hepatitis E-hit areas of northern Uganda from the current 6% to 60% in the next six months.

About 150 pit latrines have been constructed over the last three months, according to the state minister for primary health care, Dr. Emmanuel Otaala.

The latrine coverage in the affected area is below the national average of 59%. The millennium development goals’ national latrine coverage target is 72%.

“The only way we can avoid Hepatitis E is by observing proper hygiene and sanitation. The ministry staff is currently sensitising the communities,” Otaala said.
He said the people in the affected areas have been told to stop drinking water from pots and instead use jerrycans.

Pots are porous and can easily store germs. They have wide openings, which make it easy for someone to contaminate the water.

Dr Mukisa says over 20% of the deaths from Hepatitis E are among pregnant women. Over 80% of the reported cases are pregnant women.

He adds that symptomatic infection is common in young adults aged 15 to 40 years. Although hepatitis infection is common among children, it causes mild illness without jaundice and usually goes undiagnosed.

Dr Mukisa says the incubation period following exposure to the Hepatitis E virus ranges from three to six weeks. The period during which an infected person can transmit the disease is unknown.

The illness does not become chronic (long-lasting), but on rare occasions, the acute illness may damage liver cells and render the liver malfunction. This is called fulminant liver failure, and may cause death. Pregnant women are at a higher risk of dying from fulminant liver failure.

Diagnosis
Hepatitis E can be detected by microscopically examining a stool sample, but this is not a reliable test as the virus often dies when stored for a short time. Mukisa says most of the facilities to diagnose the epidemic are available in health centres in Kampala.

Like other hepatitis viruses, HEV stimulates the body’s immune system to produce antibodies to destroy the virus. Blood tests can determine elevated antibody levels, which indicate the presence of the virus in the body.

Since cases of hepatitis E are not clinically distinguishable from other types of acute viral hepatitis, diagnosis is made through blood tests to detect elevated antibodies or by detecting small portions of genetic material through a test known as reverse transcriptase polymerase chain reaction.

Hepatitis E should be suspected in outbreaks of waterborne hepatitis occurring in developing countries, especially if the disease is more severe in pregnant women, or if hepatitis A has been excluded.

If laboratory tests are not available, epidemiologic evidence can help in establishing a diagnosis.

Treatment
Symptoms of any acute hepatitis, including Hepatitis E, cannot be effectively treated. The aim of any treatment would be to alleviate symptoms through bed rest, fluid replacement and setting up strategies to prevent further transmission.

During acute infection, a patient should take a balanced diet and get enough rest. HEV infections are usually self-limited and hospitalisation is generally not required.

No available therapy is capable of altering the course of acute infection, and, therefore, prevention is the most effective approach.

Prevention
No vaccine is available, though several are being tested. The best way to prevent Hepatitis E is to provide safe drinking water. Take precaution to use sterilised water and beverages when travelling.

Since almost all HEV infections are spread by the faecal-oral route, good personal hygiene, high quality standards for public water supplies and proper disposal of waste are the most important public health interventions in the prevention of the disease.

For travellers to highly endemic areas, the usual food and water hygiene precautions are recommended.

These include avoiding drinking water of unknown purity and uncooked fruits or vegetables that are not peeled or prepared by the traveller.

Symptoms of hepatitis E
Jaundice (yellow discolouration of the skin and sclera of the eyes
Dark urine and pale stools
Loss of appetite
Enlarged, tender liver
Abdominal pain and
tenderness
Nausea and vomiting
Fever
The disease may range in severity from mild to life-threatening.

Prevention
Always drink clean water
lWash hands after visiting the toilets

Simple hygiene can prevent Hepatitis E

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