Good news: we carried out the world’s first vaccination campaign against hepatitis E

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It took place in the Bentiu displaced persons camp in South Sudan, where an outbreak of hepatitis E threatened the lives of thousands of people, especially pregnant women, for whom this disease is particularly deadly. This vaccination brings hope and changes for the future in the fight against the disease.

For the first time in the world, South Sudanese medical workers carried out a vaccination campaign in response to an outbreak of hepatitis Etoasting hope in the midst of struggle against a disease that is particularly deadly for pregnant women.

Hepatitis E is the most common cause of life-threatening acute hepatitis, causing approximately 20 million infections and 44,000 deaths each year. It is transmitted through fecal contamination of water and food; and for this reason large scale outbreaks normally occur when water and sanitation conditions are inadequate, as is the case in camps for displaced people. There is no specific treatment for hepatitis E, whose mortality rate is 25% among pregnant women and, in addition, it increases the risk of spontaneous abortions and stillbirths.

“The fight against hepatitis E has been long and frustrating,” explains Dr. Monica Rull, our medical director. “Over the past two decades, MSF has responded to hepatitis E outbreaks in camps for displaced people, attempting to control the disease in challenging conditions and seeing the devastating impact it has on vulnerable communities. With the experience of this vaccination campaign, we look forward to changing the way we fight hepatitis E in the future.”

Nyekhan is vaccinated against hepatitis E

© Peter Caton/MSF

In March and April 2022, Doctors Without Borders and the Ministry of Health of South Sudan jointly carried out the first two rounds of the vaccination campaign against hepatitis E in the camp for internally displaced people in Bentiu, in Unity State in South Sudan. About 25,000 peopleincluding pregnant women, have received the vaccine. A third and final round Vaccination will take place in October 2022.

“Due to the successful implementation and enthusiastic community response in the first two rounds, this innovative vaccination campaign can serve as an example and be replicated in similar contexts to control hepatitis E epidemics,” explains Dr. John Rumuni, Director General of Preventive Health Services at the South Sudan Ministry of Health. “I hope the vaccine will help reduce hepatitis E infections and deaths in Bentiu and elsewhere.”

the of Bentiu is the largest camp for displaced people of South Sudan, and was created in 2014 at the height of the war. Some 11,000 people currently live there, many of them fleeing recent outbreaks of violence and flooding. MSF has been present in Bentiu since its creation and we have witnessed epidemics of hepatitis E since 2015, which have emerged as consequence of the terrible living conditionsincluding lack of adequate access to water, sanitation and hygiene.

In 2021, extreme flooding and new inflows of displaced people, exacerbated already deplorable living conditions, also increasing the spread of waterborne diseases, including hepatitis E. Since July 2021, we have seen 759 patients with confirmed cases of hepatitis E at our hospital in Bentiu, 17 of which, unfortunately, passed away.

Our teams visit residents of Bentiu to vaccinate them against hepatitis E

© Peter Caton/MSF

The South Sudan Ministry of Health asked us to assist in their efforts to control the outbreak through a vaccination campaign on a large scale. The only available vaccine for hepatitis E, Hecolin, has been shown to be highly effective to prevent disease in clinical trials, and the World Health Organization has recommended that its use be considered during outbreak responses since 2015.

However, so far it has only been used individually in China, where it is licensed and used to vaccinate travelers. The vaccination campaign in Bentiu This is the first time it has been used in response to a public health emergency..

A letter describing the vaccination campaign has been published on July 21 in The Lancet Infectious Diseases, and a video presenting the campaign can be found here

“This is an important milestone for global efforts to combat hepatitis E,” says Melanie Marti, medical officer for Immunization, Vaccines and Biologics at the World Health Organization. “This is the first time that a vaccine is used to combat the effects of this life-threatening disease. And this despite the fact that the vaccine has been licensed for more than a decade, and it has been WHO policy to use it in contexts of outbreaks in 2015. At WHO we strongly recommend that all countries facing outbreaks use the vaccine against the hepatitis E, including pregnant women.

The success of the vaccination campaign in Bentiu shows that it is possible to use the vaccine in response to an outbreak, even under difficult conditions. The South Sudan Ministry of Health and MSF are monitoring and reporting the results of the vaccination campaign.

Although it is also necessary to take other control measures, including the improvement of water and sanitation services, the health authorities believe that this vaccination campaign is an important step on the path to reducing the burden of hepatitis E in the future. MSF hope that this campaign will encourage other countries to use the vaccine as part of its measures to control outbreaks of hepatitis E.

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