A group of eminent doctors have called for urgent measures to introduce a vaccine against hepatitis E infection into Nepal, where they say the lives of hundreds of women are at risk.
The virus, which spreads in contaminated water, is common in Nepal, but experts said a deadly outbreak is likely when the monsoon rains begin in July. Thousands of people are living in makeshift camps with limited or no access to clean water following the earthquakes.
Harry Dalton, a consultant gastroenterologist at the Royal Cornwall Hospitals NHS trust, the lead author of a letter published in the Lancet medical journal, said: “This strain of hepatitis has a poor outcome in pregnant women, and our calculations suggest that if an outbreak occurs, more than 500 pregnant Nepali women will die.”
Among pregnant women, hepatitis E has a mortality rate of 25%, the doctors said. They wrote: “Earthquake-affected areas are faced with a ‘perfect storm’ of risk factors: large displaced populations with limited access to clean drinking water, a lack of sanitary facilities, the approaching monsoon, an overburdened healthcare infrastructure, large amounts of circulating HEV and an at-risk population who mostly lack protective antibodies.”
The experts, including Jeremy Farrar, the head of the Wellcome Trust, and Peter Piot, the director of the London School of Hygiene and Tropical Medicine, said the risk is high and imminent.
There is a vaccine, but it is only licensed for use in China. The doctors are calling for its speedy introduction into Nepal. The World Health Organisation has said its use should not be precluded in specific situations, such as safeguarding high-risk pregnant women, despite the need for more data on its safety and efficacy.
The doctors want surveillance and testing in Nepal to identify cases and for the Nepalese government to request the vaccine and build up a stockpile.
