After earthquake, Nepal faces ‘perfect storm’ for hepatitis

Following the earthquakes in Nepal, the country faces an extremely high risk of hepatitis E during this summer's monsoons. "We are now seeing that it is likely a major cause of maternal deaths in countries where it is common," says Alain Labrique. (Credit: Gates Foundation/Flickr)

Following the devastating earthquake in Nepal that killed 8,800 people and injured more than 23,000, survivors face an extremely high risk of hepatitis E during this summer’s monsoons, experts warn.

As many as 500 expectant mothers could die from the virus in the coming months and many more could be sickened by the disease, that is primarily spread from feces to mouth via contaminated water.

“Earthquake-affected areas are faced with a ‘perfect storm’ of risk factors: large displaced populations with limited access to clean drinking water, lack of sanitary facilities, the approaching monsoon, overburdened health care infrastructure, large amounts of circulating HEV, and an at-risk population that mostly lacks protective antibodies,” the researchers write.

Neglected virus

The magnitude 7.8 initial earthquake demolished homes and buildings across Nepal, leaving, hundreds of thousands of survivors homeless. The quake also triggered avalanches, reportedly killing or fatally injuring at least 22 climbers on Mount Everest. The aftershocks included one of magnitude 7.3 on May 12.

Now, continuing threats include hepatitis E, which infects an estimated 20 million people in the world annually. While the virus can lead to liver disease, it mostly runs its course with few long-term complications. Pregnant women, however, have a mortality rate of 25 percent when infected by the virus.

“Hepatitis E is a neglected virus that isn’t well understood, but we are now seeing that it is likely a major cause of maternal deaths in countries where it is common,” says Alain Labrique, associate professor of international health and epidemiology at Johns Hopkins University and an author of the consensus statement in The Lancet.

“We are compelled to advocate for measures that reduce the risk of preventable mortality.”

Recommended steps

There is a vaccine, but it is currently only licensed in China. The World Health Organization has not recommended routine use because of a need for additional safety and efficacy data, particularly in pregnant women.


WHO has also said, however, that vaccine use should be “considered” in HEV outbreaks. The researchers estimate more than 400 pregnant women could be saved if the vaccine were used in Nepal during monsoon season, which runs from July to September.

The statement offers several recommendations for Nepal health authorities:

  • Actively work to identify cases of the disease in places where pregnant women are being treated
  • Obtain a vaccine and build a stockpile
  • Develop targeted vaccine deployment strategies, based on identification of high-risk populations and the available organizational capacity for safe implementation and monitoring of outcomes.

Other authors of the statement are from the Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Kathmandu, Nepal; the University of Exeter; Université Paul Sabatier; the University of Chicago; the Wellcome Trust; and the London School of Hygiene and Tropical Medicine.

Source: Johns Hopkins University