Hepatitis E / Eastern Chad / 2009

Final Reports // Hepatitis E

After the finalization of the study, we present the final results with several adapted reports to achieve maxim dissemination:

- Final Report, communicate at field level for government agencies and other international organizations working in the region. PDF in french

- Manuscript complete, report of the study, presentation for Master’s dissertation. PDF in spanish

- The scientific paper published in a scientific journal (Journal of Water and Health. Impact Factor: 1.64.) PDF in english

Introduction // Hepatitis E

Project title: Environmental study in two settlements based in Eastern Chad: analysis of Human Adenovirus and Hepatitis E Virus in water sources. And an update of public health impact of HEV in the area.
Location of the action: Chad
Lead manager and partners: Intermon Oxfam and University of Barcelona (coordinators)
Dates: 01/06/2009 to 30/10/2010
Donors: Intermon Oxfam (IO), University of Barcelona (UB) and CyO,7
Amount contributed:
IO: 2000 euros, UB: 1200 euros, CyO,7: 1500 euros
Personal Involved: Laura Guerrero, Alberto Ibañez, Rosina Girones

Objectives and results of the action:
The project was possible thank to the collaboration between Intermon Oxfam and the Group of Environmental Virology of the University of Barcelona.
Intermon Oxfam expressed their preoccupation and interest by performing a detailed investigation that allowed them to prevent and contain the appearance of epidemic periods of Hepatitis E in Eastern Chad due to the impact in terms of health that presents in the region.
It seemed interesting to detect the virus in the atmosphere and identify the possible sources of contamination in the refugee camps where IO work since 2007. But for it we needed very sophisticated equipment that we could only find in a reference laboratory.
The Group of Environmental Virology of the UB has more then 25 years experience in research about detection and removal of virus in water. A collaborator from the laboratory went to the field where the study was conducted and samples were collected and shipped to the reference laboratory to be analysed.
Hepatitis E, caused by infection with hepatitis E virus (HEV), is a common cause of acute hepatitis in areas with poor sanitation. In 2003 the conflict in Darfur (Western Soudan) started obligating to thousands of victims to move westwards taking refugee in Eastern Chad.
An outbreak of HEV infection affected around 2000 people in Eastern Chad (Dar Sila) in 2004. Since then, more cases of Acute Jaundice Syndrome (AJS) have been reported in the district of Dar Sila.
The investigation conducted describes the incidence in the region of AJS in the last 5 years. Moreover, water samples from drinking-water sources were screened for enteric viruses to establish the potential circulation of waterborne hepatitis virus and faecal contamination in Goz Amir Refugee camp and Dogdoré site for Internal Displaced People (IDPs).
Review of medical surveillance data indicated that AJS outbreaks are more frequently detected during the rainy season, from May until October, although the incidence (cases/1000 people/year) has been substantially decreasing since the outbreaks that occurred in 2004.
This is the first time that the HEV isolation from water has been attempted in an unstable setting as the context in Eastern Chad with a timely screening of drinking-water. Although the number of samples collected is limited HEV was not detected in the environmental samples tested (water and donkey’s stools), in accordance with the absence of HEV cases during the specific period studied. However the presence of human adenoviruses in low levels in some of the water resources studied indicate that potential routes of faecal contamination for water-borne viruses may exist.
This research has been divulgated to all the humanitarian actors working in the region and the manuscript has been accepted in the Journal of Water and Health from IWA publishing (in press).

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