Investigation of hepatitis E outbreak among refugees - Upper Nile, South Sudan, 2012-2013

Abstract

During the week of July 2, 2012, the deaths of two pregnant women and one child were reported by household mortality surveillance in Jamam refugee camp, Maban County, Upper Nile State, South Sudan. All were reported to have yellow eyes before death. During July 27-August 3, 2012, three adult males with acute onset jaundice were admitted to the Médecins Sans Frontières (MSF) hospital in Jamam camp; two died within 4 days of admission. The Republic of South Sudan Ministry of Health, United Nations High Commissioner for Refugees (UNHCR), CDC, and humanitarian organizations responded through enhanced case surveillance, a serosurvey investigation, and targeted prevention efforts. As of January 27, 2013, a total of 5,080 acute jaundice syndrome (AJS) cases had been reported from all four Maban County refugee camps (Doro, Gendrassa, Jamam, and Yusuf Batil). Hepatitis E virus (HEV) infection was confirmed in a convenience sample of cases in each camp. A cross-sectional serosurvey conducted in Jamam camp in November 2012 indicated that 54.3% of the population was susceptible to HEV infection. Across all camps, an AJS case-fatality rate (CFR) of 10.4% was observed among pregnant women. The outbreak response has focused on improving safe drinking water availability, improving sanitation and hygiene, conducting active case finding, and optimizing clinical care, especially among pregnant women. Sustaining these improvements, along with strengthening community outreach, is needed to improve outbreak control. Further investigation of the potential role for the newly developed HEV vaccine in outbreak control also is needed.

FIGURE 1

Acute jaundice syndrome (AJS) cases, by surveillance week — Jamam, Gendrassa, and Yusuf Batil refugee camps, South Sudan, 2012–2013

FIGURE 2

Cumulative acute jaundice syndrome (AJS) incidence, by age group — Jamam, Gendrassa, and Yusuf Batil refugee camps, South Sudan, July 2012–January 2013

FIGURE 3

Acute jaundice syndrome (AJS) hospital admissions and weekly hospital case-fatality rate (CFR), by week of hospitalization — Jamam, Gendrassa, and Yusuf Batil refugee camps, South Sudan, 2012–2013* * Hospital CFR not reported if the number of AJS hospital admissions in a given week was ≤5.