American Society of Tropical Medicine and Hygiene (ASTMH)

American Society of Tropical Medicine and Hygiene (ASTMH)

December 06, 2016
2 min read

High HEV seroprevalence among internally displaced people in South Sudan

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Research presented at the American Society of Tropical Medicine and Hygiene Annual Meeting revealed a high seroprevalence of hepatitis E among internally displaced individuals in Juba, South Sudan, suggesting the rate of transmission may be more common than previously thought, according to researchers.

“There is a lot of transmission going undetected with the possibility of many deaths not correctly attributed to [hepatitis E],” Andrew S. Azman, PhD, from Johns Hopkins School of Public Health, told Infectious Disease News. “To protect people in South Sudan from this disease, we need improved surveillance for the disease and development of a comprehensive plan for hepatitis E outbreak response, ideally including the use of the vaccine.”

According to Azman and colleagues, hepatitis E (HEV) infection causes significant morbidity and mortality globally; however, data on the burden and transmission outside of large, documented outbreaks in East African internally displaced persons (IDPs) and refugee camps is scarce.

For their study, the researchers set out to improve surveillance, control and understanding of HEV by characterizing the population-level exposure to the pathogen. They conducted an age-stratified serological survey among 206 IDPs in Juba, South Sudan, where there are no previously reported cases of HEV. The researchers tested participants’ serum using standard enzyme-linked immunosorbent assays (ELISAs) to estimate the population-level occurrence of HEV seroprevalence, and constructed a series of statistical models using individuals’ sero-status, state of origin and date of arrival at camp to estimate the rate of infection in the camp and the participants’ previous residence.

According to the data, the age-adjusted seroprevalence was 61% (95% CI 54-69) among the IDPs, and three participants had evidence of recent exposure. The researchers observed increasing HEV antibodies with age and a higher seroprevalence among women. They estimated that the rate of HEV exposure was approximately 5 times higher in the Protection of Civilian camp (95% credible interval, 1.2-10.2) than in the participants’ home states.

“The conditions in the displaced person camps in Juba were terrible and ripe for transmission of this waterborne disease, but we hadn’t seen any signs of an outbreak,” Azman said. “Since Hepatitis E transmission is sometimes hard to detect, and we know very little about the epidemiology of this disease, serological studies like this can allow us to better understand the true risk of exposure to the disease.” – by Savannah Demko


Azman AS, et al. Abstract 1889. Presented at: American Society of Tropical Medicine and Hygiene conference; Nov. 13-17, 2016; Atlanta.

Disclosure: Azman reports no relevant financial disclosures.