Calling the shots

  • People deserve to know what is blocking the Hepatitis E vaccine in Nepal
Calling the shots

Jan 26, 2015-

Three months ahead of the 2006 Rhododendron Revolution, I embarked on a short field assignment to the Tarai. Little did I know then that along with memories of having caught a good glimpse of the revered Buddha Boy, I would bring back with me an infection that would almost cost me my life and that of my unborn child.

The hep

I had just entered my final trimester—happy that my nausea had abated and proud of my apparent baby bump—when I returned home from a short uneventful work trip. But within 10 days, I was plagued by lethargy, indigestion, and chronic fatigue—it was then that I was diagnosed with the Hepatitis E Virus (HEV).

Many of us are familiar with this disease by the name of jaundice, although most are unaware of the differences between jaundice in newborns and in adults, especially pregnant women. HEV is very different from Hepatitis B or C, and is more of an acute form of Hepatitis A, transmitted through the ingestion of food or water contaminated with faecal matter.

Despite taking utmost precautions to avoid raw or undercooked food, and only drinking boiled or bottled mineral water, I had contracted the virus. But thanks to early medical detection and full access to support in terms of rest, nutrition, and my family’s undivided care, I managed to recover quickly and was able to carry my pregnancy to full-term.

Countless others have not been as lucky. In an adjoining hospital, I heard the infection took away two mothers along with their babies. Their condition had swiftly deteriorated mainly because by the time they got to a proper doctor, it was too late—the infection had already damaged the liver. Many more continue to share a similar fate, but this is a subject that is little talked of and has not received much attention from either the government or donors.

Endemic to Nepal

In summer last year, Biratnagar saw an outbreak of the virus, infecting over 6,000 people and killing over 10. And this is just one example that the media picked up. With leaky municipal water pipelines running adjacent with the sewer system, drinking water in most parts of the country is prone to faecal contamination, especially during the rainy season. Although the infection is generally thought to have a mild effect, unless one is pregnant or has a pre-existing liver disease, it can quickly spread amongst populations that live together and are poorly equipped in terms of hygiene or sanitation, for example, army camps and refugee or displaced peoples’ camps.

Statistics show that up to 20 percent of pregnant women, especially in their third trimester, infected with HEV can develop liver failure, resulting in the loss of life of both mother and baby. Globally, there are over 70,000 deaths caused by an estimated 20 million HEV infections each year.

HEV has been endemic in Nepal since the early 1970s, and until measures are in place where safe drinking water can be delivered to every home, and until people are made aware of the critical importance of practicing safe hygiene and sanitation, sporadic outbreaks and transmissions will continue. Women and children will continue to lose their lives.

Available next door

Since 2006, we have been hearing news that immunisation against the infection could soon be commercially available, but we have been waiting far too long for a vaccine that is available just next door. The Chinese Government approved the production of the HEV vaccine in 2011 and it has since been available for sale under the name Hepcolin for $22.50. It reportedly achieved 99 percent efficacy in over 100,000 individuals aged between 16 and 60 years. Although the World Health Organisation noted that more analysis needed to be carried out to study its efficacy in pregnant women and younger children, the numbers point overwhelmingly towards a near 99 percent success rate.

In 2003, our own Nepal Army had participated in a similar HEV vaccine trial funded by the US Army and GlaxoSmithKline. But despite the vaccine’s efficacy, GlaxoSmithKline apparently ditched all plans for mass scale manufacturing because they saw very little commercial potential. China must surely think otherwise, as the vaccine is currently being marketed in African countries where HEV is endemic.

The bottom-line is that by immunising swathes of people in high-risk areas, Nepal will not only prevent infections but will also cut costs associated with hospital visits, and in the process, contribute to achieving three of the eight Millennium Development Goals related to cutting child mortality, improving maternal health and preventing diseases.

And now that the vaccine is freely available in China, would it not be natural for us to expect our government to be the first to welcome its usage in Nepal? If not, the people surely deserve to know what is blocking it, how, and why.

Published: 27-01-2015 09:00

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