Hepatitis E vaccination during floods and monsoon rains

Pakistan has a population of 227 million people with almost 48% of the population comprising females.  Currently, the country is passing through the worst floods and their aftermath. Almost one-third of the country is under water leading to the loss of lives both of humans and livestock. As per government estimates, 33 million people across the country are affected by floods including 8.2 million women of reproductive age.

According to a UNFPA report of 30 August 2022, following floods, there are 6.4 million people who are in need of humanitarian assistance in Pakistan, with more than 1.3 women of childbearing age. UNFPA estimates that there are 650,000 pregnant women in the flood-affected areas who need maternal care and almost 73,000 women are expected to deliver next month. Similarly, about one million women and girls are at risk of gender-based violence because of the destruction of 1 million houses due to floods.

Floods and rains provide an ideal environment for mixing of drinking water with sewage water leading to the outbreaks of waterborne diseases like Dysentery, Diarrhea, Typhoid, Hepatitis A and E. Though these diseases can be easily prevented by consuming boiling water or bottled water under the current circumstances of floods and migration to a safe place, it is impossible to get clean drinking water and therefore people in distress are compelled to consume contaminated water. Though most of these diseases are self-limiting many suffer due to dehydration, electrolyte imbalance, and ill health.

Hepatitis E is a waterborne virus that mostly affects adults resulting in fever, vomiting, and yellow eyes with deranged liver functions. Though a large majority of people who get infected with Hepatitis E recover in over 8-12 weeks but elderly people, those with already existing liver disease, and immune suppressed individuals may have a difficult recovery.

Pregnant women when exposed to Hepatitis E virus suffer more with more severe disease. Almost 15-20% of pregnant women who get infected with hepatitis E may suffer from complications of Hepatitis E that may lead to abortion or death of the baby or may even lead to liver failure and death of the mother.

Data from many public and private sector tertiary care hospitals in Pakistan show a high admission rate of pregnant females suffering from Jaundice and Hepatitis E during the monsoon and rainy season. The disease in these women progresses very fast with many becoming very serious within days. Soon after admission, these hepatitis E-suffering pregnant women are often delivered early to save the baby and the mother.

Pakistan is fortunate to have a registered Hepatitis E vaccine available for ready use. It is given as 3 doses that are given Intra muscular at 0,1 and 6 months apart. The vaccine has minimal side effects and the immunity/protection lasts for 10 years. It is the best time to prevent this viral infection not only in the displaced pregnant women but also in all women of child bearing age, patients suffering from chronic liver diseases, elderly and immune compromised people to prevent the disease and save lives.

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