Hepatitis E is the commonest cause of adult jaundice in Nepal. The infectious diseases hospital in Teku will soon witness the annual rise in Hepatitis E patients. This viral disease is transmitted (to put it crudely) through the consumption of faeces. In Kathmandu, this act is not difficult to envision. Vegetables washed in the Bishnumati River are brought to party palaces and restaurants and served as fresh green salad. If they were properly cooked or soaked in adequately iodinated water for at least 20 minutes, there would be less of a problem; but eating these vegetables uncooked increases the risk of acquiring Hepatitis E and other interesting organisms. Most people that are afflicted by this disease eventually recover, but if you are pregnant, things could easily take a turn for the worse. Twenty to thirty per cent of pregnant women with Hepatitis E die of liver failure.

Twenty-one-year old Gyanu Thapa, an affluent housewife in Kathmandu, always drank boiled water at home. But when she was pregnant she craved the momos from a little restaurant on the street. She thought it was OK to drink the tap water served there, only to come down with jaundice and eventually Hepatitis E. Within weeks she died of fulminant liver failure despite the best efforts of her physicians. A vaccine could have prevented her tragic death.

An effective Hepatitis E vaccine was developed five years ago with the collaboration of the Nepal Army, Glaxo Smith Kline, and the US Army. But Glaxo lost interest in its commercial development when it realised that this product would not rake in the money. The good news is that the Chinese have recently developed an effective Hepatitis E vaccine (HEV 239) and appear to be determined to make sure it does not go the Glaxo way.

A dependable supply of clean drinking water would eliminate this problem. But that, of course, is easier said than done in Nepal.