Hepatitis E, like typhoid fever, is a water-borne infection that has caused epidemics in Asia, the Middle East, Africa, and Central America. According to the WHO, one third of the global population may have been infected by the virus, and an estimated 14 million people have the symptomatic disease annually with 300,000 deaths and 5,200 stillbirths. Doctors who look after pregnant women in Nepal know full well the possibly tragic outcome (by some estimates 30 per cent) in pregnant women who are affected by this virus who may go on to suffer fulminant hepatic failure and death.
Hence the drive in certain parts of China to vaccinate women of child-bearing age. The other well- known group pre-disposed to suffering from severe hepatitis E are patients with chronic liver disease. Often patients with cirrhosis (an example of a chronic liver disease) who has been stable will suddenly take a turn for the worse and succumb to their illness when infected by this virus.
Chinese vaccines have been used in Nepal with excellent results. The administration of the Japanese encephalitis (JE) vaccine which is made in Chengdu, China has been instrumental in decreasing JE rates in Nepal, especially in the Tarai. Unlike its Western counterpart, the Chinese vaccine is very cost-effective, and importantly side-effects have been minimal.
The Chinese don't do things in small numbers. The hepatitis E vaccine trial which was published in the Lancet in 2010 revealed that a total of 112,604 healthy adults participated in the trial with 100 per cent effectiveness and good tolerance to the vaccine. Even women who became pregnant during the course of the trial showed no adverse effects of the vaccine. The US Army working together with the Nepal Army and GlaxoSmithKline did work on another effective hepatitis E vaccine almost eight years ago, but unfortunately this vaccine is unavailable. An exercise in futility.
As they did with the successful use of the JE vaccine, Nepal's health ministry will hopefully strongly consider making this vaccine available to the vulnerable population in Nepal.