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HomeEnvironmentRevolutionizing Epidemic Control: The Impact of Hepatitis E Vaccination

Revolutionizing Epidemic Control: The Impact of Hepatitis E Vaccination

 

Hepatitis E is a viral liver illness that can be severe and is spread through water that is not safe to drink. Populations with insufficient access to clean water and sanitation face a higher risk. In South Sudan, outbreaks of hepatitis E have frequently affected camps housing internally displaced individuals and local communities. Despite the availability of a vaccine since 2011, its requirement of three doses complicates significant administration in these situations. A collaborative research effort involving Médecins Sans Frontières (MSF), MSF Epicentre, Johns Hopkins University (JHU), the South Sudan Ministry of Health, the World Health Organization (WHO), the University of Geneva (UNIGE), and the Geneva University Hospitals (HUG) conducted clinical and laboratory assessments following a vaccination campaign to evaluate how effective it was in safeguarding individuals and aiding in the control of the outbreak. Their findings indicated that the vaccine was effective with just the first two doses. These outcomes are published in the Lancet Infectious Diseases.

Hepatitis E poses significant risks, particularly to pregnant women and individuals with ongoing health issues, carrying a mortality rate that can reach 10-50%. ”The symptoms of hepatitis E resemble those of other illnesses that result in acute jaundice, complicating detection efforts. Although global incidence figures remain unclear, some estimates suggest approximately 50,000 fatalities annually,” elaborates Andrew Azman, an epidemiologist with the UNIGE-HUG Centre for Emerging Viral Diseases, MSF, and JHU, who led this study. ”The Bentiu camp in South Sudan, which shelters over 100,000 people displaced by civil conflict, frequently suffers from hepatitis E and other waterborne disease outbreaks, likely due to inadequate sanitation and recurrent flooding.”

The Hecolin vaccine, developed in China, has been recommended by WHO as a potential response to outbreaks since it received licensing in certain countries in 2011. Prior to this outbreak context, it had only been utilized in controlled clinical trials and in travel medicine within China. ”Studying the vaccine’s effectiveness in diverse populations and in areas with a different virus strain than what is found in China was crucial, as was assessing the operational feasibility of implementing a vaccination campaign,” notes Isabella Eckerle, Professor at the Faculty of Medicine and Director of the UNIGE-HUG Centre for Emerging Viral Diseases. ”Understanding its effectiveness following just two doses, as opposed to the standard three doses administered 6 months apart, was particularly important.”

A unique collaboration for research

The Centre for Emerging Viral Diseases, a specialized center co-managed by HUG and the UNIGE Faculty of Medicine, provided scientific expertise to MSF’s field teams responsible for the clinical elements of this study. ”The vaccination initiative focused on individuals aged 16 and older and unfolded in three rounds during March, April, and October 2022,” states Iza Ciglenecki, Operational Research Coordinator at MSF Switzerland. ”Our investigation then compared vaccination rates of 201 hepatitis E-positive patients from May to December 2022 with those of symptomatic-free individuals in the same area. Although the number of hepatitis E cases post-vaccination was lower than expected, our study demonstrated that two doses of the vaccine were effective, a remarkable outcome considering the difficult conditions in a displaced persons camp.”

The biological characteristics of the virus and immune responses were further analyzed using samples sent to the laboratories of the Centre for Emerging Viral Diseases. ”These lab findings, which posed challenges in on-site execution, confirmed the protective effect of the vaccine and enhanced our understanding of the virus’s transmission and diagnostic test performance, informing better outbreak response strategies in the future,” highlights Isabella Eckerle. ”This project exemplifies a fruitful collaboration between MSF’s operational skillset and our expertise in translational research and diagnostic accuracy!”

A global vaccine stockpile by WHO

As a result, the study validates that two doses of this vaccine provide protection, even amidst an outbreak, and lead to a reduction in disease occurrence. ”Our findings, along with others, have contributed to the recent approval by WHO’s International Coordinating Group (ICG) on Vaccine Provision of a hepatitis E vaccine stockpile for emergency situations. This stockpile has the potential to save numerous lives, and we eagerly anticipate its implementation. These results have also played a role in shaping WHO recommendations regarding a two-dose schedule,” concludes Andrew Azman.