In a matter of hours since I wrote about the diagnosis of a child suffering from cholera in the camp for housing the displaced population from Homs, I received yet another ProMED missive, informing us about the diagnosis of a hepatitis outbreak in the same settings. In fact, in addition to the information, there is a request for more information, especially data on the serologic diagnosis of these patients. The ProMED alert, translated by moderators, stands as below:
Viral hepatitis has started to spread among tens of displaced people in Zogra camp near Jarabulus city (125 km or 78 miles north of Aleppo) at the Syrian-Turkish border, which accommodates people displaced from Homs.
A medical source told Smart News on [Thu 19 Oct 2017] that jaundice or viral hepatitis has begun to spread among the displaced people aged 10 to 40 years in the camp. Around 100 cases of the disease have been identified in addition to almost the same number of suspected cases. It is expected that the cause of infection is water pollution, potential contamination of the distributed food or vegetables, and not washing them properly.
The source warned of the spread of infection among a larger number of people if preventive measures are not taken through awareness campaigns and maintenance of sewage networks as soon as possible.
The 10 200 persons living in the camp have previously complained of lack of food and health assistance and lack of water and electricity.
Now, this is not surprising at all, given that the risk of one water borne infection, especially in a conflict setting, is likely to increase the threat of other water borne infections, especially ones following the fecal-oral transmission pathway. Although the post does seek more information on the serology of the patients, one would not be too misplaced if they were to hazard a guess that the likely culprit was Hepatitis E, especially if a large proportion of the sickened population were adults. Hepatitis A is an omnipresent pathogen, especially in settings with inadequate sanitation barrier and constrains on water (both quality and quantity). Consequently, most people acquire the infection in their childhood and bring along the immune response alongwith them. The other worry with Hepatitis E is that although it is usually self-limiting, much like Hepatitis A, in one situation it can precipitate disasters – in pregnant women. Mortality rates in the ~30% are not unforeseen, especially if the diagnosis has been delayed.
Given the disorder which is expected in refugee camps, and the burgeoning numbers of water borne infections starting to crop up, one does feel like this is the beginning of a bad nightmare. With minimal infrastructure and sociopolitical stability available, it is likely that such an outbreak could prove difficult to contain. Immediate reassurance of water quality and quantity, and focusing on breaking the fecal-oral transmission cycle are, therefore, of vital importance.
It remains to be seen how this situation proceeds.