A number of regions across India have been marked as high risk sites for the hepatitis E virus in a global study by scientists at EPFL, Switzerland.
There are around twenty million HEV infections worldwide and roughly 50,000 deaths from the disease every year according to the World Health Organization (WHO). The EPFL have utilised machine learning, along with data reaching as far back as the 1980s, in order to construct a map of high risk regions.
While the overall prevalence of the hepatitis virus in India is poorly documented, it is well known that outbreaks are both frequent and often widespread. A potential reason for this is the means by which the virus is spread from person to person.
The EPFL study makes note of this, noting that in Europe, China, Japan and North America, the main way people catch HEV is by eating undercooked pork. The resultant illness is often not severe and rarely fatal. By contrast, in many high risk sites in rural India it was found that it was far more likely that the disease was caught through drinking from a contaminated water source.
In many areas of rural India this is a prevailing issue that is the source of a number of different diseases. Many villages and rural settlements have no access to wells, running water or sewage systems. Because of poor sanitation infrastructure, seventy percent of drinking water in India is contaminated.This issue, coupled with the practice of open defecation, causes a number of diseases to run rampant throughout these communities such as hepatitis E, cholera and acute diarrhoeal disease – the latter being India’s most common infectious disease outbreak.
Open defecation often occurs around the vicinity of local streams, ponds and lakes. If any individual is infected with a condition such as hepatitis E or cholera, they run the risk of spreading the infection to the whole community.
The study also mentions that hepatitis E epidemics generally occur after heavy rains and floods or after months-long droughts. This is a grave warning to India as it has seen heavy flooding in the last year, such as in Kerala and Mumbai.
A key concern both during and after the flooding — in addition to the potential for contaminated water — is the potential for mass displacement of individuals affected by the flooding. These people often find themselves in refugee camps until flooding has subsided. In many cases individuals may be forced to stay for prolonged periods of time if property damage is substantial.
The Kerala floods displaced more than a million people, who were sheltered in camps. These situations, where vast numbers of people are forced to stay in densely-packed environments for elongated periods of time, present ample opportunities for infectious disease to spread. The hepatitis E map developed by EPFL could at the very least better inform health experts where outbreaks may occur, allowing preparations of supplies and expertise to prevent such an occurrence.