Multi-sectoral response to the hepatitis E epidemic in the Adré health district.

Abstract

In 2024, Chad experienced its third hepatitis E epidemic in the provinces affected by the Sudanese refugee crisis. A total of 3,099 cases of hepatitis E were reported, including 12 deaths, representing a case fatality rate of 0.4% in the Adré health districts. These cases are distributed as follows: 152 (4.9%) in indigenous communities, 2,947 (95%) in refugee camps and transit zones. The most affected population are 6-17 year olds (1,649 cases), representing 53.2%. Pregnant women represent 1.5%, with 47 cases and 2 deaths, representing a case fatality rate of 4.3%.

The overall case fatality rate in the study period and area is 0.4%, lower than the expected rate of 0.5 to 4%. Even among pregnant women, this rate is 4.30% lower than the expected 10-50%.

The CATI approach, using a multisectoral intervention (IPC, RCCE, community engagement, and ownership), implemented in the Adré district, enabled rapid control of the hepatitis E epidemic and significantly reduced the incidence and case fatality rate among pregnant women, the most at-risk group. Other unexpected results achieved include the positive externality of the intervention in terms of cholera prevention and the responsiveness of the community early warning system.

The results obtained remain fragile due to the restriction of humanitarian funding.