Clinical and epidemiological characteristics of a hepatitis E outbreak in an internally displaced persons camp in Kassala, Sudan
DOI:
https://doi.org/10.18203/2349-3933.ijam20260387Keywords:
Hepatitis E virus, Outbreak, Internally displaced persons, Kassala, SudanAbstract
Background: Hepatitis E virus (HEV) is a leading cause of acute viral hepatitis in humanitarian settings. In March 2025, a large HEV outbreak occurred in an internally displaced persons (IDP) camp in Kassala, Sudan. The aim of the study was to evaluate the epidemiological and clinical characteristics of the outbreak to inform public health response.
Methods: We conducted a descriptive cross-sectional study using secondary data from the Kassala State Ministry of Health for all reported HEV cases between March and June 2025. Data were analyzed for demographic, clinical, and temporal characteristics.
Results: A total of 1,041 HEV cases were reported. The mean age was 20.3 years, with the highest attack rates in children and young adults (0-19 years). Females were disproportionately affected (60.7% of cases). The most common clinical presentations were dark urine (83.8%), fever (80.1%), and jaundice (74.4%). The epidemic curve peaked in late March, suggesting a common-source exposure. Only 1.6% of cases were laboratory-confirmed, revealing a significant diagnostic gap.
Conclusions: The 2025 Kassala HEV outbreak highlights the vulnerability of IDP populations to waterborne diseases. The findings underscore the urgent need for specific, actionable interventions, including the deployment of rapid diagnostic tests, implementation of point-of-use water treatment, and targeted health education for women and children to prevent future outbreaks.
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References
WHO. Hepatitis E. Fact sheet, 2024. Available at: https://www.who.int/newsroom/factsheets/detail/hepatitis-e. Accessed on 19 February 2026.
Centers for Disease Control and Prevention. Hepatitis E epidemiology and control, 2023. Available at: https://www.cdc.gov/hepatitis-e/hcp/epidemiology-control/. Accessed on 19 February 2026.
Teshale EH, Hu DJ, Holmberg SD. The two faces of hepatitis E virus. Clin Infect Dis. 2010;51:328-34. DOI: https://doi.org/10.1086/653943
Guthmann JP, Klovstad H, Boccia D, Hamid N, Pinoges L, Nizou JY, et al. A large outbreak of hepatitis E among a displaced population in Darfur, Sudan, 2004: the role of water treatment methods. Trans R Soc Trop Med Hyg. 2006;100:976-81. DOI: https://doi.org/10.1086/504321
Perez-Gracia MT, Suay-Garcia B, Mateos-Lindemann ML. Hepatitis E and pregnancy: current state. Rev Med Virol. 2017;27:e1929. DOI: https://doi.org/10.1002/rmv.1929
WHO. Hepatitis E – Republic of South Sudan. Disease Outbreak News, 2021. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2021-DON344. Accessed on 19 February 2026.
Khuroo MS, Khuroo MS, Khuroo NS. Hepatitis E: Discovery, global impact, control and cure. World J Gastroenterol. 2016;22:7030-45. DOI: https://doi.org/10.3748/wjg.v22.i31.7030
Hakim MS, Wang W, Bramer WM, Geng J, Huang F, de Man RA, et al. The global burden of hepatitis E outbreaks: a systematic review. Liver Int. 2017;37:19-31. DOI: https://doi.org/10.1111/liv.13237
Desai AN, Mohareb AM, Elkarsany MM, Desalegn H, Tebeje MG, El-Kafrawy SA, et al. Viral Hepatitis E Outbreaks in Refugees and Internally Displaced Populations, sub-Saharan Africa. Emerg Infect Dis. 2022;28:1038-41. DOI: https://doi.org/10.3201/eid2805.212546
WHO. Hepatitis E - Chad. Disease Outbreak News, 2024. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON517. Accessed on 08 May 2024.
Lagare A, Ibrahim A, Ousmane S, Maina L, Issa A, Ousmane S, et al. Outbreak of Hepatitis E virus infection in displaced persons camps in Diffa Region, Niger, 2017. Am J Trop Med Hyg. 2018;99:756-9. DOI: https://doi.org/10.4269/ajtmh.17-0950
Ahmed A, Seed B, Al-Absi ES, Al-Fatle K, Al-Jardani A, Al-Abri S, et al. Hepatitis E Virus Outbreak among Tigray War Refugees from Ethiopia, Sudan. Emerg Infect Dis. 2022;28:1734-6. DOI: https://doi.org/10.3201/eid2808.220397
Orf GS, El-Kafrawy SA, El-Daly M, Abd-Elsalam S, Soliman S, El-Mokhtar MA, et al. The 2023 South Sudanese outbreak of Hepatitis E virus genotype 1 was caused by a novel subgenotype. J Clin Virol. 2024;175:105749.
Teshale EH, Howard CM, Grytdal SP, Handzel T, Barry V, Kamili S, et al. Hepatitis E epidemic, Uganda. Emerg Infect Dis. 2010;16:126-32. DOI: https://doi.org/10.3201/eid1601.090764
Waqar S, Sharma B, Koirala J. Hepatitis E. Treasure Island, FL: StatPearls Publishing; 2024.
Xu B, Xia J, Yin J, He S, Li H, Zhang J, et al. Clinical features and risk factors of acute hepatitis E with severe jaundice. J Viral Hepat. 2012;19:819-25. DOI: https://doi.org/10.3748/wjg.v18.i48.7279
Spina A, Beversluis D, Irwin A, Chen T, Perea W, MacDonald L, et al. Learning from water treatment and hygiene interventions in response to a hepatitis E outbreak in an open setting in Chad. J Water Health. 2018;16:223-33. DOI: https://doi.org/10.2166/wh.2018.258
Kamani L, Larrat S, Pineda-Ramirez J, Abravanel F, Lhomme S, Izopet J. Hepatitis E: Genotypes, strategies to prevent and manage the infection. Rev Med Virol. 2021;31:e2238.
Al-Shimari FH, Mohammad AH, Al-Salihi SA, Al-Khafaji NS, Al-Mayahi ZS. Systematic review of global hepatitis E outbreaks to inform public health response. BMC Public Health. 2023;23:869. DOI: https://doi.org/10.1186/s12889-023-15792-8
Huang X, Li J, Zhang J, Xia N. Progress and Challenges to Hepatitis E Vaccine Development. Vaccines (Basel). 2024;12:670. DOI: https://doi.org/10.3390/vaccines12070719
Kirkwood CD, Dobscha KR, Lodo J, Edelstein H, Feikin DR, Teshale EH. Hepatitis E should be a global public health priority: recommendations for improving surveillance and prevention. Expert Rev Vacc. 2021;20:137-45.
Lam E, McCarthy A, Brennan M. Vaccine-preventable diseases in humanitarian emergencies among refugee and internally-displaced populations. Hum Vaccin Immunother. 2015;11:2627-36. DOI: https://doi.org/10.1080/21645515.2015.1096457
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