Title : Silent epidemics and fragile systems: Hepatitis E outbreak response in Nigeria’s internally displaced populations
Abstract:
Background: Hepatitis E virus (HEV) continues to challenge public health systems in low-resource and crisis-affected regions, with displaced populations facing heightened vulnerability. In 2017, Borno State, Nigeria’s epicenter of armed conflict and host to large internally displaced persons (IDP) camps—experienced an atypical hepatitis E outbreak spanning seven local government areas (LGAs). With fragile infrastructure and limited diagnostics, early detection and rapid containment posed unique challenges. We aim to describe outbreak dynamics, identify risk hotspots, and evaluate context-adapted public health interventions for hepatitis E among displaced populations.
Methods: A retrospective descriptive analysis was conducted from May to July 2017. Surveillance data from health facilities and IDP camps were compiled. Case definitions followed WHO/CDC standards. Active case search, geo-mapping, environmental assessments, and stakeholder interviews were employed. Blood and urine samples from suspected cases were tested using ELISA and PCR at the Lagos Virology Reference Laboratory.
Results: A total of 244 cases were identified, with 39 laboratory-confirmed. The epicenter was Ngala (77.9%), near international borders with Niger and Cameroon. Male cases accounted for 54.9%, with a mean age of 44.9 years. The epidemic curve showed a propagated pattern with a serial interval of 7 days, suggesting sustained transmission. The case fatality rate was low (0.06%), but pregnant women remained a high-risk group. Environmental assessments revealed fecal contamination and chlorination failure in water sources. Rapid interventions including health education, hyperchlorination, and antenatal prioritization resulted in a sharp decline in new cases.
Conclusion: This outbreak illustrates the intersection of forced displacement, water insecurity, and infectious disease resurgence. Hepatitis E transmission in IDP settings remains a silent epidemic in fragile states. A multisectoral outbreak response integrating WASH, surveillance, and maternal health proved both feasible and impactful, offering a replicable model for humanitarian health response globally.
Keywords:
Hepatitis E, internally displaced persons, outbreak response, WASH, Nigeria, surveillance, humanitarian health.
