LAUSR

The circulation of hepatitis E virus in the community has been a subject of interest in the present journal and more recently with regard to HIV-infected pregnant women and their children in Malawi [1]. We here wish to draw attention to an emerging high prevalence of hepatitis E infection in the Province of Punjab, Pakistan. There have been various outbreaks of hepatitis E in Pakistan during the last four decades, predominantly due to the consumption of contaminated water. From 1984 to 1985, three small outbreaks occurred in three cities of Pakistan namely Quetta, Mardan and Rawalpindi [2]. In 1986, 85 cases of hepatitis E were observed in a residential community of urban Karachi, with one death of a pregnant female [3]. A college campus at Sargodha suffered outbreak of acute viral hepatitis (133 cases) due to hepatitis E in 1987 [4]. Between December 1993 and March 1994, a major outbreak of hepatitis E occurred (3827 cases, with an overall attack rate of 10.4%) in Islamabad, the capital of Pakistan, due to the malfunction of a water treatment plant [5]. A hospital-acquired outbreak of hepatitis E occurred in a neurosurgery ward at Karachi during December 2000–March 2001 with an overall ward attack rate of 15.9% (18/113 patients) [6]. Moreover, another outbreak of hepatitis E occurred in the military unit of Abbottabad due to water contamination in 2002 [7]. Since the beginning of 2019, numerous cases of hepatitis E have been reported throughout the province Punjab. The number of positive cases varied from 20 to 130 per month from every district of Punjab. The situation was worst in metropolitan cities. Unfortunately, there was neither sufficient media coverage of the outbreak nor public awareness campaigns to contain this situation. On 26 April 2019, shocking figures became public knowledge when media channel ‘City 42’ reported that around 300 patients were diagnosed with hepatitis E on daily basis in Lahore, the capital city of province Punjab. According to The News [8], there is an alarming surge in hepatitis E cases in Lahore and no locality seems to be an exception. Areas such as Sant Nagar, Krishan Nagar, Sanda, Outfall Road, Karim Park, Ichhra, Gulberg, Shadbagh, and Township have been particularly hit by the disease. Finally, to address this issue, Directorate General of Health Services, Punjab with the collaboration of National Institute of Health, Islamabad as well as World Health Organization, issued a letter (Letter no. 794-982) on 25 April 2019, which included the directions regarding case management of hepatitis E, its prevention techniques as well as control guidelines. These directions were given to all 25 District headquarters hospitals and 85 Tehsil headquarters. However, this alone is not enough and there is a dire need to educate the general public regarding Hepatitis E and its preventive strategies (boiling water before consumption, avoiding uncooked foods, vegetables, hand hygiene, etc.) using all available resources e.g. awareness campaigns, print, electronic, and social media to effectively combat this outbreak. Moreover, unless the Government takes extreme actions to prevent contamination of drinking water these devastating outbreaks will continue to occur.