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Summary

Hepatitis E is an emerging waterborne virus endemic in regions with poor sanitation and hygiene, including large parts of Asia, Africa and South America. It is responsible for medium- to large-sized waterborne epidemics, causing a large proportion of cases with sporadic acute hepatitis.
Hepatitis E Virus (HEV) was very inefficiently cultured until now and no experimental data has been published on HEV disinfection. Some studies have suggested that drinking chlorinated surface water did not appear to reduce the risk of infection.
However, recently has been described a new HEV strain, that can be now used for developing disinfection and stability studies.
The development of experimental data on HEV stability in water will bring to humanitarian actors specific protocols for interventions on water or food borne HEV epidemics as well as a better understanding of risk factors and routes of HEV infection.

Challenge(s) addressed

• Understand effectivity of water disinfection methods in presence of HEV.
• Improve understanding on HEV epidemiology and transmission routes.

Innovation factor

The innovation proposed in this application consist on producing for the first time consistent experimental assays on HEV stability against main disinfection water treatments, filling this gap in virology and answering an operational need on water services in vulnerable settings with the end up objective of developing Standard Operational Protocols on Water Treatment in Hepatitis E outbreak scenario.

Added value

Effective and feasible water treatments should be identified to prevent human infection on HEV outbreaks (mainly transmitted by oral-faecal route) in emergency interventions.

Innovation phases

It will consist of 4 main phases:
1) Create an experimental system to analyse HEV removal/inactivation.
2) Characterise inactivation profiles for each treatment.
3) Developing Standard Protocol for water disinfection in HEV outbreak settings
4) Identification of sources of contamination and transmission routes in a HEV outbreak

Key deliverables/impact

The target beneficiaries of an evidence-based Standard Protocol for water disinfection in HEV outbreak settings, and a better understanding of risk factors and transmission routes (key to prevent, control and limit HEV outbreaks) are WASH stakeholders, specifically humanitarian International NGOs, local NGOs and Government Health officers related to WASH work in HEV prevalent areas or HEV outbreaks.

Latest Updates

The WADHE project is incredibly grateful to receive the HIF large grant award

25 Nov 2013

There has become a major need to develop standard protocols for Water Disinfection of Hepatitis E Virus (WADHE) humanitarian interventions. In the last decade, several outbreaks of this emergent virus have been affecting populations mainly in Africa and Asia. WHO estimates that every year there are 20 million Hepatitis E infections, over three million acute cases of hepatitis E, and 70 000 hepatitis E-related deaths.

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2013Nov

Hepatitis E Virus grows and multiplies in vitro

16 Jan 2014

Before starting disinfection experiments in water we needed to have lots of Hepatitis E Virus viable particles to expose them to different treatments (chlorine, UV, flocculation…), in order to understand how effective they are towards this important pathogen causing recurrent epidemics in central Africa and Asia. Last month (Dec 2013) a new outbreak has been reported by WHO in Tanzania.

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2014Jan

Chlorine inactivation of hepatitis E virus and human adenovirus 2 in water

01 Oct 2014

Hepatitis E virus (HEV) is transmitted via the fecal–oral route and has been recognized as a common source of large waterborne outbreaks involving contaminated water in developing countries. Thus, there is the need to produce experimental data on the disinfection kinetics of HEV by chlorine in water samples with diverse levels of fecal contamination. Here, the inactivation of HEV and human adenovirus C serotype 2 (HAdV2), used as a reference virus, was monitored using immunofluorescence and quantitative reverse transcription polymerase chain reaction (RT-qPCR) assays. HEV has been shown to be susceptible to chlorine disinfection and presented equivalent kinetics to human adenoviruses. The C(t) values observed for a 2-log reduction of HEV were 0.41 in buffered demand-free water and 11.21 mg/L × min in the presence of 1% sewage. The results indicate that the inactivation kinetics of HEV and HAdV2 are equivalent and support the use of chlorine disinfection as an effective strategy to control HEV waterborne transmission.

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Oct

Chlorine water treatment is effective towards Hepatitis E Virus

30 Oct 2014

Experimental assays on HEV stability towards water treatment performed by WADHE team have given important basis to develop Standard Protocols for HEV outbreak response, as until this study there was no scientific evidence on HEV susceptibility to major disinfectants (chlorine, UV treatment, etc).

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Final report: water disinfection protocols for Hepatitis E Virus (WADHE)

01 Dec 2014

Hepatitis E virus (HEV) is an emerging waterborne virus endemic in regions with poor sanitation and hygiene, including large parts of Asia, Africa and South America. But there is little understanding of the effectiveness of water disinfection methods in the presence of HEV or HEV epidemiology and transmission routes. This project aims to produce, for the first time, consistent experimental tests on HEV stability against the main disinfection water treatments, filling a gap in virology and helping to develop standard operational protocols on water treatment in a Hepatitis E outbreak scenario. The final report provides information on the project methodology, activities, outputs, impact and dissemination of learning.

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Dec

Technical Brief: Hepatitis E outbreak response

01 Dec 2014

Hepatitis E Virus (HEV) is an emerging waterborne virus endemic in regions with poor sanitation and hygiene, including large parts of Asia, Africa and South America. The most outbreak spread across South Sudan between 2012-14, with over 10,000 cases and cross-border infection into neighbouring countries. When such outbreaks occur, the humanitarian personnel in the area may have had little previous experience of handling this disease and its outbreaks. The consequent lack of preparedness can lead to much concern in the population, and unclear responses from field workers. As there are currently no curative therapies for Hepatitis E infection, prevention is the key intervention to limit the impact of this deadly disease. This technical briefing note documents the current knowledge on Hepatitis E transmission routes and discusses the issues on the potential methods of response and prevention.

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Environmental Investigation in Maban, South Sudan: Preliminary Results

12 Jan 2017

Hepatitis E virus (HEV) is an emerging waterborne virus endemic in regions with poor sanitation and hygiene, including large parts of Asia, Africa and South America. But there is little understanding of the effectiveness of water disinfection methods in the presence of HEV or HEV epidemiology and transmission routes. This study of HEV epidemics in several refugee camps in Maban County, South Sudan, sought to obtain information on the potential transmission routes for the virus

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2017Jan

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