Hepatitis E infection in flood-affected areas posed a concern to expectant mothers.

The dissemination event primarily focused on the health effects of flood waters and the potential role of Hepatitis E vaccination in mitigating health risks, particularly in pregnant women. The event was hosted by Health Services Academy, Islamabad on the request of Ferozsons Laboratories Limited on September 27, 2022.
An estimated 33 million people have been affected and displaced. About 6.4 million need immediate humanitarian assistance, including more than 128,000 pregnant women, with 42,000 births expected in the next three months.
The stagnant flood waters, spreading over one third of the country, may take up to six months to recede, increasing the risks of water-borne diseases such as Hepatitis E, malaria, dengue, and cholera. Lack of access to safe drinking, proper sanitation, resources and medical supplies, and overcrowding of camps of internally displace persons (IDPs) increases the risks of outbreaks.
Among all the potential outbreaks, hepatitis E virus (HEV) outbreak is of great concern for pregnant women. HEV infection progress to liver failure and death. Miscarriages and neonatal deaths are common complications of HEV infection. The fatality rate among pregnant women may go as high as 15–20%, whereas the fetal mortality rate can reach as high as 40%.
Among the control strategies for preventing the outbreak are the controlling the source of infection such as improving access to safe drinking water, personal and food hygiene, proper disposal of human waste; prompt diagnosis of the infection and management of the cases; and vaccination.
The first and only vaccine for Hepatitis, which goes by the brand name Hecolin, was developed and licensed in China in 2012 & now available in Pakistan. It is a three-dose vaccine with a schedule of 0,1 & 6 and a rapid schedule of 0, 7 & 21. Given the grim public health situation caused by floods in Pakistan, this vaccine is suggested to have the potential to prevent outbreaks and save people from severe health complications, particularly pregnant women. WHO 2015 position paper define the role of hepatitis vaccine in outbreak situation like floods, internally displaced population However, there are concerns about the use of hepatitis E vaccine in pregnant woman efficacy of the HEV is well established and data of more then 8.5 years in now available. In Pakistan Vaccine is approved & registered under the strict rules & regulation of Drug regulatory authority of Pakistan (DRAP).
Outside China, Food and Drug Administration (FDA) has approved the Chinese vaccine, Hecolin, to enter a clinical trial in the United States, there is ongoing large-scale trial in Bangladesh, recently the first ever Hepatitis E reactive mass vaccination campaign was done targeted 27,000 individuals aged 16–40 years living in the Bentiu (South of Sudan) internally displaced persons camp due to floods, including pregnant women , The World Health Organization expressed consideration of the Hepatitis E vaccine during outbreaks in its position paper in 2015. However, more data is required to test it, for instance, its compatibility with other medications such as Tetanus Toxoid (TT, given to women during pregnancy). Administering the vaccine to vulnerable population in Pakistan under strong ethical protocols may create the opportunity to generate local data. However, it is recommended to control the potential outbreaks through control strategies such as access to clean water, proper waste management, hygiene and diagnose and management system.