6 ǀ PREVENTION
Considering the importance and wide circulation of HEV in humans and
animals, global public health priority needs to be given for enhancing
monitoring and surveillance as well as adopting adequate mitigation
strategies for prevention and control of HEV and associated zoonotic
significance with the virus.138 HEV 239, Hecolin®
vaccine (Xiamen Innovax Biotech, China) is available in private market
in China and WHO is yet to approve it for use in endemic settings and
disease outbreaks worldwide. In HEV outbreaks, the two important
preventive approaches comprise the provision of drinking clean water and
improving the sanitary disposal of human waste. Implementing these
approaches in a timely manner in regions where the HEV epidemic occurs
is a challenging issue.139
In many parts of the world, the anti-HEV antibodies (IgM and IgG)
seroprevalence has been recorded both in humans and animals and as well
as from the environmental samples. Several factors contribute to the
increasing HEV infection rate, including low socioeconomic status, poor
hygiene, low access to clean water, lack of proper sanitation, and
unavailability of a hepatitis E vaccine commercially especially in the
high endemic regions (Figure 3). Global availability of the effective
vaccine to tackle future HEV disease outbreaks, larger analysis of
magnitude of the worldwide burden, improving diagnostics and
epidemiological methodologies, improving standards of water quality,
hygiene and sanitation in endemic regions along with implementation of
one health approach are need for effective prevention and control of
HEV. Awareness with regards to the prevalence and spatial distribution
of HEV in livestock animals, especially in the pigs and strengthening of
HEV testing in boars, along with controlling environmental contamination
of the virus could play vital role in implementing appropriate
prevention and control strategies to avoid transmission of HEV infection
from animals to humans.