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.