New York, June 17 (IANS): A group of experts on infectious disease from around the world has warned that during the coming monsoon season, survivors of the recent earthquake face a "very high" risk of an hepatitis E outbreak.

The document, published in the journal Lancet, said that the outbreak could be especially deadly for pregnant women.

The conditions in the April tremor that killed over 8,500 people and injured more than 23,000 have left conditions ripe for hepatitis E virus (HEV), which is primarily spread from feces to mouth via contaminated water, said the document signed by Alain Labrique from Johns Hopkins Bloomberg School of Public Health.

"Earthquake-affected areas are faced with a 'perfect storm' of risk factors: large displaced populations with limited access to clean drinking water, lack of sanitary facilities, the approaching monsoon, overburdened healthcare infrastructure, large amounts of circulating HEV and an at-risk population that mostly lacks protective antibodies."

According to them, 500 pregnant women could die from the virus in the coming months and many more could get sick.

There are an estimated 20 million hepatitis E infections in the world annually. While the virus can lead to liver disease, it mostly runs its course with few long-term complications. Yet pregnant women have a mortality rate of 25 percent when infected by the virus, the researchers said.

"There is a safe and effective vaccine available, but it is currently only licensed for use in China."

The World Health Organisation has not recommended its routine use because there is a need for additional safety and efficacy data, particularly in pregnant women.

The researchers estimated more than 400 pregnant women could be saved if the vaccine were used in Nepal during monsoon season, which runs from July to September.