A widespread spread program to sensitize people in Kitgum district about proper hygiene and sanitation has not been effective. 191 new cases of Hepatitis E have been reported in Kitgum in the past four weeks. Hepatitis E is a waterborne disease transmitted through feces. It occurs in areas where low standards of sanitation promote the transmission of the virus. Tony Toolit, the Kitgum Secretary for Health, says Hepatitis E has flared up in areas that flew under the radar in the early months of the two-year epidemic. He says the largest numbers of Hepatitis E cases are from Kitgum Town Council, Labongo Layamo, Amida and Lukung sub-county. Toolit admits that he doesn't know how else to address the problem. He says he cannot do anything about the refusal of residents to adhere to recommendations for proper disposal of waste and better sanitation practices. Alex Oyet, the LC5 councilor for Mucwini sub-county, says some parishes like Okol, Pubec and Ogwapoke have managed to contain the Hepatitis E outbreak by punishing anyone who does not obey strict bylaws on hygiene. He says the parishes fined any offenders 1,000 shillings per offense and many people cleaned up their act. However Oyet says not even fines can convince someone to change personal hygiene practices. //Cue in: iPersonal hygiene#i Cue: i#individual initiative.i// Hepatitis E has killed 148 people and hospitalized 9,613 others since its outbreak in 2007.