SOUTH SUDAN—Doctors Without Borders/Médecins Sans Frontières (MSF) has initiated a mass vaccination effort to combat a lethal Hepatitis E outbreak in South Sudan.

This program is being carried out in conjunction with the Ministry of Health to protect women and girls of reproductive age, who are most vulnerable to disease-related deaths.

Since April 2023, 501 cases of Hepatitis E have been treated at the MSF facility in Old Fangak, Jonglei state, with 21 patients dying, the majority of whom were women.

The fatality rate for pregnant women can be as high as 40%, and there is no cure; therefore, many people with late stages of illness do not survive.

Fangak County is the most afflicted, and it is located in a rural area of northern South Sudan on the Sudd marshes—a vast area of wetland studded with small towns where people have severely limited access to even the most basic healthcare.

People in Fangak County also faces numerous obstacles even before Hepatitis E claimed their lives, including island inaccessibility due to flooding, increased malaria cases, and malnutrition.

Another difficulty is the limited availability and expensive expense of the Hepatitis E vaccination, which requires three doses.

There is just one licensed manufacturer in China, and the quantity is limited. It is also more substantial than other vaccines, making it harder to transport and store, especially in remote locations like Old Fangak.

These limitations present significant obstacles to responding to disease outbreaks in emergency contexts such as South Sudan. MSF advocates for the removal of these barriers so that far more people, particularly women and girls, can be safeguarded.

To avoid people having to make this journey to seek medical care, MSF is attempting to reach them first using canoes and, on occasion, speedboats to transport mobile clinics to isolated settlements. However, because of the location of the communities affected by the outbreak, MSF has had to adjust their routine activities to reach individuals at risk.

MSF’s vaccine program is the first to be carried out during the acute stages of an active Hepatitis E outbreak anywhere in the world, and it has been made more difficult by the remoteness and isolation of the South Sudanese region where it is taking place.

The vaccine was created in 2012, and the World Health Organization (WHO) has approved it for use in emergency circumstances since 2015.

However, despite its permission, it has only ever been used once.  In 2022, the vaccine was deployed for the first time in a major vaccination program conducted by MSF in the Bentiu displacement camp in South Sudan, protecting around 25,000 people.

The most recent effort in Fangak County builds upon the experience in Bentiu, but the setting is significantly different.

Mamman Mustapha, MSF’s chief of mission in South Sudan, stated that approximately 20 million individuals get infected each year, with three million exhibiting symptoms that necessitate treatment.

However, not everyone can receive treatment on time, particularly in nations with poor health facilities, such as South Sudan, he claims.

Even if they do make it to the hospital, it is typically too late because the sickness has no cure, and 70,000 people die from it each year.

MSF plans to fully vaccinate 12,776 women and girls aged 16 to 45 by June 2024, when the immunization campaign will be completed.

In addition to the vaccine program, Mustapha stated that they are providing case treatment and referrals at the MSF hospital, as well as doing community awareness campaigns and epidemiological surveillance.

MSF has encouraged international and local health and humanitarian organizations to take measures to improve water and sanitation in Old Fangak.

This can be accomplished by raising awareness, building proper sewage and sanitation facilities, including toilets and waste disposal systems, and drilling boreholes to ensure the availability of safe drinking water.This is critical for controlling the spread of Hepatitis E and preventing future outbreaks.

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