The Africa Centres for Disease Control and Prevention (Africa CDC) is working closely with the Ministry of Health in the Republic of South Sudan to manage a suspected disease outbreak, exhibiting symptoms similar to those of Viral Haemorrhagic Fever (VHF) in the remote areas of Dukubela, Pacime, and Dajo areas of Longechuck County, Upper Nile State.

The outbreak was initially reported on June 16, 2023 by the Nile Initiative Development Organization (NIDO) during a supervisory visit to Dajo Primary Health Care Unit. NIDO found that the disease seemed to have originated from Dukubela, a mountainous area of Longechuk county that borders the Southern Blue Nile in Sudan and Assosa areas in Ethiopia. This area has recently seen an influx of returning residents and refugees from the ongoing conflict in Sudan.

The Africa CDC deployed technical experts to support the Ministry of Health in conducting a comprehensive risk assessment, support the development of a comprehensive national response plan, and strengthen capacity in coordination, surveillance, laboratory operations and risk communication and community engagement (RCCE).

Symptoms observed in the affected individuals include high fever, bloody vomiting and stool, rash, cough, sore throat, red eyes, runny nose, blurred vision, and generalized weakness. NIDO reported that the disease had affected approximately 150 people, resulting in 23 deaths. These deaths occurred within three days of the onset of the disease. However, those who survived past the initial five days showed signs of improvement.

In response to the health crisis, the Ministry of Health, alongside the World Health Organization, swiftly dispatched a multidisciplinary Rapid Response Team to Longechuk. This team delivered medical supplies, carried out disease-specific consultations and conducted active case finding in the Dajo & Pacime communities.

After a thorough field investigation, the Rapid Response Team line-listed 227 suspected cases and 29 related deaths. Laboratory tests for 45 samples confirmed cases of malaria and measles, with 71% of samples testing positive for malaria, 58% for measles and a co-infection rate of 45%. Despite that all the 45 samples tested negative for viral haemorrhagic fevers, ruling it out as a potential source of the outbreak, health authorities remain on high alert by maintaining surveillance measures in place to promptly identify and respond to any disease threat.

“Our strategy includes escalating preparedness and response activities, intensifying cross-border collaboration for improved surveillance and information sharing, and rolling out an integrated campaign for Measles vaccination and Malaria control in Longechuck County and surrounding areas. We are appealing to our partners, including Africa CDC, to strengthen our laboratory capacity, particularly in pathogen genomic sequencing for timely detection of diseases threat,” said Hon. Dr. Ader Macar Aciek, Undersecretary, Ministry of Health.

Longechuck is a remote location bordering Ethiopia and Sudan, and the difficult terrain, particularly in Pacime, poses unique challenges to managing this health crisis. Residents face a challenging nine-hour walk to the nearest healthcare facility in Dajo. The influx of returnees and refugees further strains the existing scarce medical resources in the area.

Communication infrastructure like phones and the Internet are unavailable in the area, leaving the only feasible means of communication as satellite phones. Despite these hurdles, an integrated response plan is underway.

Africa CDC is working closely with the Ministry of Health to identify priority areas of intervention with greater impact. Ongoing initiatives include coordinating emergency response systems at national and sub-national levels, procuring lab equipment and supplies, and boosting laboratory capabilities for efficient sample handling. Communications are underway between the Ministry of Health and Africa CDC’s technical team to explore the possibility of institutionalizing sequencing capacities in the Republic of South Sudan.

In these difficult circumstances, the coordinated efforts of the Ministry of Health, Africa CDC, and partners aim to alleviate the current emergency and strengthen healthcare systems to manage future disease outbreaks better.