PRO/AH/EDR> Undiagnosed hemorrhagic fever – South Sudan (02): RFI, measles, malaria


A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: 3 Aug 2023
Source: Outbreak News [edited]

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

The outbreak was initially reported on 16 Jun 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

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

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