A push to tackle an outbreak of hepatitis E in South Sudan is being hampered by flooding that has isolated populations and turned villages into islands.
A pioneering vaccination drive has begun to protect people against a spate of cases but the true scale of the disease outbreak is unknown.
Health workers with the charity Médecins Sans Frontières (MSF) face eight-hour boat trips to deliver vaccines to some of the affected villages in Fangak county, in northern South Sudan.
MSF said it knew of 21 deaths and had treated more than 500 people infected with hepatitis E in the past nine months, but the majority of people in the region are cut off from healthcare.
It is the first time a vaccination campaign has been attempted during the acute stage of a hepatitis E outbreak, with the added logistical problem of shipping the vaccines from China, where they are produced.
Hepatitis E spreads through contaminated water, has no cure and is potentially fatal to pregnant women. Although rare in the developed world, it infects more than 20 million people a year lacking proper sanitation in poorer countries.
MSF wants to reach 12,000 women aged 16 to 45 by June but faces extreme challenges.
“Fangak county is situated in an extremely remote part of northern South Sudan on the Sudd marshes – a vast area of wetland dotted with small communities, where people have exceptionally limited access to even the most basic of health care,” said Mamman Mustapha, MSF’s head of mission in South Sudan.
“Even getting our routine childhood vaccinations to Old Fangak is a challenge. It is only possible to reach the hospital by boat, using the Nile River, or by air.”
Repeated flooding in Fangak, in Jonglei state, has put much of the countryside under water, with repeated flooding also exacerbating malaria rates, as mosquitoes thrive in stagnant flood waters.
Damage to crops and livestock has also contributed to child malnutrition, which was higher in Jonglei than anywhere else in South Sudan with 130,000 cases in 2023.
Mustapha said the real scale of the hepatitis E problem, which kills 70,000 people – mostly women – each year, is not known in Fangak.
“We know for certain that 21 people have died from hepatitis E during this current outbreak, but that is only because they were able to reach the hospital. It is very likely that many more people have passed away at home, without being able to even try and access treatment,” said Mustapha.
MSF said high costs of vaccines are a barrier to more widespread vaccination.
The hepatitis E vaccine was recommended for use by WHO in 2015 but has only been used once before, in South Sudan’s Bentiu displacement camp in 2022.
