South Sudan – World’s First Vaccination Campaign to Control Hepatitis E Outbreak 
hepatitis e
Medicins Sans Frontieres and the South Sudan Ministry of Health vaccinate people in Bentiu, the largest internally displaced persons camp in South Sudan.

In a global first – over 25,000 people in South Sudan have been vaccinated in the world’s first mass vaccination campaign to contain an outbreak of hepatitis E, a disease especially fatal for pregnant women.

The outbreak occurred in Bentiu, the largest internally displaced persons camp in South Sudan. Outbreaks of hepatitis E have been seen there since 2015, due to appalling living conditions, including inadequate water, sanitation, and hygiene. 

The most recent outbreak has seen 759 patients with confirmed hepatitis E, 17 of whom have died. 

Hepatitis E is the most common cause of acute viral hepatitis, causing approximately 20 million infections and 44,000 deaths every year. It is transmitted through faecal contamination of food and water. Large scale outbreaks typically occur in mass displacement camps, where water and sanitation are inadequate. 

While hepatitis E has a fatality rate of up to 25% among pregnant women, as well as an increased risk of spontaneous abortions and stillbirths, there is no specific treatment for the disease, so preventing its spread is critical.  

“The fight against hepatitis E has been long and frustrating,” said Dr Monica Rull, Medical Director, Médecins Sans Frontières (MSF). 

First time vaccine has been used in a public health emergency

In response to the outbreak, Médecins Sans Frontières (MSF) and South Sudan’s Ministry of Health jointly carried out the first two rounds of a hepatitis E vaccination campaign in Bentiu in March and April 2022. 

Around 25,000 people, including pregnant women, received Hecolin, the only available hepatitis E vaccine, developed and tested in China, where it is licensed and used primarily to vaccinate travellers. While the World Health Organization has recommended that it be used in outbreak response since 2015, the campaign in Bentiu was the first time the vaccine had been used at scale, in response to a public health emergency.

A third and final round of vaccinations will be conducted in October 2022. South Sudan’s Ministry of Health and MSF are monitoring and reporting on the results of the vaccination campaign.

Hepatitis E vaccination campaign considered a success

Hepatitis E factors in South Sudan’s high maternal death toll.

Both MSF and the South Sudan Ministry of Health have praised the ‘successful’ response to the vaccination campaign, saying it can be a model replicated in future outbreaks. 

“Given the successful implementation and the community’s enthusiastic response in the first two rounds, this innovative vaccination campaign can serve as an example and be replicated in similar settings managing hepatitis E outbreaks,” said Dr John Rumunu, Director General for Preventive Health Services, South Sudan Ministry of Health. 

“I hope the vaccine will help reduce infections and deaths from hepatitis E in Bentiu and beyond.”

“Over the last two decades, MSF has been responding to hepatitis E outbreaks in a wide range of displacement camps, trying to control the disease in challenging conditions and seeing the devastating impact on extremely vulnerable communities,” said Rull. 

“With the experience of this vaccination campaign, we hope to change the way we tackle hepatitis E in the future.”

WHO has called the campaign a “significant milestone” in the fight against hepatitis E. Melanie Marti, a WHO Medical Officer for the Department of Immunization, Vaccines & Biologicals, said, “It is the first time a vaccine has been used to combat the effects of this potentially devastating disease.”

Image Credits: MSF Innovation/Twitter , Stephen Rynkiewicz/Twitter .

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