“The lab results are not consistent with the symptoms, and that is what is concerning,” Dr. Rohit Chitale, an epidemiologist with the US Centers for Disease Control and Prevention, told IRIN in a phone interview.
So far the risk of an epidemic seems low. The disease hasn’t come anywhere near the levels of the Ebola epidemic that appeared in 2014 and tore through the West African countries of Guinea, Sierra Leone, and Liberia.
Since late December, South Sudan has had 51 reported cases of what the World Health Organization is referring to as “undiagnosed haemorrhagic fever syndrome”. All cases are from two counties in the northwest: Aweil North, where 45 people were infected and 10 died; and Aweil West, where there have been six cases, none fatal.
The region borders Darfur in Sudan, where 469 cases of undiagnosed haemorrhagic fever syndrome were reported between August and November 2015, and 129 people died, according to the WHO.
“Because of frequent population cross-border movement between Sudan and South Sudan, the risk of international spread of the disease cannot be ruled out,” the WHO said in a statement.
Searching for answers
So far, 33 blood samples have been shipped from South Sudan to WHO laboratories in Uganda, Senegal, and South Africa. Five turned up positive for onyong-nyong, three for chikungunya, and one for dengue. Those mosquito-borne viruses, however, do not explain the 10 deaths. All samples tested negative for Ebola and Zika.
“Further laboratory testing is ongoing that may confirm the causative agent,” said the WHO.
The new disease may not even result from a virus at all. The WHO said “ecological risk factors” in the region suggest that it could be carried by mosquitos, ticks or fleas. But researchers are also conducting tests to determine if it could be transmitted through food or water contaminated by bacteria, parasites or viruses.
“Currently, there is no evidence of person-to-person transmission of the disease,” the organisation said.
Young people appear to be most at risk, with 74.5 percent of the victims below 20 years of age.
“Based on the data so far, it may be something that children and women are exposing themselves to,” said Chitale, from the CDC.
He said that violent conflict and underdevelopment are hampering efforts to solve the mystery of what’s causing the disease in Aweil, which may be the same as the one that cropped up in Darfur last year.
“There are a whole host of challenges in uncovering the cause of this outbreak,” he said. “For example, the regional instability, the poor infrastructure, and therefore just a lack of easy access.
South Sudan’s severely underfunded health system also hampers efforts to identify and control the disease. The health ministry has taken the lead role in the response, but it has not been given a budget to do so.
The government’s expenditure on health accounted for only four percent of GDP in 2013, the eighth lowest rate in the world, according to the World Bank. The 2016 national budget allocated more than 10 times the amount of funding to its military than it did to the health sector.
After almost half a century of war, South Sudan split from Sudan in 2011, but clashes continued to erupt along the newly-drawn border as well as between tribal and militia groups. In 2014, South Sudan’s military split along tribal lines and civil war erupted. The conflict choked off oil production, virtually the only source of revenue, further impoverishing the country.
Still, health ministry officials say they are trying their best with the resources they have.
“Since December, we have put in place some safety measures,” said Dr. John Rumunu, director general for preventive health services at the health ministry in the capital, Juba.
The building is almost always lacking electricity since the ministry cannot afford to run generators and city power is rare.
“We have been communicating the risk, and we are asking people to come for whomever has these kinds of symptoms,” he said in an interview in his dimly lit office.
(PHOTO: A patient gets treated at a hospital run by Médecins Sans Frontières in the South Sudan town of Malakal. Anna Surinyach/MSF)