Kala-Azar epidemic threatens thousands in South Sudan

MSF says growing evidence requires a concerted response to the upsurge in this fatal disease.
"The fact that all age groups and both sexes are affected, and that these people have not travelled in from elsewhere indicates an epidemic outbreak", says Keus. "We know from our experience in other places how devastating this can be. It is vital that we quickly discover the extent of the problem in this area."
Nairobi - The rapidly increasing numbers of people identified as suffering from the deadly parasitic disease, kala-azar, in Latjor state, Upper Nile in South Sudan, suggests that an epidemic is spreading in a particularly vulnerable population. The medical emergency relief organisation, Medecins Sans Frontieres (MSF), says these people need urgent help from international agencies to assess and treat what appears to be a very threatening outbreak. MSF has just set up a clinic in the small town of Bimbim and within a week has 150 patients under treatment for kala-azar. Twenty more arrive every day. Most of the people reported that they had already lost at least one family member to the disease. MSF's health advisor for Sudan, Kees Keus, who has just been in Bimbim, says the evidence points to this being a new epidemic in a resident population with little acquired resistance to kala-azar. "The fact that all age groups and both sexes are affected, and that these people have not travelled in from elsewhere indicates an epidemic outbreak", says Keus. "We know from our experience in other places how devastating this can be. It is vital that we quickly discover the extent of the problem in this area." Another clinic run by the organisation Adventist Development Relief Agency (ADRA) in nearby Kechkoun is seing a similar pattern of disease. 145 patients are under treatment there. MSF has received worrying reports of what could be even more cases in the much larger town of Nassir, which is some twelve hours walk from Bimbim. So far, however, it has not been possible to get there and confirm the extent of the problem. There are very few medical facilities in Latjor state and the Upper Nile region has suffered from high rates of malnutrition throughout the year. MSF believes that a concerted effort by aid agencies is required to locate, assess and treat those suffering from this latest epidemic. Medical note on kala-azar: It is a parasitic disease, also known as visceral leishmaniasis, transmitted by the bite of the sand fly. Once in the blood, it weakens the immune system. Most people die from common infections that the immune system can no longer handle, like pneumonia, diarrhoea or tuberculosis. Malnutrition, which is extremely common in Sudan, also weakens the immune system and increases the risk of dying from kala-azar. MSF has been providing treatment for kala-azar in Sudan since 1988. The spread of the disease is encouraged by the civil war, annual food shortages and the mass population movements that result from both. There is no vaccine and Kala-azar is always fatal if untreated but it can be cured with drug injections over 30 days and intensive feeding.