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Burden of Meningitis
South Sudan, as one of the seven East African countries in the African meningitis belt, continues to experience recurrent meningococcal meningitis outbreaks, with the most recent incident caused by serogroup X (NmX) in 2023. The country faces unique challenges, including ongoing conflict, humanitarian crises, inconsistent health facility functionality, shortages of healthcare workers, and limited access to essential supplies. These factors underscore the urgent need for a comprehensive, evidence-based risk assessment to guide vaccine introduction and appropriate strategies.
In alignment with the “Defeat Meningitis by 2030” initiative and the recommendations outlined in the WHO Position Paper (2023), the Ministry of Health of South Sudan is preparing to transition from MenAfrivac to the new multivalent meningococcal conjugate vaccine (Men5CV/ Men5CV), targeting serogroups ACXWY. This transition is critical for reducing mortality and disability associated with bacterial meningitis, particularly among vulnerable populations aged 1–19 years.
State level data from 2017 to 2025 recorded 1513 suspected meningitis cases and 127 deaths representing a case fatality rate of 8.4 percent. Northern Bahr el Ghazal, Unity, Eastern Equatoria, and Warrap reported the highest numbers of suspected cases. Seven outbreaks were documented between 2017 and 2025 in three states.
Pathogen confirmation for this period shows Streptococcus pneumoniae at 53 percent, NmW at 25 percent, Hib at 12 percent, NmX at 5 percent, GBS at 3 percent, and other organisms at 2 percent. Multiple counties reported suspected cases across the period with variation in detection linked to confirmation capacity and access constraints.
Counties that did not implement MenAfriVac preventive campaigns during 2016 and 2018 include Ayod, Uror, Canal or Pigi, Leer, Mayendit, Manyo, Fashoda, and Panyikang. These counties retain unvaccinated cohorts with increased susceptibility.