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Biological Health Hazard – Yellow Fever Epidemic (WHO Situation Update): Africa, ex. China

2016/05/16

YELLOW FEVER – AFRICA (55): WHO
********************
Published Date: 2016-05-14 16:32:43
Subject: PRO/EDR> Yellow fever – Africa (55): WHO
Archive Number: 20160514.4222137

Date: Thuesday, 12 May 2016
Source: WHO Situation Report [edited]

Summary
——-
– A yellow fever outbreak was detected in Angola late in December 2015 and confirmed by the Institut Pasteur Dakar (IP-D) on 20 Jan 2016. Subsequently, a rapid increase in the number of cases has been observed.

– As of 11 May 2016, Angola has reported 2267 suspected cases of yellow fever with 293 deaths. Among those cases, 696 have been laboratory confirmed. Despite vaccination campaigns in Luanda, Huambo and Benguela provinces circulation of the virus in some districts persists.

– 3 countries have reported confirmed yellow fever cases imported from Angola: Democratic Republic of the Congo (DRC) (39 cases), Kenya (2 cases) and People’s Republic of China (11 cases). This highlights the risk of international spread through non-immunised travellers.

– On 22 Mar 2016, the Ministry of Health of DRC confirmed cases of yellow fever in connection with Angola. The government officially declared the yellow fever outbreak on 23 Apr [2016]. As of 11 May, DRC has reported 3 probable cases and 41 laboratory confirmed cases: 39 imported from Angola, reported in Kongo Central province and Kinshasa and 2 autochthonous cases in Ndjili, Kinshasa and in Matadi, Kongo Central province. The possibility of locally acquired infections is under investigation for at least 10 non-classified cases in both Kinshasa and Kongo Central provinces.

– In Uganda, the Ministry of Health notified yellow fever cases in Masaka district on 9 Apr 2016. As of 11 May [2016], 51 suspect cases and 7 laboratory confirmed cases have been reported from 3 districts: Masaka, Rukungiri and Kalangala. According to sequencing results, those clusters are not epidemiologically linked to Angola.

– The virus in Angola and DRC is largely concentrated in main cities. The risk of spread and local transmission to other provinces in the 3 countries remains a serious concern. The risk is high also for potential spread to bordering countries especially those classified as low risks for yellow fever disease (i.e. Namibia, Zambia) where the population, travellers and foreign workers are not vaccinated against yellow fever.

Surveillance
————
Angola
– From 5 Dec 2015 to 11 May 2016, the Ministry of Health has reported a total of 2267 suspected cases with 293 deaths and 696 laboratory confirmed cases. There are confirmed cases in 14 of the 18 provinces and suspect cases are present in all provinces. Local transmission is present in 7 provinces, in 21 districts; 70 percent of these cases are reported in Luanda province. Namibe province, bordering Namibia, recently reported confirmed cases and local transmission.

– Despite a decreasing trend, the outbreak in Angola remains of high concern due to persistent local transmission in Luanda. Although vaccination efforts have reached more than 7 million people, local transmission has been reported in 6 provinces (urban areas and main ports) and there is a high risk of spread to neighbouring countries.

– The risk of establishment of local transmission in other provinces where no autochthonous cases are reported is high. DRC has reported cases imported from 2 provinces in Angola where no local transmission is currently reported (Cabinda and Zaire). Cabinda is an exclave and province of Angola and is separated from the rest of Angola by a narrow strip of territory belonging to the DRC and bounded on the north by the Republic of the Congo. This poses also a further risk of transmission in DRC and Republic of the Congo.

Democratic Republic of the Congo
– On 22 Mar 2016, the Ministry of Health of DRC, notified human cases of yellow fever in connection with Angola. The yellow fever outbreak was officially declared on 23 Apr [2016].

– As of 11 May [2016], DRC has reported 44 Yellow Fever cases linked to Angola, 41 of those are laboratory confirmed cases with 39 imported from Angola, reported in Kongo Central and Kinshasa provinces, and 2 autochthonous cases in Ndjili, Kinshasa and Matadi, Kongo Central province.

– The possibility of locally acquired infections is under investigation for at least 10 non- classified cases in both Kinshasa and Kongo Central provinces. For a further 3 probable cases results are still pending at IP-D.

– Given the large Angolan community in Kinshasa, combined with the presence and activity of the _Aedes_ mosquito, the potential risk of local transmission in DRC in general and in the whole of Kinshasa in particular, is high. The situation needs to be closely monitored.

Uganda
– On 9 Apr 2016, Uganda notified WHO of yellow fever cases in the south-western district of Masaka. As of 11 May [2016], 51 suspected cases of yellow fever have been reported in 7 districts and 7 cases have been laboratory confirmed (5 in Masaka, one in Rukungiri and one in Kalangala).

– Uganda is experiencing local transmission of yellow fever outbreak. According to sequencing results, the outbreak is not linked to Angola and indicates high similarities with the virus which caused the outbreak in 2010.

Other countries bordering Angola
– On 28 Apr [2016], the Ministry of Health of Namibia reported one suspected case of yellow fever, imported from Benguela, Angola: the suspected case was hospitalized 1st in Benguela, Angola and then in Uganda, at the Engela district hospital in the Ohangwena region (near the border with Angola). Based on subsequent laboratory tests, this case was reported to be negative for yellow fever on 6 May [2016].

– No suspected cases of yellow fever have been reported in the Republic of the Congo or Zambia. However, Namibia and Zambia share a long and porous border with Angola and controlling population movements between the 3 countries will be challenging.

– 3 countries have reported confirmed yellow fever cases exported from Angola: DRC (39 cases), Kenya (2 cases) and People’s Republic of China (11 cases). This highlights the risk of international spread through non-immunised travellers.

Risk assessment
– The outbreak in Angola remains of high concern due to:
— Persistent local transmission in Luanda despite the fact that more than 7
million people have been vaccinated.
— Local transmission reported in 7 highly populated provinces including Luanda.
— The continued extension of the outbreak to new provinces and new districts.
— High risk of spread to neighbouring countries. Confirmed cases have already travelled from Angola to People’s Republic of China, DRC and Kenya. As the borders are porous with substantial crossborder social and economic activities, further transmission cannot be excluded. Viraemic patients travelling pose a risk for the establishment of local transmission especially in countries where adequate vectors and susceptible human populations are present.
— Inadequate surveillance system capable of identifying new foci or areas of cases emerging. High index of suspicion of ongoing transmission in areas hard to reach like Cabinda.

– For DRC, a field investigation conducted in April concluded that there is a high risk of local transmission of yellow fever in the country. Given the limited availability of vaccines, the large Angolan community in Kinshasa, the porous border between Angola and DRC and the presence and the activity of the vector _Aedes_ in the country, the situation needs to be closely monitored.

– The virus in Angola and DRC is largely concentrated in main cities. The risk of spread and local transmission in other provinces in the 3 countries remains a serious concern. The risk is high also for potential spread to bordering countries especially those classified as low risk (i.e. Namibia, Zambia) and where the population, travelers and foreign workers are not vaccinated for yellow fever.

Response
——–
– Vaccinations campaigns started 1st in Luanda province at the beginning of February and mid-April [2016] in Benguela and Huambo.

– As of 10 May [2016], 11.7 million doses were shipped to Angola.

– DRC and Uganda are GAVI Alliance eligible countries thus the vaccination campaigns in these countries will be covered by GAVI Alliance.

– 2.2 million vaccines and ancillaries are to arrive in DRC by mid-May [2016] for conducting an emergency vaccination campaign targeting 7 health zones (zones de santé) in Kongo Central province and N’djili health zones in Kinshasa province.

– 700 000 yellow fever vaccines arrived in Uganda and the vaccination campaign will start on 19 May [2016].

– Namibia requested 450 000 doses (in 10 dose vials) for yellow fever vaccine for travellers and refugees.

– International media attention to yellow fever has been minimal. However, Angola has issued press information related to control measures in place in country. Other coverage has focussed on ensuring vaccination related to travel and prevention of spread of disease.

– A Q&A on the current yellow fever outbreak has been posted on the WHO website.

– WHO briefed communication leadership across the UN related to communications issues and resources for joint coordinated response to inquiries about the outbreak.


Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[The yellow fever situation in the 3 countries continues to be worrisome, as reported cases numbers increase. Little mention is made of the availability of YF vaccine for the region and to satisfy the requests from the 3 countries with ongoing transmission, nor whether Namibia’s request will be filled. This concern has been mentioned by the ProMED-mail moderators in several previous posts.

A HealthMap/ProMED-mail map showing the locations of the African countries mentioned can be accessed at: http://healthmap.org/promed/p/3948. – Mods.TY/JW]

See Also

Yellow fever – Africa (54): Angola 20160512.4218603
Yellow fever – Africa (53): vaccine 20160510.4212027
Yellow fever – Africa (52): WHO 20160506.4206937
Yellow fever – Africa (51): Uganda, RFI 20160506.4204265
Yellow fever – Africa (50): Uganda, WHO 20160503.4199924
Yellow fever – Africa (49): Congo DR, WHO 20160502.4197790
Yellow fever – Africa (48): current situation 20160430.4194719
Yellow fever – Africa (47): Uganda, Kenya 20160429.4193015
Yellow fever – Africa (46): Uganda, Kenya 20160427.4185740
Yellow fever – Africa (45): Uganda, Kenya 20160423.4179151
Yellow fever – Africa (44): Uganda 20160422.4177724
Yellow fever – Africa (43): Angola comment 20160420.4172389
Yellow fever – Africa (42): Congo DR (Kinshasa) 20160416.4164060
Yellow fever – Africa (41): Uganda (MQ) susp, RFI 20160414.4159929
Yellow fever – Africa (40): Angola, WHO 20160414.4158727
Yellow fever – Africa (39): Uganda (MQ) 20160413.4157158
Yellow fever – China (08): ex Angola 20160413.4156986
Yellow fever – Africa (38): Angola (HM) 20160412.4155494
Yellow fever – Africa (37): Congo DR 20160412.4155377
Yellow fever – Africa (36): Uganda (MQ) 20160411.4153034
Yellow fever – Africa (35): Angola 20160409.4149455
Yellow fever – Africa (34): Angola, WHO 20160404.4137096
Yellow fever – China (07): ex Angola 20160403.4136699
………………………………………….sb/dk/ty/jw/je/dk

Yellow fever – Africa (29): Angola 20160326.4119621
Yellow fever – Africa (28): Angola, Chinese workers 20160324.4116627
Yellow fever – Africa (27): Angola 20160323.4114429
Yellow fever – Africa (26): Congo DR 20160320.4107262
Yellow fever – Africa (25): Angola comment 20160319.4106114
Yellow fever – Africa (24): Kenya ex Angola 20160318.4104819
Yellow fever – China (05) ex Angola 20160325.4119422
Yellow fever – China (04) ex Angola 20160322.4109684
Yellow fever – China (03): ex Angola 20160319.4106312
Yellow fever – China (02): ex Angola 20160318.4105105
Yellow fever – China: ex Angola, 1st case in Asia 20160313.4089857
Yellow fever – Africa (23): Angola (HL) 20160317.4102488
Yellow fever – Africa (21): Angola 20160315.4095607
Yellow fever – Africa (18): Angola 20160313.4090378
Yellow fever – Africa (17): Angola 20160310.4084268
Yellow fever – Africa (16): Angola 20160227.4053826
Yellow fever – Africa (15): Angola, fake vaccine, SE Asia, WHO alert 20160224.4047041
Yellow fever – Africa (14): Angola 20160223.4044335
Yellow fever – Africa (13): Angola (HL) 20160219.4033812
Yellow fever – Africa (12): Angola 20160213.4019319
Yellow fever – Africa (11): Angola 20160211.4012749
Yellow fever – Africa (10): Angola (HM) 20160210.4010453
Yellow fever – Africa (09): Angola 20160208.4003005
Yellow fever – Africa (08): Angola RFI 20160204.3995342
Yellow fever – Africa (07): Angola (LU) RFI 20160201.3984228
Yellow fever – Africa (05): Angola (HL) 20160129.3977685
Yellow fever – Africa (04): Angola (LU) conf, RFI 20160127.3965357
Yellow fever – Africa (03): Angola (LU) comment, RFI 20160123.3959897
Yellow fever – Africa (02): Angola (LU) RFI 20160122.3958601
………………………………………….mpp/ty/msp/sh

Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases


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