Yellow fever situation report

Angola epidemiological update (as of 6 October):
The last confirmed case had symptom onset on 23 June.

42 probable cases were reported in the last 4 weeks

Angola epidemiological update (as of 6 October):
The last confirmed case had symptom onset on 23 June.

42 probable cases were reported in the last 4 weeks

Phase II of the vaccination campaign launched on 10 October. The target population consists of more than 2 million people in 12 districts in 10 provinces.

Democratic Republic of the Congo epidemiological update (as of 12 October):


The last confirmed non-sylvatic case had symptom onset on 12 July.

A new confirmed, sylvatic case was reported from Lingomo Health Zone in Tshuapa province.

16 probable cases are under investigation (4 in Kinshasa, 8 in Kwango, and 1 case each in Bas Uele, Kwilu, Lualaba and Sud Ubangi provinces).

The reactive vaccination campaigns in Feshi Health Zone in Kwango province is ongoing and will begin shortly in Mushenge Health Zone in Kasai province.

Analysis

The continuing detection and investigation of probable (including the 42 probable cases in Angola) and sylvatic cases demonstrate that active surveillance is ongoing. Nevertheless, it is important to note persistent difficulties in surveillance and laboratory confirmation capacities, which may delay case detection. A strong and sustained surveillance effort remains crucial.




The status of the probable cases in Angola will be reviewed by the Ministry of Health’s Final Classification Committee once the investigations are completed on their exposure history and yellow fever vaccination status.

Yellow fever situation report

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Angola: 3748 suspected cases

Angola: 3748 suspected cases

In Angola, as of 21 July 2016 a total of 3748 suspected cases have been reported, of which 879 are confirmed. The total number of reported deaths is 364, of which 119 were reported among confirmed cases. Suspected cases have been reported in all 18 provinces and confirmed cases have been reported in 16 of 18 provinces and 80 of 125 reporting districts.

Mass reactive vaccination campaigns first began in Luanda and have now expanded to cover most of the other affected parts of Angola. Recently, the campaigns have focused on border areas. All districts continued with house to house immunization campaigns and routine vaccination.

Democratic Republic of the Congo: 1907 suspected cases

According to the latest confirmed information, DRC has reported 1907 suspected cases (as of 20 July) and 68 confirmed cases (as of 24 June) including 95 reported deaths (Table 1). Cases have been reported in 22 health zones in five of 26 provinces. Of the 68 confirmed cases, 59 were imported from Angola, two are sylvatic (not related to the outbreak) and seven are autochthonous.

The recent technical difficulties at the national laboratory in the Democratic Republic of The Congo (DRC) have been resolved and the laboratory confirmation of yellow fever cases in DRC has resumed. According to the preliminary results of tests performed on a backlog samples, seven new patients have tested positive for yellow fever. Additional investigations to determine the definitive status of these cases are ongoing. Until these investigations are completed, the official case count in DRC remains unchanged.

In DRC, surveillance efforts have increased and vaccination campaigns have centred on affected health zones in Kinshasa and Kongo Central and Kwango. Reactive vaccination campaigns started on 20 July in Kisenso health zone in Kinshasa province and in Kahemba, Kajiji and Kisandji health zones in Kwango province.

The risk of spread

Seven countries (Brazil, Chad, Colombia, Ghana, Guinea, Peru and Uganda) have reported yellow fever outbreaks or sporadic cases not linked to the Angolan outbreak.

An Emergency Committee (EC) was convened on 19 May 2016. The WHO Director-General accepted the EC’s assessment that the urban yellow fever outbreaks in Angola and DRC are serious public health events which warrant intensified national action and enhanced international support. The situation does not currently constitute a Public Health Emergency of International Concern.

Vaccination

WHO Strategic Advisory Group of Experts (SAGE) on Immunization reviewed existing evidence that demonstrates that using a fifth of a standard vaccine dose would still provide protection against the disease for at least 12 months and possibly longer. This approach, known as fractional dosing, will be implemented in a pre-emptive mass vaccination campaign in DRC in Kinshasa.

Risk assessment

The outbreak in Angola is receding and no confirmed case has been reported in the country during July (as of 21 July). The confirmed case with the most recent date of symptom onset, 23 June, was reported in Cuanhama district in Cunene province. However, a high level of vigilance needs to be maintained throughout the country.

In DRC, the situation remains concerning as the outbreak has spread to three provinces. Given the presence and activity of the vector Aedes in the country, the outbreak might extend to other provinces, in particular Kasai, Kasai Central and Lualaba.

Transmission of yellow fever in Angola and DRC is mainly concentrated in cities; however, there is a high risk of spread and local transmission to other provinces in both countries. In addition, the risk of 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.

Yellow fever situation report

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In Angola, as of 24 June 2016 a total of 3464 suspected cases have been reported, of which 868 are confirmed.

In Angola, as of 24 June 2016 a total of 3464 suspected cases have been reported, of which 868 are confirmed. The total number of reported deaths is 353, of which 116 were reported among confirmed cases. Suspected cases have been reported in all 18 provinces and confirmed cases have been reported in 16 provinces and 79 of 125 reporting districts.

Mass vaccination campaigns first began in Luanda and have now expanded to cover most of the other affected parts of Angola. Recently, the campaigns have focused on border areas. Despite extensive vaccination efforts circulation of the virus persists.
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Democratic Republic of the Congo: 1307 suspected cases

As of 23 June, in the Democratic Republic of The Congo (DRC), the total number of notified suspected cases is 1307, with 68 confirmed cases and 75 reported deaths. Cases have been reported in 22 health zones in five provinces. Of the 68 confirmed cases, 59 were imported from Angola, two are sylvatic (not related to the outbreak) and seven are autochthonous.

Surveillance efforts have increased and vaccination campaigns in DRC have centred on affected zones in Kinshasa and Kongo Central.

The risk of spread

Two additional countries have reported confirmed yellow fever cases imported from Angola: Kenya (two cases) and People’s Republic of China (11 cases). These cases highlight the risk of international spread through non-immunised travellers.

Seven countries (Brazil, Chad, Colombia, Ghana, Guinea, Peru and Uganda) are currently reporting yellow fever outbreaks or sporadic cases not linked to the Angolan outbreak.

Vaccination

WHO Strategic Advisory Group of Experts (SAGE) on Immunization reviewed existing evidence that demonstrates that using a fifth of a standard vaccine dose would still provide protection against the disease for at least 12 months and possibly longer. This approach, known as fractional dosing, is under consideration as a short-term measure, in the context of a potential vaccine shortage in emergencies.

Risk assessment

The outbreak in Angola remains of high concern due to:

Persistent local transmission despite the fact that nearly 11 million people have been vaccinated;

Local transmission has been reported in 12 highly populated provinces including Luanda.

The continued extension of the outbreak to new provinces and new districts.

High risk of spread to neighbouring countries. As the borders are porous with substantial cross border social and economic activities, further transmission cannot be excluded. Viraemic travelling patients pose a risk for the establishment of local transmission especially in countries where adequate vectors and susceptible human populations are present;

Risk of establishment of local transmission in other provinces where no autochthonous cases are reported;

High index of suspicion of ongoing transmission in hard-to-reach areas like Cabinda;



Enhanced surveillance is needed and further strengthening of surveillance is underway.

SOURCE World Health Organization (WHO)

Yellow fever situation report

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GENEVA – A yellow fever outbreak was detected in Luanda, Angola, late in December 2015.

GENEVA – A yellow fever outbreak was detected in Luanda, Angola, late in December 2015. The first cases were confirmed by the National Institute for Communicable Diseases (NICD) in South Africa on January 19, 2016 and by the Institut Pasteur Dakar (IP-D) on January 20. Subsequently, a rapid increase in the number of cases has been observed.

Summary:

Angola: 2954 suspected cases

From the beginning of the outbreak on 15 December 2015 to 8 June 2016, Angola has reported 2954 suspected cases of yellow fever including 328 deaths. Among those cases, 819 have been laboratory confirmed. Despite extensive vaccination campaigns in several provinces, circulation of the virus persists.


As of 8 June 2016 three new provinces in Angola have reported local transmission, bringing the total number of districts with local transmission to 33 in 11 provinces, including Luanda.

The total number of reported cases in Angola increased from 11 April 2016 onward, while the number of laboratory confirmed cases remains stable. This can be attributed to the intensification of surveillance activities in most provinces.

Democratic Republic of The Congo: 57 laboratory confirmed cases

From the beginning of the outbreak on 22 March 2016 to 8 June 2016, the Democratic Republic of The Congo (DRC) has reported three probable cases and 57 laboratory confirmed cases: 51 of those are imported from Angola, reported in Kongo Central, Kinshasa and Kwango provinces, two are sylvatic cases in Northern provinces, and four are autochthonous cases in Ndjili and Kimbanseke districts, in Matadi (Kongo Central) and in Kwango province.

Uganda: 68 suspect cases

From the beginning of the outbreak on 9 April 2016 to 8 June 2016, the Ministry of Health of Uganda, has reported 68 suspected cases, of which three are probable and seven are laboratory confirmed. Confirmed cases have been reported from three districts: Masaka (five cases), Rukungiri (one case) and Kalangala (one case). According to sequencing results, those clusters are not epidemiologically linked to Angola.

The risk of spread

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

Three countries have reported confirmed yellow fever cases imported from Angola: DRC (51 cases), Kenya (two cases) and People’s Republic of China (11 cases). This highlights the risk of international spread through non-immunised travellers.

A further three countries have reported suspected cases of yellow fever: Ethiopia (one probable case), Ghana (four suspect cases) and Republic of Congo (one suspect case). Investigations are ongoing to identify the vaccination status of the cases and determine if they are linked with Angola. The two suspect cases previously reported in Sao Tome and Principe have been discarded.

Risk assessment

The outbreak in Angola remains of high concern due to:

Persistent local transmission in Luanda despite the fact that approximately 8 million people have been vaccinated.

Local transmission has been reported in 11 highly populated provinces including Luanda. Kuanza Norte, Luanda Norte, Cunene and Malenge are the provinces that most recently reported local yellow fever transmission.

The continued extension of the outbreak to new provinces and new districts.

High risk of spread to neighbouring countries. As the borders are porous with substantial cross border social and economic activities, further transmission cannot be excluded. Viraemic travelling patients pose a risk for the establishment of local transmission especially in countries where adequate vectors and susceptible human populations are present.

Risk of establishment of local transmission in other provinces where no autochthonous cases are reported.

High index of suspicion of ongoing transmission in hard-to-reach areas like Cabinda.

Inadequate surveillance system capable of identifying new foci or areas of cases emerging.



About the author

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Juergen T Steinmetz

Juergen Thomas Steinmetz has continuously worked in the travel and tourism industry since he was a teenager in Germany (1977).
He founded eTurboNews in 1999 as the first online newsletter for the global travel tourism industry.

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