2016 yellow fever epidemic in Angola

Epidemic curve for yellow fever cases in Angola as of 24 April 2016[1]

On 20 January 2016, the health minister of Angola reported 23 cases of yellow fever with 7 deaths among Eritrean and Congolese citizens living in Angola in Viana municipality, a suburb of the capital of Luanda. The first cases (hemorrhagic fever suspected as being yellow fever) were reported in Eritrean visitors beginning on 5 December 2015 and confirmed by the Pasteur WHO reference laboratory in Dakar, Senegal in January.[2][3] The outbreak was an urban cycle of yellow fever transmission, which can spread rapidly.[4] Moderators from ProMED-mail stressed the importance of initiating a vaccination campaign immediately to prevent further spread. The CDC classified the outbreak as Watch Level 2 (Practice Enhanced Precautions) on 7 April 2016.[5] The WHO declared it a grade 2 event on its emergency response framework having moderate public health consequences.[6]

By early February, suspected cases were being reported from southern Huila province, about a 1000 kilometers south, and the provinces of Bié, Benguela, Cunene, Cabinda, Hula, Huambo, Malange, Kwanza Sul, Uige, Zaire and Kwanza Norte.[7] As of 9 March 2016, the WHO reported that there were 65 confirmed cases, 813 suspected cases, and 138 deaths in Angola.[8] On 22 March, WHO reported that cases had occurred in 6 of the 18 provinces of Angola, and that transmission was ongoing. Suspected and confirmed cases totaled 1,132, with 375 cases laboratory confirmed and 168 deaths,[9][10] but totals were probably higher.[11] As of 24 April, suspected cases were 2,023 and laboratory-confirmed cases totaled 653; total deaths were 258.[12] The disease had been reported in 13 of 18 provinces of Angola by 24 April.

Geographic distribution of yellow fever in Angola as of 10 April 2016.[13]

On 13 March 2016, the Chinese government confirmed that a 32-year-old male Chinese citizen who had been in Angola had developed yellow fever on return.[14][15] The case was the first imported yellow fever case in China in history. Yellow fever has never appeared in Asia even though the mosquito vector is present.[16] Additional cases have since been reported in people who first had symptoms while in Luanda.[17] Thirteen suspected cases and six deaths were also reported on 20 March in the Democratic Republic of Congo.[18] Two cases imported from Angola, including one death, were reported in Kenya.[19] ProMED-mail moderator Jack Woodall warned that "spread could make the Ebola and Zika epidemics look like picnics in the park!" and that "international action should start now."[20] Chinese authorities have strengthened thermal imaging at airports to detect passengers with elevated body temperatures.[21] A Chinese medical team deployed to Angola vaccinated 120 Chinese nationals as part of epidemic research.[22] More than 250,000 Chinese nationals live in Angola. On 8 April 2016, ten North Korean workers in Angola were reported to have died of yellow fever.[23]

On 25 March 2016, a case was reported in Fujian Province, in a woman who returned from Angola on 12 March.[24] Fujian is within the predicted distribution of Aedes aegypti, the mosquito that transmits the yellow fever virus to humans. Mosquito-borne diseases can become endemic in a new geographic area when local mosquitoes become infected by feeding on an imported case.[25] Between 18 March and 22 April, the WHO was notified of 11 imported cases in China.[26]

On 22 March April 2016, the WHO was notified of 21 deaths from yellow fever in the Democratic Republic of the Congo, some in a province that borders Angola.[27] Since early January, 453 people were suspected of having contracted yellow fever in the Congo, as of 22 March, with 45 deaths.[28] Of the suspected cases, 16 were confirmed by the Pasteur Institute laboratory in Dakar.[29] As of 30 April, ongoing yellow fever transmission was present in Congo DR and Uganda.[30] The outbreak in Uganda is apparently unrelated to the outbreak in Angola.[31] According to WHO, cases have been exported from Angola to China, Congo DR, and Kenya as of 13 April.[32]

On 28 March, ProMED-mail moderators Jack Woodall and Tom Yuill issued another strongly worded warning on the threat of yellow fever for countries that now have endemic dengue fever (and thus the mosquito vector of yellow fever and dengue fever, Aedes aegypti), and particularly for countries in Asia, where until recently yellow fever has never appeared. Other parts of the world where yellow fever is present but usually in the quiescent jungle cycle, and where there is regular air travel, such as Brazil, may also be vulnerable.[33] They stressed that world stocks of 7 million doses of vaccine have been exhausted in the vaccination campaign against the outbreak in Angola. If yellow fever spread to the 18 countries in Asia where the mosquito vector is present, more than 2 billion people will be at risk. They stated: "Apocalyptic forecasts of the numbers of fatalities from Ebola turned out to be wildly wrong, and we can hope that will again be the case here, but given the way Zika has exploded in the Western hemisphere, we can't count on it." [34] The CDC said they cannot assist as much in the outbreak because all its experts are involved in efforts against the Zika virus outbreak in the Americas.[35] Starting on 26 April, ProMED-mail issued a series of posts on pre-planning information for countries at risk of importation of yellow fever, covering vaccination, mosquito control, quarantine and personal protection measures.[36][37]

Vaccination campaign

With help from the World Health Organization (WHO), the Angolan Ministry of Health began a campaign of preventive measures including vector control and vaccination in Viana in the first week of February.[38] However, the minister reported that the government had enough vaccine for routine vaccination, but not enough to contain an outbreak.[39] The WHO was supporting the Angolan government in immunization of 6.7 million people in Luanda province with the aim of vaccinating at least 80% of the population at risk of infection.[40] The vaccine supply began to run low by late March, with the director of the CDC, Tom Friedman, warning that "It's possible we could run out of vaccine."[41] The goal of the vaccination campaign in Luanda province was to vaccinate 88 percent of the population (5 804 475 of 6 583 216); ProMED reported that the total national stock of yellow fever vaccine as of 29 Mar 2016 was 1 032 970 doses.[42] As of 10 April 2016, almost 6 million people had been vaccinated in Luanda.[43] On 19 April, the WHO reported that the campaign had been extended into the provinces of Huambo and Benguela where local transmission is reported.[44] On 24 April, the WHO reported that 7.3 million people had been vaccinated in the three provinces.[45]

If the epidemic were to spread, particularly into Asia, the global supply of vaccine would be insufficient to protect the millions of people that would need to be vaccinated to curb an epidemic.[46] As an emergency measure, experts have suggested using one-fifth of the usual dose to extend existing supplies of vaccine.[47]

Efforts to prevent international spread are confounded by the practice of selling falsified yellow fever vaccination certificates.[48] The fake cards are sold to people who are required to have proof of vaccination after travel to areas where yellow fever is endemic. On 11 February 2016, the Pasteur Institute (WHO) in Senegal warned of fake yellow fever vaccine on the international market.[49]

Vaccination recommendations for the “yellow fever belt” of Africa, 2015[50]

References

  1. ↑ "Situation Report: Yellow fever outbreak in Angola, 24 April 2016". www.afro.who.int. Retrieved 28 April 2016.
  2. ↑ "Situation report: Yellow fever outbreak in Angola, 14 March 2016". www.afro.who.int. Retrieved 5 April 2016.
  3. ↑ "Yellow fever - Africa (16): Angola 2016-02-27 10:11:59 Archive Number: 20160227.4053826". Pro-MED-mail. International Society for Infectious Diseases. Retrieved 17 March 2016.
  4. ↑ "Yellow fever - Africa (18): Angola". Pro-MED-mail. International Society for Infectious Diseases. Retrieved 15 April 2016.
  5. ↑ "Yellow Fever in Angola". Traveler's Health. Centers for Disease Control and Prevention. Retrieved 8 April 2016.
  6. ↑ "Yellow fever - Africa (40): Angola, WHO". Pro-MED-mail. International Society for Infectious Diseases. Retrieved 15 April 2016.
  7. ↑ "Yellow fever - Africa (16): Angola 2016-02-27 10:11:59 Archive Number: 20160227.4053826". Pro-MED-mail. International Society for Infectious Diseases. Retrieved 17 March 2016.
  8. ↑ "Angola immunizes 6.7 million people against yellow fever". WHO Regional Office for Africa. World Health Organization. Retrieved 17 March 2016.
  9. ↑ "Yellow Fever – Angola". Emergencies preparedness, response. World Health Organization. Retrieved 23 March 2016.
  10. ↑ "Angola grapples with worst yellow fever outbreak in 30 years". World Health Organization. Retrieved 25 March 2016.
  11. ↑ "Yellow fever death toll rises to at least 250 in Angola". Mail Online. 15 March 2016. Retrieved 17 March 2016.
  12. ↑ "Situation Report: Yellow fever outbreak in Angola, 24 April 2016". www.afro.who.int. Retrieved 28 April 2016.
  13. ↑ "Situation Report: Yellow fever outbreak in Angola, 11 April 2016". www.afro.who.int. Retrieved 13 April 2016.
  14. ↑ "Yellow fever - China: ex Angola, 1st case in Asia 2016-03-13 16:14:53". ProMED-mail. International Society for Infectious Diseases. Retrieved 19 March 2016.
  15. ↑ "Yellow Fever – China". World Health Organization. Retrieved 30 March 2016.
  16. ↑ Vainio, J; Cutts, F (1998). Yellow Fever. World Health Organization.
  17. ↑ "Yellow fever - China (03): ex Angola 2016-03-19 22:06:08 20160319.4106312". ProMED-mail. International Society for Infectious Diseases. Retrieved 19 March 2016.
  18. ↑ "Yellow fever - Africa (26): Congo DR 2016-03-20 15:03:46 Archive Number: Archive Number: 20160320.4107262". ProMED-mail. International Society for Infectious Diseases. Retrieved 17 March 2016.
  19. ↑ "Yellow fever - Africa (24): Kenya ex Angola 2016-03-18 18:40:36". ProMED-mail. International Society for Infectious Diseases. Retrieved 17 March 2016.
  20. ↑ "Yellow fever - China: ex Angola, 1st case in Asia 2016-03-13 16:14:53". ProMED-mail. International Society for Infectious Diseases. Retrieved 17 March 2016.
  21. ↑ "Guangdong strengthens monitoring of body temperature on passengers (2)". Xinhua/Liu Dawei. 16 February 2016. Retrieved 20 March 2016.
  22. ↑ "Yellow fever - Africa (32): Angola 2016-03-29 20:31:42 Archive Number". International Society for Infectious Diseases. Retrieved 30 March 2016.
  23. ↑ Herald, The Korea. "N. Korean workers die of yellow fever in Angola: RFA". www.koreaherald.com. Retrieved 10 April 2016.
  24. ↑ "Yellow fever - China (05) ex Angola 2016-03-25 17:56:49 Archive Number: Archive Number: 20160325.4119422". ProMED-mail. International Society for Infectious Diseases. Retrieved 17 March 2016.
  25. ↑ "Zika Virus Spreads to New Areas — Region of the Americas, May 2015–January 2016". Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention. Retrieved 26 March 2016.
  26. ↑ "Yellow Fever – China". World Health Organization. Retrieved 1 May 2016.
  27. ↑ "Congo Records 21 Yellow Fever Deaths". The New York Times. 12 April 2016. Retrieved 12 April 2016.
  28. ↑ "Yellow fever - Africa (37): Congo DR". www.promedmail.org. Retrieved 2016-04-13.
  29. ↑ "Yellow fever – Democratic Republic of the Congo". World Health Organization. Retrieved 3 May 2016.
  30. ↑ "Yellow fever - Africa (48): current situation". www.promedmail.org. International Society for Infectious Diseases. Retrieved 1 May 2016.
  31. ↑ "Yellow fever – Uganda". World Health Organization. Retrieved 3 May 2016.
  32. ↑ "Yellow fever – Angola". World Health Organization. Retrieved 1 May 2016.
  33. ↑ "Opinion: Who's Afraid of Yellow Fever? Why We Should Be". The Rio Times. Retrieved 24 April 2016.
  34. ↑ "Yellow fever - countries with dengue: alert 2016-03-28 20:39:56 Archive Number: Archive Number: 20160328.4123983". ProMED-mail. International Society for Infectious Diseases. Retrieved 29 March 2016.
  35. ↑ Jr, Donald G. Mcneil (4 April 2016). "Yellow Fever Outbreak in Angola Strains Health Organizations". The New York Times. Retrieved 7 April 2016.
  36. ↑ "Yellow fever - pre-planning for at-risk countries: vaccine". www.promedmail.org. International Society for Infectious Diseases. Retrieved 26 April 2016.
  37. ↑ "Yellow fever - pre-planning for at-risk countries (02): mosquito control". www.promedmail.org. International Society for Infectious Diseases. Retrieved 27 April 2016.
  38. ↑ "Yellow fever - Africa (09): Angola 2016-02-08 09:32:03 Archive Number 20160208.4003005". ProMED-mail. International Society for Infectious Diseases. Retrieved 17 March 2016.
  39. ↑ "Yellow fever - Africa (07): Angola (LU) RFI 2016-02-01 14:32:42 Archive Number: 20160201.3984228". Pro-MED-mail. International Society for Infectious Diseases. Retrieved 17 March 2016.
  40. ↑ "Angola immunizes 6.7 million people against yellow fever". WHO Regional Office for Africa. World Health Organization. Retrieved 17 March 2016.
  41. ↑ "Yellow fever vaccine shortage as outbreak in Angola spreads". CNN. Retrieved 29 March 2016.
  42. ↑ "Yellow fever - Africa (34): Angola, WHO 2016-04-04 12:10:59 09:32:03 Archive Number 20160404.4137096". ProMED-mail. International Society for Infectious Diseases. Retrieved 5 April 2016.
  43. ↑ "Situation Report: Yellow fever outbreak in Angola, 10 April 2016". www.afro.who.int. Retrieved 15 April 2016.
  44. ↑ "Angola extends yellow fever vaccination campaign to Huambo and Benguela provinces". www.afro.who.int. Retrieved 21 April 2016.
  45. ↑ "Situation Report: Yellow fever outbreak in Angola, 24 April 2016". www.afro.who.int. Retrieved 28 April 2016.
  46. ↑ Merelli, Annalisa. "The world is running short of yellow fever vaccines—and millions are at risk". Quartz. Retrieved 17 April 2016.
  47. ↑ "Yellow fever vaccine supply: a possible solution - The Lancet". www.thelancet.com. Retrieved 17 April 2016.
  48. ↑ "Yellow fever - Africa (06): Nigeria, fake cards". ProMED-mail. International Society for Infectious Diseases. Retrieved 17 March 2016.
  49. ↑ "Yellow fever - Africa (15): Angola, fake vaccine, SE Asia, WHO alert 2016-02-24 13:32:43 Archive Number: 20160224.4047041". Pro-MED-mail. International Society for Infectious Diseases. Retrieved 17 March 2016.
  50. ↑ "Yellow fever – Uganda". World Health Organization. Retrieved 3 May 2016.

External links

Wikivoyage has a travel guide for Yellow fever.
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