Friday, May 20, 2016

WHO Yellow Fever Sitrep - May 20th


The World Health Organization has posted its latest Sitrep on Yellow Fever.  I've only posted the summary and risk assessment, so follow the link to download and read the full report. 

WHO Yellow Fever Situation Report (20 May 2016)

  •  A yellow fever outbreak was detected in Angola late in December 2015 and confirmed by the Institut Pasteur Dakar (IP-D) on 20 January 2016. Subsequently, a rapid increase in the number of cases has been observed.
  • As of 19 May 2016, Angola has reported 2420 suspected cases of yellow fever with 298 deaths. Among those cases, 736 have been laboratory confirmed. Despite vaccination campaigns in Luanda, Huambo and Benguela provinces circulation of the virus in some districts persists.
  •  Three countries have reported confirmed yellow fever cases imported from Angola: Democratic Republic of The Congo (DRC) (42 cases), Kenya (two cases) and People’s Republic of China (11 cases). This highlights the risk of international spread through non-immunised travellers.
  •  On 22 March 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 April. As of 19 May, DRC has reported five probable cases and 44 laboratory confirmed cases: 42 imported from Angola, reported in Kongo central province and Kinshasa and two autochthonous cases in Ndjili, Kinshasa and in Matadi, Kongo Central province. The possibility of locally acquired infections is under investigation for at least eight 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 April 2016. As of 19 May, 60 suspect cases, of which seven are laboratory confirmed, have been reported from three 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 Angola, DRC and Uganda 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.
  • An Emergency Committee (EC) regarding yellow fever was convened by WHO’s Director-General under the International Health Regulations (IHR 2005) on 19 May 2016. Following the advice of the EC, the Director-General decided 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 events do not at this time constitute a Public Health Emergency of International Concern (PHEIC). The statement can be found on the WHO website

Risk assessment

  • The outbreak in Angola remains of high concern due to:
  1. Persistent local transmission in Luanda despite the fact that more than seven million people have been vaccinated.
  2. Local transmission reported in seven highly populated provinces including Luanda.
  3. The continued extension of the outbreak to new provinces and new districts.
  4. High risk of spread to neighbouring countries. Confirmed cases have already travelled from Angola to DRC, Kenya and People’s Republic of China. 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.
  5. Inadequate surveillance system capable of identifying new foci or areas of cases emerging.
  6. 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 three 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.
  • Uganda and some countries in South America (Brazil and Peru) are facing yellow fever outbreaks or sporadic cases of yellow fever. Those events are not related to the Angolan outbreak but there are needs for vaccines in those countries in a context of limited YF vaccines stockpile.

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