Credit CDC Yellow Book
# 6765
Five weeks ago Yellow Fever was confirmed in Sudan after several weeks of reports of a `mysterious illness’ that had claimed several dozen lives (see WHO: Yellow Fever Outbreak In Sudan).
Yellow fever (aka Yellow Jack) is a viral disease transmitted by the Aedes mosquito (and others). A relatively safe and effective vaccine is available and travelers to parts of equatorial Africa and South America are often advised to get it.
Today the World Health Organization has updated the situation in Sudan, including details on a planned mass vaccination campaign.
Yellow fever in Sudan - update
6 December 2012 - As of 4 December, a total of 732 suspected cases of yellow fever, including 165 deaths have been reported in 33 out of 64 localities in Darfur. Laboratory results have confirmed yellow fever by IgM ELISA test and PCR in 40 clinical samples. Tests were conducted at the National Public Health Laboratory in Khartoum, with support from the US Naval Medical Unit 3 (NAMRU-3), WHO Collaborating Center for Emerging Infectious Diseases.
Currently, the Federal Ministry of Health is organizing an emergency mass vaccination campaign against yellow fever. The first phase of the campaign began on 21 November 2012, to cover 2.2 million people, and the second phase of the campaign is planned for this month, to cover an additional 1.2 million at risk population.
The vaccination campaign is being supported by the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG1), GAVI Alliance, ECHO, Central Emergency Response Fund (CERF), Sudan Common Humanitarian Fund (CHF), and non-governmental organizations working where the campaign is being carried out.
A comprehensive assessment of the outbreak is ongoing, to obtain additional epidemiological, laboratory and entomological information to understand the evolution of the outbreak and the risk of the epidemic.
WHO has activated the Global Outbreak Alert and Response Network (GOARN) and is deploying additional experts including an entomologist, virologists and an epidemiologist to support the ongoing response in the country.
1 The YF-ICG is a partnership that manages the stockpile of yellow fever vaccines for emergency response on the basis of a rotation fund. It is represented by United Nations Children's Fund (UNICEF), Médecins Sans Frontières (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC) and WHO, which also serves as the Secretariat. The stockpile was created by GAVI Alliance.
The CDC’s 2012 Yellow Book describes the clinical presentation of Yellow Fever this way:
Asymptomatic or clinically inapparent infection is believed to occur in most people infected with YFV. For people who develop symptomatic illness, the incubation period is typically 3–6 days.
The initial illness presents as a nonspecific influenzalike syndrome with sudden onset of fever, chills, headache, backache, myalgias, prostration, nausea, and vomiting. Most patients improve after the initial presentation.
After a brief remission of hours to a day, approximately 15% of patients progress to a more serious or toxic form of the disease characterized by jaundice, hemorrhagic symptoms, and eventually shock and multisystem organ failure. The case-fatality ratio for severe cases with hepatorenal dysfunction is 20%–50%.
On November 29th the CDC’s Traveler’s Health division issued an Outbreak Notice for Yellow Fever in Sudan, with the following recommendations (excerpt).
How Can Travelers Protect Themselves?
Travelers can protect themselves from yellow fever by getting vaccinated against yellow fever and by preventing mosquito bites.
- Get yellow fever vaccine.
- CDC recommends that all travelers 9 months of age or older receive a yellow fever vaccine if they are traveling to areas south of the Sahara Desert. The vaccine is not recommended for people traveling only to the Sahara Desert or the city of Khartoum. (See map.)
- Visit a yellow fever vaccination (travel) clinic to get your vaccine.
- You should receive this vaccine at least 10 days before your trip
- After you receive the vaccine, your doctor or nurse should give you a signed and stamped “International Certificate of Vaccination or Prophylaxis” (ICVP).
- One vaccine will last 10 years.
- Prevent mosquito bites
- Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.
- Use an insect repellent with one of the following active ingredients. Higher percentages of active ingredient provide longer protection.
- DEET
- Picaridin (also known as KBR 3023, Bayrepel, and icaridin)
- Oil of lemon eucalyptus (OLE) or PMD
- IR3535 (Avon Skin So Soft Bug Guard Plus)
- Always use insect repellent as directed.
- If you are also using sunscreen, apply sunscreen first and insect repellent second.
- Reapply as directed.
- Follow package directions for using repellent on children
- If you feel sick and think you might have yellow fever
- Talk to your doctor or nurse immediately if you develop a fever during or soon after travel
- Get lots of rest, and drink plenty of liquids.
- Use acetaminophen to reduce pain and fever. Do not take pain relievers that contain aspirin or nonsteroidal anti-inflammatory medications such as ibuprofen
- By avoiding mosquito bites, you are less likely to spread the disease to others.
- Seek health care immediately if you have cold, clammy skin; confusion; shortness of breath; swelling in the face; and weakness
