YELLOW FEVER UPDATE. DPGH Meeting Dr. Grace Saguti NPO/DPC 13 July 2016

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1 YELLOW FEVER UPDATE DPGH Meeting Dr. Grace Saguti NPO/DPC 13 July 2016

2 Outline Introduction Yellow fever situation report & Risk Assessment: Angola WHO Recommendations Vaccination TZA status & Action Undertaken by government Additional information 2

3 3 Introduction

4 Yellow fever situation report In Angola, as of 1 July 2016 a total of 3552 suspected cases have been reported, of which 875 are confirmed. The total number of reported deaths is 355, of which 117 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. In the Democratic Republic of The Congo (DRC). According to the latest available information (as of 24 June), 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 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. In DRC, surveillance efforts have increased and vaccination campaigns have centred on affected health zones in Kinshasa and Kongo Central. 4

5 Yellow fever situation report (2) 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 nonimmunised travelers. 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. 5

6 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. 6

7 WHO Recommendations Vaccination Yellow fever vaccination is carried out for two different purposes: 1. To prevent the international spread of the disease by protecting countries from the risk of importing or spreading the yellow fever virus. These are requirements established by the country. The fact that a country has no requirement for yellow fever vaccination does not imply that there is no risk of yellow fever transmission. 2. To protect individual travellers who may be exposed to yellow fever infection. Yellow fever vaccination is recommended for all travellers 9 months old in areas where there is evidence of persistent or periodic yellow fever virus transmission. Yellow fever vaccination is generally not recommended in areas where there is low potential for yellow fever virus exposure (no human yellow fever cases ever reported and evidence to suggest only low levels of yellow fever virus transmission in the past). 7

8 Emergency Committee (EC) regarding yellow fever ( 19 May 2016) The event does not at this time constitute a Public Health Emergency of International Concern (PHEIC). Committee strongly emphasized the serious national and international risks posed by urban yellow fever outbreaks and offered technical advice on immediate actions for the consideration of WHO and Member States in the following areas: the acceleration of surveillance, mass vaccination, risk communications, community mobilization, vector control and case management measures in Angola and the Democratic Republic of Congo; the assurance of yellow fever vaccination of all travellers, and especially migrant workers, to and from Angola and Democratic Republic of Congo; the intensification of surveillance and preparedness activities, including verification of yellow fever vaccination in travellers and risk communications, in at-risk countries and countries having land borders with the affected countries. 8

9 YF Tanzania Status Tanzania is mapped by WHO as Low risk to Yellow At Risk geographical areas Border regions Points of entry Forest areas At risk groups Travellers to and from Yellow Fever endemic areas People working at Points of entry Communities living in border regions People engaging in forest activities 9

10 Action Undertaken by government Current Control Measures; Surveillance at health facility Screening of travelers entering the Country through points of entry and Provision of YF Vaccination to eligible travelers. Challenges/ Constrains Ineffective vector control activities Inadequate environmental sanitation Shortage of vaccine (in country and globally) Laboratory capacity Mushrooming of fake vaccination certificates 10