YELLOW FEVER The Recurring Plague

Size: px

Start display at page:

Download "YELLOW FEVER The Recurring Plague"

Elijah Wilson
6 years ago
Views:

1 SASTMM: Shifting And Overstepping boundaries YELLOW FEVER The Recurring Plague Oyewale Nigerian Academy of Science

2 Yellow Fever The Recurring Plague Brief historical overview of Yellow Fever Current Yellow Fever outbreaks Impact of Yellow Fever outbreaks globally What Future for Yellow Fever?

3 Date Event YELLOW FEVER-HISTORY 3000 BC. Evolved in Africa around 3,000 years ago YF outbreak -Canary Islands off the African coast 1600s Imported into the western hemisphere on slave ships from West Africa. First definitive evidence of yellow fever in the Americas- Mayan manuscripts 1648 describing YF outbreak in the Yucatan and Guadeloupe. Outbreaks reported in the United States, New York (1668), Boston (1691), and Charleston (1699). Yellow fever spread to Europe Cadiz, Spain epidemic killed > s Other epidemics in Seaports of Britain and France Epidemics reported in West Indies, Central America and USA 1778 Outbreak among French soldiers in St. Louis Senegal Outbreaks in West Africa- Sierra Leone, Senegal, Gambia, Fernando Po Annual outbreaks in New Orleans with >26,000 cases of yellow fever.

4 Date Event YELLOW FEVER-HISTORY 1898 More YF deaths in Cuba than deaths from YF Spanish-American war Formation of Reed YF Commission 1900 Proven transmission of YF infection to humans by Ae. aegypti mosquito The last outbreak in the United States occurred in New Orleans Panama Canal completed following YF control through mosquito control YF vaccines developed, the 17D vaccine and the FN vaccine. 1940s Mass campaigns were conducted using the 17D vaccine in S. America & the FN vaccine in French-controlled areas of Africa. 1960s YF in S. America, widespread outbreaks in West Africa 2005 GAVI yellow fever investment - MPC in West Africa Reduced incidence of YF in West Africa YF outbreaks shift to East and Central Africa 2016 Severe outbreaks in Angola & DRC; independent Uganda outbreak 2017 YF outbreak in Nigeria

5 From West Africa to Europe and Americas

THE SYNONYMS OF YELLOW FEVER 1494 - Known as Contagion By

Distemper Continua Putrida Icteriodes Caroliniensis Yellow

6 THE SYNONYMS OF YELLOW FEVER Known as Contagion By known by >152 names American Pestilence Barbados Distemper Continua Putrida Icteriodes Caroliniensis Yellow Jack Shall We Let Him In?' Political Cartoon on Yellow Fever Wall Art

7 YELLOW FEVER THE VIRUS An Arthropod-borne virus arbovirus - diverse group of viruses transmitted by arthropods between vertebrate hosts Vertebrate hosts of YF are monkeys and man Prototype member of the over 70 related Flaviviruses of the Flaviviridae family, including DEN, JE, BAN, WESS, WN, ZIKA YF virus is also classified as a hemorrhagic fever virus, because major bleeding with hematemesis and melena occur in some cases

8 YELLOW FEVER VIRUS Single serotype, with antigenic differences between strains African and American strains are ddistinguishable by lab techniques and pathogenecity for laboratory mice 2 genotypes in Africa, with 1, or 2 in the Americas

9 YELLOW FEVER ENDEMIC ZONES

10 No report of YF in Asia YELLOW FEVER: INCIDENCE & GEOGRAPHICAL DISTRIBUTION Non-introduction of YF to Asia Low viremia in infected humans Cross protection due other flavivirus infections (DEN, JE etc) Low vector competence (Ae. albopictus)

11 FOREST Transmission Pattern Peri-sylvatic communities CITY Explosive Yellow Fever Epidemic FOREST Sylvatic yellow fever TOWN Enzootic & Epizootic Yellow Fever NOMADIC GROUPS TOWN

13 Characteristics of Yellow Fever Disease 3-7 day incubation with an acute onset: initial malaria-like Runs a mild to fatal course, remission in 4-5 days, death 7-10 days Hepato-renal & neurotropic with/out haemorrhage; mortality as high as 20-50% in hepato-renal disease.

15 Yellow Fever The Recurring Plague Current Yellow Fever outbreaks Impact of Yellow Fever outbreaks globally What Future for Yellow Fever?

16 ~ 70 YEARS OF REPORTING YELLOW FEVER TO WHO South America Africa

THE 6000 RELENTLESS MARCH OF YELLOW FEVER THROUGH AFRICA 1 5000 4000 1989-ANGOLA 2008-NAMIBIA 1992-KENYA 2009-R-CONGO 1994-GABON 2013- UGANDA 1995-BURUNDI 2016-ANGOLA, DRCONGO

17 THE 6000 RELENTLESS MARCH OF YELLOW FEVER THROUGH AFRICA ANGOLA 2008-NAMIBIA 1992-KENYA 2009-R-CONGO 1994-GABON UGANDA 1995-BURUNDI 2016-ANGOLA, DRCONGO 2001-DRCONGO UGANDA CAF, KENYA,, CHINA 2017 NIGERIA 0,9 0,8 0,7 0, ,5 0, , ,2 0,

18 OUTBREAKS & SUSPECTED YF CASES YF IN AFRICA Before 2006 After 2006

19 YF OUTBREAKS IN 2016 Equator Trop. Of Capricorn Countries reporting YF cases

20 BACKGROUND YELLOW FEVER IN NIGERIA,

24 Urban YF epidemics - Factors Unplanned urban growth unprecedented Crowded tropical urban centers provide ideal ecological conditions to maintain viruses and mosquito vectors At risk YF susceptible population exceeds 2.5 billion people

25 Millions of Passengers Urban YF epidemics- Factors Globalization provides ideal mechanism to move viruses and vectors among population centers Global Air Network In 2016, estimated 3 billion passengers will travel by air Mean passengers per year

SPREAD OF YELLOW FEVER CASES FROM ANGOLA NATIONAL As of Sep.

$vaccinated in ANG & DRC 7M vaccinated with fraction dose of YF vaccine$ provinces 2473 samples lab tested, 76 confirmed/16 deaths Of 57 confirmed

26 SPREAD OF YELLOW FEVER CASES FROM ANGOLA NATIONAL As of Sep suspected cases /373 deaths in 16 of 18 provinces 17M people vaccinated in ANG & DRC 7M vaccinated with fraction dose of YF vaccine LUANDA INTERNATIONAL DRCongo- as of 5 Oct suspected cases in 26 provinces 2473 samples lab tested, 76 confirmed/16 deaths Of 57 confirmed cases, 13 autochthonous Also cases exported to Mauritania (1) & Kenya (2) INTER-CONTINENTAL China 11

YELLOW FEVER IN EUROPE WAS FROM 1700-1730 Between 1979 and 1996

28 YELLOW FEVER IN EUROPE WAS FROM Between 1979 and 1996 there episodes of YF importation into Europe by unvaccinated tyravelers

29 YELLOW FEVER IMPORTATION TO EUROPE & AMERICA Imported Case Year From To Age/Sex Vacc. Status Outcome 1979 Senegal France 42/M Not vaccinated Died 1979 Senegal France 25/M Not vaccinated Died 1988 West Africa* Spain 37/F Vaccinated** Died 1996 Brazil USA 42/M Not vaccinated Died 1996 Brazil Switzerland 53/M Not vaccinated Died There have been 7 additional YF importation to Europe from Ivory Coast (1999), Gambia (2002), plus 5 additional cases from US to Europe..latest being March 2017 from Suriname to the Netherlands *, travelled through several countries: Niger, Mali, Burkina Faso & Mauritania **, Had history of vaccination 5 years prior to travel, but probably received Hep B, and not YF vaccine

YELLOW FEVER IMPORTATION, 1979-2002 From To Year 1979 Senegal France 1988 W.

30 YELLOW FEVER IMPORTATION, From To Year 1979 Senegal France 1988 W. Africa Spain 1996 Brazil USA 1996 Brazil Switzerland 1999 CIV Germany 1999 Venezuela USA 2000 Suriname Netherlands 2001 Gambia Belgium 2002 Brazil USA

31 Yellow Fever The Recurring Plague Brief historical overview of Yellow Fever Current Yellow Fever outbreaks Impact of Yellow Fever outbreaks globally What Future for Yellow Fever?

32 OBSERVATIONS on the ORIGIN OF THE MALIGNANT BILIOUS, OR YELLOW FEVER IN PHILADELPHIA By Benjamin Rush

33 1853: NEW ORLEANS YELLOW FEVER EPIDEMIC Records show that 7, 849 people died in New Orleans in 1853 due to yellow fever.

34 YELLOW FEVER IMPACT ON ECONOMY estimated that because of yellow fever s disruption of business on the Mississippi River, more than fifty steamboats had been tied up and their crews discharge

35 YELLOW FEVER & EDUCATIONAL INSTITUTIONS.opening of schools was delayed for months, while in severe epidemics of yellow fever, the institutions served as temporarily YF hospital s and orphan asylums

36 YELLOW FEVER: INFLUENCE ON INSURANCE For New Orleans, many of the insurance companies refused failed to insure altogether

37 YELLOW FEVER IMPACT ON SOCIAL ACTIVITIES.the disease spreads alarm, the people are panic-stricken; there is disruption of the bonds which held men together, and for the time, the society is dissolved

Construction re-started in 1904 and canal opened in 1914 5,609 (4,500 West Indians and 350

38 YELLOW FEVER & PANAMA CANAL Construction started in 1880, abandoned in 1889 ~22, 000 (60%) of workers from accidents and diseases YF & malaria. Construction re-started in 1904 and canal opened in ,609 (4,500 West Indians and 350 Americans) died The sanitary control of mosquitoes Aedes and Anopheline mosquitoes YF & malaria vectors reduced YF transmission permitting canal completion

39 YELLOW FEVER & PUBLIC HEALTH Africa contributes more than 90% of global yellow fever morbidity and mortality. In 2013, YF burden in Africa estimated as 130,000 (range 51, ,000) and 78,000 (range 19, ,000) deaths disrupts existing health care delivery services, overstretch scarce internal resources, fatigues donor assistance and results in gross wastage of vaccines.

40 YYELLOW FEVER & PUBLIC HEALTH Resurgence of yellow fever in Africa because of collapse of health care delivery systems; lack of appreciation of the full burden/impact of YF low political commitment by governments poor disease surveillance; and uncoordinated outbreak response and control measures,

41 Yellow Fever The Recurring Plague Brief historical overview of Yellow Fever Current Yellow Fever outbreaks Impact of Yellow Fever outbreaks globally What Future for Yellow Fever?

42 YELLOW FEVER INITIATIVE (YFI) AND GAVI SUPPORT YF-IC 2005 YF-IC continuation 2008 Final IC 2013 YF-Long Term Strategy YF Position Paper 2003 First RA 2007 Revision Case definition 2010 Strategic Framework Group A,B C YF Position Paper 2013 > 134 m people protected

43 ACHIEVEMENT OF THE 2005 INITIATIVE million people vaccinated No YF epidemics in WA since 2006 YF Preventive Campaign Completed Partially completed Planned, RA done Vaccinated (in million) Coverage (%) Togo Senegal Mali Burkina Faso Cameroon Benin Liberia Sierra Leone Guinea Côte d'ivoire ,4 84 Ghana ,6 88 CAR

CONTROL OF YELLOW FEVER IN WEST AFRICA VACCINATIONS WITH FNV & REPORTED YF CASES: 1934-1953 GAVI THREE PRONG STRATEGY & REPORTED YF OUTBREAKS: 2004-2015 10 180 500 9 160 450 400 8 8 140 350 7 7 7 120

44 CONTROL OF YELLOW FEVER IN WEST AFRICA VACCINATIONS WITH FNV & REPORTED YF CASES: GAVI THREE PRONG STRATEGY & REPORTED YF OUTBREAKS: '34 '35 '36 '37 '38 '39 '40 '41 '42 '43 '44 '45 '46 '47 '48 '49 '50 '51 '52 '

45 WHAT IF YELLOW FEVER GETS INTO ASIA? WHAT YELLOW FEVER IN ASIA CAN CAUSE

46 ELIMINATING YELLOW FEVER EPIDEMICS (EYE) A WHO-UNICEF-GAVI MEETING MAY CHATEAU DE PENTHES, GENEVA Summary & Key Discussion Points

47 Previous Strategy WHY EYE? Angola nor DRC not categorized as high-risk countries, so did not conduct PMVCs. The capital cities, Luanda and Kinshasa Outbreaks particularly affected Non immunized expatriate workers infected & exporting YF to countries outside endemic zone Millions of vaccine doses used, depleting stockpile

48 PROTECT AT-RISK POPULATIONS PREVENT INTERNATIONAL SPREAD CONTAIN OUTBREAKS RAPIDLY Strategic Objective 1: Protect at-risk populations EYE Goal: To eliminate the risk of YF epidemics globally by 2026 Where risk is high, vaccinate everyone 475 mio vaccine doses for national preventive mass vaccination campaigns in 13 countries Vaccinate every child; find and vaccinate everyone who has been missed Strengthen surveillance and build laboratory capacity Monitor immunity 55 mio vaccine doses annually for routine immunisation in 26 countries Catch-up campaigns where indicated Cost and work plan to be defined Cost and work plan to be defined Protect at-risk populations Prevent international spread Strategic Objective 2: Prevent international spread Protect high-risk workers Cost and work plan to be defined Apply the International Health Regulations Cost and work plan to be defined Build resilient urban centres Cost and work plan to be defined Rapidly contain outbreaks Strategic Objective 3: Contain outbreaks rapidly Ensure emergency stockpile vaccines always readily available maintain 6 mio vaccine doses for emergency stockpile Prepare for rapid response Cost and work plan to be defined

49 We must see ACCOUNTABILITY In the operation of the EYE and in its IMPLEMENTATION We must NOT close the eye to those NATIONAL competing interests against EYE success We must open the EYE to ensuring NATIONAL OWNERSHIP of the EYE We must see GOOD GOVERNANCE in affected YF countries

50 PREVENTING AND CONTROLLING EMERGING DISEASES IN AFRICA A reliable & sustainable disease surveillance system Efficient laboratory support and back up Commitment to IHR (2005) Political will and commitment Adopting the One Health concept

51 Five Keys to the success of EYE 1. Political commitment for sustainable national /regional YF control strategies Essential for leadership in YF at-risk countries to committing to preventing epidemics and embracing the need to providing expertise and resources to work with EYE. 2. Governance and partnerships Coordination of the implementation of EYE activities with continuous monitoring and evaluation of implementation is essential for success.

52 Five Keys to the success of EYE 3. Accessible, affordable vaccines in sustained vaccine market YF risk changes rare potentials for increasing YF vaccine- demand and supply must be aligned for timely and effective risk reduction strategy. 4. Sustainable, efficient disease surveillance/lab. diagnosis The rapid detection of and efficient response to outbreaks are essential for sustainable YF control 5. Accelerated research and development for new tools and better practices Research partnerships with all stakeholders essential for identifying needs for and development of effective tools for YF control

53 GAVI, ECHO, CERF financial support YELLOW FEVER PARTNERSHIP Collaboration Ministries of Health WHO: coordination and technical support UNICEF: technical support and vaccine and supply procurement GOARN (AMP, CDC, PATH, Institut Pasteur etc.) implementation, training ICG (WHO, UNICEF, MSF, IFRC)

54 TIGER WOODS TIGERS WOOD

55 FROM THE ARCHIVES In 1835, a case of black vomitus is recorded. The origin of the outbreak was ascribed to importation from Fernando Po and by others from Zangara, 400 Boyce R. (1911) History of Yellow Fever in West Africa British Medical Journal Vol 1, No, 2613 p Jan miles distant. It was seriously proposed to BUILD A HIGH WALL to keep out this pestilential breeze, which it was alleged came from this town. SO BUILDING WALLS IS NOTHING NEW

56 Organizers of the Conference for the invitation Distinguished Ladies & Gentlemen for your attention

THE SITUATION OF YELLOW FEVER IN THE AFRICAN REGION: THE PLAN TO END YF EPIDEMICS IN 2026

THE SITUATION OF YELLOW FEVER IN THE AFRICAN REGION: THE PLAN TO END YF EPIDEMICS IN 2026 Dr Zabulon Yoti WHO AFRO Technical Coordinator for Health Emergencies 1 About 100 acute public health events annually