Yellow Fever Outbreak in Darfur Situation Report 4 9 November 2012

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Yellow Fever Outbreak in Darfur Situation Report 4 9 November 2012 Health cadres treat suspected yellow fever cases in Darfur (left photo) as well as ensure that containment measures are in place

- A total of 266 suspected cases, including 85 deaths (with case fatality rate of 31.8%), have been reported as of 8 November 2012.

Rehaid Albirdy, Genaina, Kernik, Baidha, Habila, Forbranga, Saraf Omra and Alseraif. - About 72.9% of the reported cases are from Central Darfur, 10.

9, 47.6% are in the age 15-29.9 and 15.4% are 30-44.9 years and 6.6% are in the age group of 45 years and above. - Blood samples were obtained in 13% of the cases.

1 Yellow Fever Outbreak in Darfur Situation Report 4 9 November 2012 Health cadres treat suspected yellow fever cases in Darfur (left photo) as well as ensure that containment measures are in place such as spraying of vehicles carrying patients to hospitals (right photo). Epidemiology - The outbreak has affected 20 localities in Central, South, West, North and East Darfur. - A total of 266 suspected cases, including 85 deaths (with case fatality rate of 31.8%), have been reported as of 8 November Since the last week of September, reports of cases were received from the localities of Zalengei, Nertity, Wadisalih, Azoom, Mukjer, Bendisi, Nyala, Kass, Kubum, Sharq Agabal, Yassin, Mershingm, Rehaid Albirdy, Genaina, Kernik, Baidha, Habila, Forbranga, Saraf Omra and Alseraif. - About 72.9% of the reported cases are from Central Darfur, 10.9% are from South Darfur, 12% are from West Darfur, 4.1% are from North Darfur and 0.1% are from East Darfur % of the reported cases are in the age group 2-4.9, 27.5% are in the age group , 47.6% are in the age and 15.4% are years and 6.6% are in the age group of 45 years and above. - Blood samples were obtained in 13% of the cases. Out of the 28 samples, 10 tested positive for yellow fever by RT-PCR at the Central Public Health Laboratory in Khartoum. 2 positive samples were found in samples from each of Nertity and Wadi Salih locality (Central Darfur), 1 positive sample from each of Zalengei (Central Darfur), Genaina and Kernik (in West Darfur) and 3 positive samples from Kass locality in South Darfur). Some of the samples tested negative for Crimean-Congo haemorrhagic fever (CCHF) and chikungunya. 1

no of cases no of cases and deaths Graph below shows reported suspected cases of yellow fever by date of onset in Central, South West, North and East Darfur in the period 2 September to 8 November,

2 no of cases no of cases and deaths Graph below shows reported suspected cases of yellow fever by date of onset in Central, South West, North and East Darfur in the period 2 September to 8 November, 2012 (Source FMoH) Reported suspected cases of yellow fever by date of onset in Central, South West, North and East Darfur in the period 2 September to 8th of November, 2012-(Source FMoH) cases 5 0 date of reporting (2-Sep to---) Graph below shows suspected cases of yellow fever and reported deaths in Central, West, South and North Darfur from Week 39 to Week 44 (Source FMoH). 9 8 Suspected cases of yellow fever and reported deaths in Central, West, South and NorthDarfur in the period W 39 to W 44 (Source FMoH) DEATHS CASES W 39 W 40 W 41 W 42 W 43 W 44 Epid Week (W 36--)

3 fever vomiting joint pain convulsions Table below presents suspected cases of yellow fever: Attack rate (AR) and case fatality rate (CFR) per locality in affected localities in Greater Darfur between 2 September and 8 November State Locality no of Attack cases rate deaths CFR South Darfur Nyala % Sharq Algabal % Kass Mershing % Kubum % Rehaid Albirdy % Central Darfur Zalingei Wadisalih Azoom Nertity % Mukjer % Bendisi % West Darfur Genaina % Beidha % Habila % Kernik % Forbranga % North Darfur Saraf Omra % Alseraif East Darfur Yassin % Total Locality % Patients presented to health facilities with common symptoms. The most frequent symptoms are fever which is present in 98.6% of the cases, bleeding in 63.5% and vomiting in 58.3%. Please see figure below showing frequency of most common symptoms reported in the notified suspected cases of viral hemorrhagic fever in Darfur from 2 September to 8 November, Figure below shows distribution of age group in the reported cases of suspected cases of yellow fever, in Greater Darfur between 2 September and November, % % 80.00% 60.00% 40.00% 20.00% 0.00% symptoms 2 up to and above

Actions taken - The Wali (Governor) of Central Darfur together with the State s health authorities visiting the Strategic Health Operations (also known as SHOC) Room in Zalengei for developments/ and

4 Actions taken - The Wali (Governor) of Central Darfur together with the State s health authorities visiting the Strategic Health Operations (also known as SHOC) Room in Zalengei for developments/ and updates of the outbreak, its containment measures, difficulties and challenges. - The yellow fever vaccination plan which will cover 3,587,772 populations, in the age group 9 months and above, has been finalized. However this depends on the reconfirmation of the diagnosis by the reference laboratory, the Institute Pasteur, in Dakar, Senegal. - Technical support teams from FMoH are on the ground in Central, South and West Darfur for initial support to conduct entomological surveys conducted in the affected areas and set up blood bank units in Geneina and Zalengei in West and Central Darfur. - So far more than 100 medical doctors and medical assistants have beem trained in South Darfur on disease surveillance, case management, outbreak investigation and infection prevention and control. The Ministry of Health and the World Health Organization facilitated the training programmes. - Epidemiologically silent' localities of Mukjer and Bendsi in Central Darfur started to report cases and health cadres have started to sensitize communities. - The International Coordination Group (ICG) was alerted for vaccines for a possible reactive vaccination campaign awaiting reconfirmation of diagnosis by Institute Pasteur in Senegal. Recommendations - It has been recommended by WHO to continue laboratory testing of patients samples from newly affected localities. - Strengthening the operational support to Central Darfur state such as funding of the on-going outbreak containment measures (active case finding, vector control and community mobilization) needs to be prioritized.

Highlights. Epidemiology

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