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Yellow fever in Sudan - update

22 NOVEMBER 2012 - The Federal Ministry of Health (FMOH) in Sudan began a 10-day mass vaccination campaign against yellow fever in Darfur on 20 November 2012, in response to the outbreak.

As of 17 November 2012, the outbreak is reported to have affected 26 localities, with a total of 459 suspected cases including 116 deaths. Two cases were confirmed by IgM ELISA test and RT-PCR by the WHO regional reference laboratory for yellow fever, the Institut Pasteur in Dakar, Senegal. An outbreak investigation team led by the Ministry of Health, with support from WHO are in the field to assess the extent of the outbreak and prioritize areas for the mass vaccination campaign.

With support from the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG), the Central Emergency Response Fund (CERF), and international non-governmental organizations (INGOs), the vaccination campaign will be carried out in the most affected 12 localities in Darfur region, targeting approximately 2.2 million people.

The YF-ICG is a partnership which manages stockpile of yellow fever vaccines for emergency response. 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.

Seven INGOs, including the International Committee of the Red Cross, MSF-Belgium, MSF-Spain, MSF-Swiss, Merlin, Save the Children-Swiss, and International Medical Corps are currently working in the 12 localities prioritized for the vaccination campaign. They will actively support the FMOH in this emergency response.

WHO is supporting the State Ministries of Health in conducting field investigations to better assess the epidemiological situation and the risk of disease spread, as well as on-the-job trainings for health staff to strengthen their disease surveillance systems and to improve collection of samples and laboratory diagnosis.

WHAT IS THE RISK OF INTERNATIONAL SPREAD OF YELLOW FEVER ?

The risk of international spread is greater than before. In the past devastating outbreaks occurred mainly in sea ports. Today, most cities are connected to most of the world by more rapid means of transport, train or plane. So far, the virus circulation has remained within the borders of historically endemic countries, but the virus could spread quickly and cause epidemics in areas with a high density of vectors and a non immune population.

Yellow fever resurgence : impact of mass vaccination campaigns

Historically yellow fever (YF) has caused devastating epidemics in Europe, Africa, South, Central and North America, but, for unknown reasons, yellow fever has not spread to Asia yet. The development of the live attenuated 17D vaccines in the 1930s was a turning point in the history of the disease. One dose of YF vaccine provides protection for at least 10 years and possibly lifelong. The vaccine is considered to be very safe.

Successful attempts to control yellow fever through compulsory immunization took place in the beginning of the 20th century : in some French speaking African countries (Benin, Burkina Faso, Cameroon, Chad, Cote d'Ivoire, Congo, Gabon, Guinea, Senegal, Togo) mass vaccination campaigns were carried out between 1933 and 1961 and resulted in the gradual disappearance of the disease.

Until the early 1990s, almost 30 years after the end of the mass preventive immunization campaigns, yellow fever remained only very sporadically active in the countries that benefited from those campaigns. However, during the same period, countries such as Ethiopia, Gambia, Ghana, Guinea Bissau, Liberia, Nigeria and Sierra Leone, which did not benefit from mass vaccination campaigns, experienced large epidemics.

Recently many small outbreaks have been reported in several countries, for the most part West African, indicating a re-emergence of yellow fever.

The interruption of regular mass vaccination campaigns in Africa has played a major role in the current resurgence of yellow fever. The resurgence began in equatorial Africa, with the 1990 epidemic in Cameroon (173 cases) in which 79% of the victims were children aged under 10 years. The disease then struck in West Africa and since 1995 this has been the region most affected by yellow fever.

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OUTBREAK NEWS

Novel Coronavirus infection in the United Kingdom

23 SEPTEMBER 2012 - On 22 September 2012, the United Kingdom (UK) informed WHO of a case of acute respiratory syndrome with renal failure with travel history to the Kingdom of Saudi Arabia (KSA) and Qatar.

The case is a previously healthy, 49 year old male Qatari national that presented with symptoms on 3 September 2012 with travel history to the KSA prior to onset of illness. On 7 September he was admitted to an intensive care unit (ICU) in Doha, Qatar. On 11 September, he was transferred to the UK by air ambulance from Qatar. The Health Protection Agency of the UK (HPA) conducted laboratory testing and has confirmed the presence of a novel coronavirus .

The HPA has compared the sequencing of the virus isolate from the 49 year old Qatari national with that of a virus sequenced previously by the Erasmus University Medical Centre, Netherlands. This latter isolate was obtained from lung tissue of a fatal case earlier this year in a 60 year-old Saudi national. This comparison indicated 99.5% identity, with one nucleotide mismatch over the regions compared.

Coronaviruses are a large family of viruses which includes viruses that cause the common cold and SARS. Given that this is a novel coronavirus, WHO is currently in the process of obtaining further information to determine the public health implications of these two confirmed cases.

With respect to these findings, WHO does not recommend any travel restrictions. Information regarding requirements and recommendations for the Hajj season in 2012 can be found at http://www.who.int/ith/updates/20120730/en/index.html

CHOLERA OUTBREAK

Cholera in Sierra Leone

22 AUGUST 2012 - Since the beginning of the year, Sierra Leone has recorded 11 653 cases of cholera, with 216 deaths (Case Fatality Rate of 1.9%). The rate of new cases has accelerated rapidly since the beginning of August: since then, 5 706 cases have been recorded, and two new districts, Bonthe and Kono, have been affected by the epidemic. Ten of the country’s 13 districts are now registering cases and this spread emphasizes the need to rapidly scale up the response.

The two most heavily affected districts are Western Area and Tonkolili.

The President of Sierra Leone has declared the escalating cholera epidemic a “humanitarian crisis”. Consequently, a multi-sectoral approach to the response has been adopted involving the Ministry of Health and Sanitation (MOHS), as well as other line ministries such as finance, information and communication, and local government, together with partners and stakeholders. A National Emergency Task force has been established with sub-committees dealing with surveillance, case management, water and sanitation, logistics and social mobilization. The WHO Country Office (WCO) in Sierra Leone is chairing a weekly meeting of partners and stakeholders to better coordinate harmonize and strategize support.

The MOHS, in partnership with Médecins sans Frontières (MSF), UNICEF, WHO, and other partners, is implementing the following prevention and control activities: epidemiological investigation, surveillance, case management at established cholera treatment centres, water and sanitation control measures, social mobilization and community education.

WHO is supporting Sierra Leone in the areas of epidemiology, social mobilization and surveillance. WHO has deployed two epidemiologists, and three cholera experts from Zimbabwe to support coordination, public information, social mobilization, case management and infection control.

WHO does not recommend that any travel or trade restrictions be applied to Sierra Leone.