Within a day, nausea and muscle aches take a cursory turn for a high fever, hemorrhaging, jaundice, bleeding from orifices, renal failure and, within just two weeks, death. This is Yellow Fever, and it’s afflicting Central and East Africa.
There have been 1,645 suspected cases, 516 of which are laboratory-confirmed and 230 resultant in death in Angola thus far. The epidemic is the first Angola has endured in 30 years, first plaguing the capital city, Luanda, in December 2015. It has since spread to 16 of the country’s 18 provinces—five of which have local transmission: Huambo, Huila, Benguela, Uige and Kwanza Sul.
The country’s poor refuse collection, teeming garbage pile-ups and standing waters are breeding grounds for Aedes aegypti mosquitos—the same mosquitos that spread the Zika, Chikungunya and Dengue viruses—which transmit the disease. But Angola has evidently run out of money to afford fuel for refuse collection vehicles and wages, and the government of Luanda has a multimillion-dollar debt to the operators of waste compilation.
Likewise, the level of urbanization—grounds for epidemics—in Africa has soared from 15 to 40 percent over the last five decades, and is estimated to reach 55 percent in 2050. But Angola has been clear of an outbreak since 1988, when 37 cases of the Yellow Fever lead to 14 deaths.
“Since the Yellow Fever Initiative was launched in 2006, Yellow Fever control has been making significant progress in West Africa. Since 2006, more than 105 million people have been vaccinated, and no Yellow Fever outbreaks were reported in West Africa during 2015,” Tarik Jašarević, media relations spokesperson at the World Health Organization (WHO), told Her Report. “However, a large urban Yellow Fever outbreak has been ongoing in Angola since December 2015 and this is raising concerns about the need to strengthen mass vaccination in Central and East Africa.”
Prior to 2010, most Yellow Fever outbreaks were reported from 12 West African countries—Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Liberia, Mali, Nigeria, Senegal, Sierra Leone and Togo. After the implementation of combined vaccination strategies, preventive mass vaccination campaigns and routine immunization, however, the burden in those areas has decreased dramatically.
The Yellow Fever vaccine is a live-virus vaccine that has been used for several decades, and a single dose provides lifelong protection.
But the decrease in disease activity has also meant a shift from West Africa to Central and East Africa, where no preventive mass vaccination campaigns have been conducted. For example, the last major Yellow Fever outbreak occurred in Darfur, Sudan in 2012 with more than 847 reported cases that resulted in 171 deaths.
“The virus was probably introduced to Luanda following an increased viral circulation of the virus among monkeys in the forest. When introduced in urban areas, the high density of Aedes mosquitos and low immunity and vaccination rates of the population are the right cocktail for large epidemics,” Jašarević said.
It costs less than $2 USD ($1.58) to vaccinate a person. The bundled vaccine dose costs between $0.80-$1.30 USD per dose.
By the end of May, WHO, alongside the Ministry of Health and support from partners, aims to vaccinate more than 10.2 million people in Luanda and five other provinces reporting local transmission of Yellow Fever using 10.6 million vaccine doses (7.4 million doses for Luanda and 3.2 million for the five provinces). WHO has already dispatched 7.4 million does to reach seven million in Luanda and, as of March, nearly six million have been vaccinated.
It will cost nearly $18 million USD to control the outbreak. At present, WHO needs 3.2 million doses for vaccinating the other five provinces in April, which will cost $5.5 million USD.
The vaccination campaign has already shown results with fewer reports of new infections in Luanda, meeting the minimum coverage of at least 80 percent of the population to prevent outbreaks.
“Overall, Luanda has achieved 80 percent vaccine coverage. However, when looking at the municipal level, some municipalities have not attained sufficient vaccine coverage. Efforts are ongoing to improve vaccination coverage in these areas,” Jašarević explained.
It is recommended that anyone above nine months of age is vaccinated. There’s one major dilemma: the global vaccine shortage. But WHO has already tapped into the International Coordination Group emergency stockpile and the Centers for Disease Control and Prevention has said it cannot give Africa as much help as it normally would: Most of its mosquito-disease experts are fighting the Zika virus in Brazil, Puerto Rico and elsewhere.
“To address the shortage, vaccination campaigns are being prioritized for those people in provinces reporting local transmission because of the limited supply of vaccines. WHO, with manufacturers and partners’ support, diverted shipments of vaccines for national routine immunization programs in other countries to Angola until the emergency stockpile was replenished. The stockpile was replenished as at end March 2016,” Jašarević said.
WHO therefore recommends that governments increase disease surveillance and strengthen vector control through removing or reducing areas where vectors can easily breed. The organization also suggests that people use mosquito repellent and sleep under bed nets, keep their homes and living environments free of still water, use air conditioning or screens on windows and doors, and wear long-sleeved shirts and long pants.
Yellow Fever does not discriminate: Women and men alike are at extreme risk, though getting vaccinated poses potential adverse effects for pregnant and nursing women. Hence, when possible, avoiding travel to Yellow Fever epicenters is highly encouraged at this time.