AT A GLANCE
This document is intended to guide the international response to the 2016 yellow fever outbreak in Angola and Democratic Republic of the Congo, and a concurrent yellow fever outbreak in Uganda, including preparedness for the importation of cases in non-affected countries. This coordinated approach to interrupt the chain of transmission is informed by lessons learned over the past six months. The strategy is timed to take advantage of the current dry season, when logistics will be more advantageous to transport vaccines to where they are most needed as the global stockpile is replenished. The document provides an overview of the current situation, and outlines the response strategy for the rapid containment of current outbreaks and the prevention of international spread. An update to this framework will be published in early June 2016, and provide further fine detail of how WHO and its partners are meeting the framework’s strategic objectives.
The overview and strategy were developed with input from WHO’s regional office for Africa, the WHO Country Offices of Angola, the Democratic Republic of the Congo, and Uganda, and from partners including Médecins Sans Frontières, the Prevention and Control Program Communicable Disease Control Directorate of the Department of Health, Western Australia Adjunct/University of Western Australia, UNICEF regional offices for West and Central Africa (WCARO) and East and Southern Africa (ESARO), UNICEF headquarters, and from The University of Texas Medical Branch (UTMB Health).
Background Yellow Fever is endemic in tropical areas of Africa and Central and South America. Thirty four (34) countries in Africa and thirteen (13) in Central and South America are either endemic for, or have regions that are endemic for, yellow fever.
On 21 January 2016 WHO received official notification through the International Health Regulations (2005) of a yellow fever outbreak in Angola. The first suspected cases were reported in late December from Luanda – the country’s capital city and main trade and travel hub, with a population of over 6 million people. The disease, which is transmitted in urban settings by the Aedes aegypti mosquito, spread rapidly in Luanda. From there, cases were exported to the rest of the country. By early May, all 18 of Angola’s provinces had reported suspected cases of yellow fever; 6 provinces had confirmed local mosquito-borne transmission. Cases of yellow fever have also been exported from Angola to China and Kenya.
On 22 March the Democratic Republic of the Congo (DRC), which borders Angola to the south, confirmed the detection of imported cases of yellow fever in areas bordering Angola by analysis at the Kinshasa National Institute of Bio-medical Research (INRB) and Pasteur Institute Dakar (IPD). By 8 June over 800 suspect and confirmed cases had been reported in districts bordering Angola, including evidence of local mosquito-borne transmission in the capital, Kinshasa, and the country’s main seaport Matadi. Together these two large urban settlements have a population of over 11 million people and are well connected to international travel and trade routes. On 21 May 2016 The Republic of Congo reported a probable case of yellow fever in the town of Madingou, located close to the border with DRC and Angola. WHO provided immediate technical assistance to the Congolese Ministry of Health, and is currently undertaking full field investigations to determine the nature and possible source of infection. Resources have been mobilised to strengthen local surveillance and diagnostic capacity.
In addition to the yellow fever outbreak taking place in and around Angola, on 26 March WHO received official notification of a yellow fever outbreak in Uganda. By 1 June, 61 suspected and confirmed cases had been reported from three districts. Analysis of the genetic sequence of the circulating virus indicates that the Ugandan outbreak is not linked to the outbreak in Angola. Further unrelated outbreaks in 2016 have been reported from Peru in April and Brazil in May. These outbreaks are being monitored closely, but at this stage are limited to non-urban areas.