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Monday, May 9, 2016

GAVI Alliance funds Uganda yellow fever vaccination as outbreak rages on

By Esther Nakkazi

Uganda has received 714,579 doses of yellow fever vaccine, from the GAVI Alliance, worth 643,765 US dollars (over shs 2 billion), for an emergency reactive mass vaccination campaign in two districts.

Masaka and Rukungiri districts have been hit by a yellow fever outbreak recording 30 suspected cases and 11 deaths. Uganda started experiencing a yellow fever outbreak in January 2016 prior to this it reported a yellow fever outbreak in 2010 that affected five districts in the northern part of the country.

The  International Coordination Group on vaccines comprising of UNICEF, WHO, MSF, and the IFRC okayed for GAVI to pay for the vaccines. 

Immunisation of 698,850 people, aged six months and above will be done in the two districts and a campaign is scheduled to begin in the second week of May.

“The importance of carrying out a massive vaccination campaign is to interrupt the transmission. With this exercise, the affected population will be able to achieve immunity against yellow fever,” said Ms Aida Girma, UNICEF representative in Uganda.

Currently, the Government of Uganda, through the Ministry of Health and its partners, UNICEF, WHO, MSF and CDC, is supporting social mobilization activities, facilitation of health workers, and capacity building of health teams in the affected districts. 

Social mobilization activities include engaging local leaders and village health teams to conduct interpersonal and door-to-door communication with communities in small groups. Utilization of the local media using radio messages is also on-going.

Dr Jane Ruth Acheng, the Director General of Health Services at the Ministry of Health is the overall coordination of the response being done by the National Task Force and she says the general objective of the response plan is to reduce avoidable morbidity and mortality due to the outbreak.

According to WHO, there is no specific treatment for yellow fever but the international organisation recommends that patients should be provided with supportive treatment which includes rehydration therapy for dehydration, analgesics for fever, diazepam for restlessness, and bed nets for preventing the spread of infection.

Vaccination is the major preventive measure against the disease because it is highly effective,” added Dr Wondimagegnehu Alemu, WHO country representative in Uganda. 

The WHO situation report released on 5th May shows that countries in Africa have suffered from a yellow fever outbreak. One was detected in Angola late in December 2015 and confirmed by the Institut Pasteur Dakar (IP-D) on 20 January 2016. Subsequently, a rapid increase in the number of cases has been observed.

It reported that as of 4 May 2016, Angola has reported 2,149 suspected cases of yellow fever with 277 deaths. Among those cases, 661 have been laboratory confirmed. Despite vaccination campaigns in Luanda, there is still circulation of the virus in most districts of Luanda and in five additional provinces.

Three countries have reported confirmed yellow fever cases exported from Angola: Democratic Republic of The Congo (DRC) (37 cases), Kenya (two cases) and People’s Republic of China (11 cases). Namibia has also reported a suspect yellow fever case exported from Angola. This highlights the risk of international spread through non-immunised travellers.

On 22 March 2016, the Ministry of Health of DRC notified human cases of yellow fever in connection with Angola. The Government officially declared the yellow fever outbreak on 23 April. As of 4 May, DRC has reported 5 probable cases and 39 laboratory confirmed cases: 37 imported from Angola, reported in Kongo central province and Kinshasa and two autochthonous cases in Ndjili, Kinshasa and Matadi, Kongo central province. The possibility of locally acquired infections is under investigation for at least 10 non-classified cases in both Kinshasa and Kongo central provinces.

The virus in Angola and DRC is largely concentrated in main cities and is likely to have been introduced to the cities following increased yellow fever viral circulation among monkeys in the forest.

What is yellow fever?

Yellow fever is a viral infection that is transmitted to humans through a bite from a mosquito carrying the yellow fever virus. It causes fever, yellowing of the eyes, and bleeding from any part of the body. The "yellow" in the name refers to the jaundice (Nkaka) that affects some patients.
What are the signs and symptoms of yellow fever?
After three to six days of infection with the yellow fever virus, the following signs and symptoms usually appear:
  • Rapid onset fever
  • Abdominal pain
  • Diarrhoea
  • Vomiting
  • General body weakness
  • Yellowing of the eyes
  • Loss of appetite
  • Bleeding from any part of the body
Some patients may develop yellow eyes, abdominal pain, bleeding from the mouth, nose, eyes and stomach. Most patients fight the infection and the signs and symptoms disappear after three to four days. However, those unable to fight the infection worsen (toxic phase) and many of these eventually die within 10 to 14 days.

How is yellow fever spread?
The yellow fever virus is spread by mosquitoes, which transmit the virus to humans through a bite, leading to the spread of the disease in communities. The infected mosquitoes that spread the disease usually bite people during the day. They breed in open containers around homes, as well as pools of stagnant water and bushes.
Who is at risk of getting yellow fever?

Anyone who is bitten by an infected mosquito can get the disease. However, it is important to note that some members of the community may be more at risk of catching the disease than others, for example: 
  • Anyone who is not immunized against yellow fever;
  • People who work or live in forests
How is yellow fever treated?

There is no specific treatment for yellow fever. Health workers can only offer supportive care to treat dehydration and fever. Bacterial infections linked to the diseases can be treated with antibiotics. It is important to seek early treatment when symptoms show.

How can yellow fever be prevented?
  • Vaccination
  • Mosquito control
  • Personal protection: wear long sleeve shirts or blouses, trousers, long dresses and long skirts 

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