Day: September 5, 2022

Yellow fever is endemic in the WHO African Region and was among the top five most frequently reported events in the region in 2019 and 2020. Twenty-seven countries in Africa have been classified as high-risk by the Eliminate Yellow fever Epidemics (EYE) global strategy. From 1 January 2021 to 26 August 2022, a total of 12 countries in the region have reported 184 confirmed cases and 274 probable cases, including 21 deaths, reflecting ongoing complex viral transmission.

Risk factors for onward spread and amplification include low population immunity, population movements, viral transmission dynamics, and climate and ecological factors that have contributed to the spread of Aedes mosquitoes. Response measures, most notably reactive and preventive vaccination campaigns, are ongoing in the affected countries. Since the beginning of 2021, over 3.9 million people have been vaccinated through reactive vaccination campaigns in Cameroon, Central African Republic, Chad, Ghana, and Kenya.

Description of outbreaks

In 2021, nine African countries – Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of Congo, Gabon, Ghana, Nigeria, and Republic of the Congo – reported a total of 151 confirmed cases of yellow fever (for more details, please see the Disease Outbreak News published on 23 December 2021). Of these nine countries, six continue to report confirmed cases of yellow fever with ongoing transmission in 2022, while Côte d’Ivoire and Nigeria have reported probable cases and Gabon has not reported further cases since 2021.

In 2022, two additional countries, Kenya and Uganda, have reported confirmed cases of yellow fever. From 1 January to 26 August 2022, a total of 33 confirmed cases of yellow fever were reported from eight African countries including Central African Republic (33%, 11 cases), Cameroon (24%, eight cases), Democratic Republic of Congo (13%, four cases), Kenya (9%, three cases), Chad (6%, two cases), Republic of the Congo (6%, two cases), Uganda (6%, two cases), and Ghana (3%, one case).

Ten countries – Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of Congo, Ghana, Kenya, Niger, Nigeria, and Republic of the Congo – have also reported a total of 274 probable cases of yellow fever from 1 January 2021 to 26 August 2022 (Table 1).

The majority of cases over the entire period were reported in the last quarter of 2021 (Figure 1), with Ghana reporting around 33% of all confirmed cases. Of 184 confirmed cases, 73% are aged 30 years and below, and the male-to-female ratio is 1.2. The case count and the number of outbreaks are anticipated to continue evolving as the Region enters the seasonal period when there is often an increase in cases notified.

Epidemiology of yellow fever

Yellow fever is an epidemic-prone, vaccine-preventable disease caused by an arbovirus transmitted to humans by the bites of infected Aedes and Haemagogus mosquitoes. The incubation period ranges from 3 to 6 days. Many people do not experience symptoms, but when they occur the most common are fever, muscle pain with prominent backache, headache, loss of appetite, and nausea or vomiting. In most cases, symptoms clear after 3 to 4 days. A small proportion of cases progress to the toxic phase with systemic infection affecting the liver and kidneys. These individuals can have more severe symptoms of high-grade fever, abdominal pain with vomiting, jaundice and dark urine caused by acute liver and kidney failure. Bleeding can occur from the mouth, nose, eyes, or stomach. Death can occur within 7 – 10 days in about half of cases with severe symptoms.

Yellow fever is prevented by an effective vaccine, which is safe and affordable. A single dose of yellow fever vaccine is sufficient to grant sustained immunity and life-long protection against yellow fever disease. A booster dose of the vaccine is not needed. The vaccine provides effective immunity within 10 days for 80-100% of people vaccinated, and within 30 days for more than 99% of people vaccinated.

Public health response

WHO is providing coordination and technical support to countries in conducting comprehensive investigations and outbreak response. Response measures by affected countries include:

**Strengthening surveillance and laboratory capacity **

• WHO is supporting national authorities with field investigations, including training of health personnel on yellow fever case investigation, review of case investigation reports, and undertaking case classification sessions to ascertain the epidemiological classification of yellow fever cases;
• The Eliminate Yellow fever Epidemics (EYE) strategy continues to support international shipment of yellow fever samples to regional reference laboratories since 2019, as well as ongoing laboratory testing and capacity building;
• Data management activities have been strengthened.

Vaccination

• Reactive vaccination campaigns (RVC)
  • As part of the outbreak response to the reported cases, there have been seven RVC (two in Ghana, two in Chad, and one each in Central African Republic, Cameroon, and Kenya);
  • From 1 January 2021 to 26 August 2022, a total of 3 991 568 persons have been vaccinated with support from the International Coordination Group (ICG);
  • An additional RVC has been approved by ICG for implementation in Central African Republic and is expected to launch in September 2022 with a target of 345,920 people.
• Preventive mass vaccination campaigns (PMVC)
  • PMVC target areas at high risk of virus transmission and inadequate population immunity. In total, approximately 80 million people are expected to be protected by PMVC in 2022;
  • Of the countries affected in this outbreak, Nigeria (in select States) and the Republic of the Congo have begun their PMVC this year; the Democratic Republic of the Congo and Uganda have also planned vaccination activities in the last quarter of 2022.

WHO risk assessment

According to the EYE strategy, twenty-seven countries in the African region are high-risk countries for yellow fever based on timing and intensity of yellow fever virus transmission, transmission potential and assessment of urban risk. Re-emergence of yellow fever was reported in 2020 with two outbreaks in West African countries with history of mass vaccination (in Guinea and Senegal, now contained). Since late 2021, the situation has intensified with 12 countries across the region reporting probable and confirmed cases.

WHO assesses the risk at regional level to be high. Current multi-country outbreaks and active virus circulation in West, Central and East Africa have resulted in increased morbidity and mortality, with continued risk of amplification and spread. The immunization coverage for yellow fever has been suboptimal in most of the affected countries and in specific populations. According to WHO and UNICEF estimates, in 2021, the routine childhood vaccination immunization coverage for yellow fever in the African region was 47%. This is much lower than the 80% threshold required to confer population immunity against yellow fever, indicating that a large population remains susceptible to yellow fever with a risk of continued transmission.

Immunization coverage by countries reporting probable and confirmed cases in West, Central and East Africa are as follows: Cameroon (54%), Central African Republic (41%), Chad (45%), Republic of the Congo (67%), Côte d’Ivoire (65%), Democratic Republic of the Congo (56%), Gabon (53%), Ghana (94%), Kenya (7%), Niger (80%), and Nigeria (63%). Uganda plans to introduce yellow fever vaccine into routine immunization in August 2022. Further information on immunization coverage can be found here.

Many countries in West, Central, and East Africa have been facing political instability and insecurity, in addition to concurrent outbreaks (including COVID-19, Ebola virus disease, cholera, meningitis, malaria, monkeypox, circulating vaccine-derived poliovirus type 2 (cVDPV2), chikungunya, leishmaniasis, plague, Lassa fever, etc.). These could contribute to delayed case investigation and hinder the surveillance and response efforts against yellow fever.

The risk at global level is assessed to be low as no exported cases of yellow fever linked to these 12 countries with probable or confirmed cases since January 2021 have been reported.

WHO advice

• Surveillance: WHO recommends close monitoring of the situation with active cross-border coordination and information sharing, due to the possibility of cases in neighbouring countries. Enhanced surveillance with investigation and laboratory testing of suspect cases is recommended.
• Vaccination: Vaccination is the primary means of prevention and control of yellow fever. Yellow fever vaccination is safe, highly effective and a single dose provides life-long protection. Completion of nation-wide population protection through vaccination will help avert the risk of future outbreaks. WHO supports national plans by countries reporting yellow fever outbreaks to introduce yellow fever vaccination into the routine immunization programme and complete preventive mass vaccination activities to rapidly boost population immunity.
• Vector control: In urban centres, targeted vector control measures are also helpful to interrupt transmission. As a general precaution, WHO recommends avoidance of mosquito bites including the use of repellents and insecticide treated mosquito nets. The greatest risk for transmission of yellow fever virus is during the day and early evening.
• Risk communication: WHO encourages its Member States to take all actions necessary to keep travellers well informed of risks and preventive measures including vaccination. Travellers should be made aware of yellow fever symptoms and signs and instructed to rapidly seek medical advice if presenting signs and symptoms suggestive of yellow fever infection. Returning travellers who are infected may pose a risk for the establishment of local cycles of yellow fever transmission in areas where a competent vector is present.
• International travel and trade: WHO advises against the application of any travel or trade restrictions to the Region. WHO recommends vaccination against yellow fever for all international travellers, aged nine months of age or older, going to areas determined by the WHO to be at risk for yellow fever transmission. For additional areas, the recommendation for vaccination of international travellers is subject to the assessment of the likelihood of exposure of each individual traveller. Detailed information is available here.

In accordance with the IHR (2005) third edition, the international certificate of vaccination against yellow fever becomes valid 10 days after vaccination and the validity extends throughout the life of the person vaccinated. A single dose of WHO approved yellow fever vaccine is sufficient to confer sustained immunity and life-long protection against yellow fever disease. A booster dose of the vaccine is not needed and is not required of international travellers as a condition of entry.

Source: World Health Organization

• From 24-26 August, the ETC undertook a joint mission with OCHA and implementing partner INTERSOS to the camp for Internally Displaced People (IDPs) in Bria to follow up on activities to improve the Common Feedback Mechanism (CFM).

• The free-of-charge ETC phone booth service in the IDP camp in Bria was reoperationalized on 2 August, after an increase in demand caused the service to be shut down in the last week of July. In August, an average of 41 calls were made per week.

• The ETC is continuing its efforts to raise the necessary funds to reactivate internet services in the 10 sites that were disconnected as of 1 August due to a persistent shortfall in funding.

Activities

Internet connectivity

The ETC continues its efforts to raise the necessary funds to reactivate internet services in 10 sites―Alindao, Bambari, Bouar, Bria, Bossangoa, Bangassou, Birao, Kaga Bandoro, Paoua, and Zemio. The ETC connectivity services were disconnected in the 10 sites as of 1 August due to a persistent shortfall in funding.

Connectivity services continue to be provided to 25 users in Batangafo through a VSAT set up in 2019, thanks to the in-kind donation of Global ETC partners Ericsson Response and emergency.lu.

Source: World Food Programme

Libreville – Countries around the world are feeling the impacts of climate change, which is affecting their communities. In Africa, migration induced by slow onset events such as droughts, desertification, deforestation, water scarcity, rising sea levels, coastal erosion has increased in occurrence and severity over the last few decades due to the adverse effects of climate change.

The Africa Climate Week, organized from 29 August to 2 September, presented an opportunity for African countries to discuss regional climate action solutions ahead of the COP27, the global climate change forum that will take place in Egypt in November.

Human mobility in Africa carries a long history and is a key driver for the resilience of communities. As part of the 2063 African Union Agenda and the Global Compact for Migration objectives, there is now recognition that migration can become a development enabler, a strategy to improve sustainable livelihoods, and adapt to environmental pressures and climate change.

The West and Central Africa region accounted for 265,400 internally displaced people (IDPs) due to disasters (such as floods, storms, or landslides), approximatively 3% of total IDPs in as of the end of 2021, according to the Internal Displacement Monitoring Centre. And so far in 2022, the Republic of Congo has been the most affected country, according to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), followed by Chad, Liberia, Nigeria, and Niger. 11 countries are considered flooding hotspots by OCHA in 2022 including Chad, Côte d’Ivoire, and The Gambia.

In the East and Horn of Africa, a fourth consecutive year of drought in the region has engendered loss of livestock and livelihoods, leaving millions of people severely affected in Kenya, Somalia, and Ethiopia, and pushing tens of thousands of families to leave their homes in search of food, water and pasture, many to urban areas.

“These figures compel us to collaborate to design sustainable solutions for people to stay, sustainable solutions for people on the move, and sustainable solutions for people to move”, said Caroline Dumas, IOM Director General’s Special Envoy on Migration and Climate Action. Designing such solutions implies not only cooperation and intersectoral policy dialogue and policy coherence, but also to look at the solutions communities are already developing.”

For a continent hosting 37 per cent of the world’s nomadic population, labour migration has always been a way for rain-fed rural communities to cope with environmental pressures.

“While there has been growing recognition of human mobility in the context of Climate Change in the global narrative, funding sources remain scarce”, added Ambassador Caroline Dumas, at the Africa Climate Week. African stakeholders often stress the lack of accessibility of Climate Finance by the communities who need it most. We need to contribute to address this important issue altogether.”

Last month, Member States from the Intergovernmental Authority on Development (IGAD), the East African Community and the States of East and Horn of Africa, signed the Kampala Declaration on Migration Environment on Climate Change. The signatory states urgently call for the world to respond to the impact of climate change on human mobility across the region and continent, and support affected communities, who are among the world’s most vulnerable, to adapt to climate change realities. This declaration also recognizes the need for creating and increasing investment in green economy, such as circular economy, renewable energy and energy efficiency, climate smart agriculture, digital economy, and nature-based solutions.

Source: International Organization for Migration