Author: pr.web

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

Renewed intercommunal fighting that broke out in northern Blue Nile state on Thursday, continued the following day, despite a curfew set by the state government. At least 21 people were killed.

The death toll from the clashes between Hausa and other ethnic groups in El Roseires and the area south of the town rose to 21 on Friday. 33 people were wounded. The violence also led to new displacement.

Mohamed Mousa, representative of the Hausa in Blue Nile state, who signed a cessation of hostilities agreement in end July, told Radio Dabanga on Friday afternoon that seven people were killed in Teiba in El Roseires and the village of Ganis on Thursday. At least 10 were injured, including two children.

He said that a large group carrying knives and sticks launched an attack on worshipers in an El Roseires mosque during Friday prayers, which led to the killing of 14 people. 23 others were wounded, some of them seriously.

The Blue Nile state Security Committee sent forces to all areas that witnessed the violence to separate the two parties.

In a statement on Friday, the Security Committee explained that the reasons for the outbreak of the violence were not yet known, and that a committee has been formed to investigate the matter.

According to the statement, fighting resumed in Um Darfa, south of El Roseires, on Friday morning. Government forces intervened and manged to contain the situation.

The Sudanese Humanitarian Aid Commission said on Friday that at least 18 people were killed in Blue Nile state, as a result of renewed clashes between Hausa tribesmen and other communities in the Blue Nile state. Thousands of people fled the violence, and sought refuge in the state capital of Ed Damazin.

Land, hostility, gold rush

In mid-July, fighting erupted between Hausa and Berta and other ethnic groups in the northern part of Blue Nile state. At least 105 people were killed, and thousands of people fled to Ed Damazin and safe parts of El Roseires.

Those clashes allegedly erupted after the Hausa requested the establishment of a “civilian authority” that the other ethnic communities viewed as a means of gaining access to the land.

The El Roseires Resistance Committees however in July described the violence as a manifestation of the hostility between the two factions of the Sudan People’s Liberation Movement-North (SPLM-N) that split in 2017 following a leadership rift. The resistance committees accused the authorities of neglecting their duties because they ignored warning signs and chose not to act even after the first attacks.

Kholood Khair, leading member of a think-and-do tank in Khartoum, viewed the violence from a different angle: “This is a gold rush and a building of war chests by the emerging ethnic blocs of Burhan and the Centre vs Hemedti and the Periphery, giving a radically militarised trajectory to Sudan’s political future”.

The violence in July led to the displacement of about 31,000 people, many of whom sought refuge in schools in Ed Damazin and El Roseires that have by now turned into a kind of camps for the displaced.

The clashes also sparked protests across Sudan, as the Hausa people demanded justice for the dead. Most of the demonstrations remained peaceful, but the protests in Kassala in eastern Sudan turned into bloody clashes after angry young Hausa torched government offices in the city. Two of them reportedly died.

‘Black Africans’

A demonstration in Khartoum on July 19, launched from the poor southern district of Mayo was dispersed by tear gas. Activists tweeted that the demonstrators did not receive much support. “I expected more people to show up and tell them “you will never walk alone”, “we’re all Hausa” as resistance committees usually do, instead I noticed a lot of hostility and outright racism,” one of them said.

The Hausa in Sudan are part of the Hausa ethnic group, which is very influential in West Africa, politically and culturally. In the process of traveling and trading for centuries, some of them migrated east to places like Sudan – where they, as “black Africans” are still seen by many as outsiders.

Source: Radio Dabanga

In the developing Horn of Africa drought crisis, and as attention on the situation in Somalia rises, Kenya is at risk of falling into the shadows.

Kenya has now experienced four consecutive failed rainy seasons and is likely to experience a fifth by the end of 2022. As livestock die and crop production reduces, families are struggling to access sufficient food.

A lack of milk for children and lactating women is having a significant impact on nutrition.

FEWS NET last week raised concerns of a possible risk of IPC (Integrated Food Security Phase Classification) 5 in Kenya across the Arid and Semi-Arid Lands (ASALs) by the end of the year. Six counties may face an emergency level of food security (IPC 4) and eight a crisis level (IPC 3). There are also widespread critical levels of malnutrition, with 942,000 children in need of malnutrition treatment.

Alliance2015 members and the ASAL Humanitarian Network (AHN) have a wide footprint across the ASALs and have switched overwhelmingly to emergency programming to stave off the worst effects of a food security, nutrition and WASH crisis.

To fight food insecurity, cash is proving a particularly effective tool. ACTED leads the Kenya Cash Consortium and with the AHN, Concern and Oxfam, sustained cash assistance across the ASALs is improving food consumption and dietary diversity. Welthungerhilfe (WHH) also uses cash in Marsabit, Turkana, Tana River and Kajiado, and Cesvi in Isiolo. As prices continue to rise, families struggle to meet their basic needs, forcing them to make tough choices and prioritize expenses. Urgent scale up and continuous market monitoring is needed to address rising malnutrition and food insecurity.

To improve nutrition outcomes, Concern and WHH are supporting integrated nutrition outreach by county governments, facilitating surveillance and referral of malnutrition cases as well as the prepositioning of nutrition supplies in various health facilities. However, this must be scaled up, along with the provision of nutrition supplies and essential medicines to health facilities in remote areas. Since nutrition cannot be addressed solely by treatment, nutrition interventions must be integrated with those improving food security.

To address the WASH situation, Alliance2015 members and the AHN are implementing a broad range of activities to safeguard access to water, both for families and livestock, suitable sanitation and effective hygiene. This includes rehabilitation of strategic water points, provision of essential hygiene items and trainings to prevent water-borne diseases.

Alliance2015 members and AHN partners call for:

Urgent and equitable attention on Kenya for drought response funding: Currently allocated resources are insufficient as national and international humanitarian actors urgently require significant additional resources to save lives and protect livelihoods in the short-term;

Urgent planning for medium term actions: Given the long-lasting impact on livelihoods and food production, the situation will not be reversed even with a fair rainy season. Agro-pastoralists in particular will need support to recover and diversify their income-generating activities to build back resilience and the ability to withstand future shocks;

Continued support to national humanitarian actors at the forefront of the response:

Alliance2015 members work overwhelmingly in partnership with national actors and support the strengthening of locally-led humanitarian response to ensure effective targeting and a quality, efficient and timely response;

Scaled up investment in early action mechanisms: Humanitarian donors and responders, along with other relevant stakeholders, must continue to invest in early warning and early action approaches. These approaches should link identification with response through clear financing mechanisms to mitigate the impact of slow-onset crises, such as drought.

Source: ASAL Humanitarian Network

Security Update

In June incessant attacks in Ancuabe and Chiure districts triggered significant movement of population with a total of 83,983 people being displaced majority of them being women and children (67,524). Thus with this influx of IDPs across Cabo Delgado province, the Government and site service providers have planned to upgrade five sites (in Metuge (Unidade 2 and Centro de Nacuta) and three in Chiure (Nacivare, Ocua, and Megaruma) as transit centers. In Pemba where the arrival of 12,364 displaced people (including 6,128 children) adds up to the to the existing caseload authorities have requested the support of the humanitarian community to relocate 2,000 newly displaced people from Pemba to two areas identified for the establishment of new resettlement sites – i.e. N’naua (Metoro administrative post) and Nanona (Mesa administrative post)

The month of July witnessed a wave of attacks in Macomia and in Nangade with an attack on the district’s headquarters. Despite these problems, positive developments have been observed in the town of Mocímboa da Praia, which has recently seen a gradual return of displaced people, especially from Palma district. The town in dire need of water supply system with the government outlining plans to rehabilitate basic infrastructure beginning in September 2022. Equally, there was good news from districts with reports of the resumption of artisanal fishing activity, which had been suspended after the town was captured by insurgent’s two years ago. At the close of the month similar attacks were recorded in Meluco where an estimated 2,009 individuals (585 households) were displaced to Meluco sede

Source: World Health Organization