Yellow Fever [to 7 May 2016]
http://www.who.int/emergencies/yellow-fever/en/

.
Editor’s Note:
Yellow Fever information is now aggregated on a separate page with its own situation report as below.
.

Yellow Fever – Situation Report – 5 May 2016
SUMMARY
:: A yellow fever outbreak 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.
:: As of 4 May 2016, Angola has reported 2149 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.
:: In Uganda, the Ministry of Health notified yellow fever cases in Masaka district on 9 April 2016. As of 4 May, seven yellow fever cases are laboratory confirmed in three districts: Masaka, Rukungiri and Kalangala. According to sequencing results, those clusters are not epidemiologically linked to Angola.
:: 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.

Risk assessment
:: Persistent local transmission in Luanda despite the fact that almost six million people have been vaccinated.
:: Local transmission reported in six highly populated provinces including Luanda.
:: High risk of spread to neighbouring countries. Confirmed cases have already travelled from Angola to People’s Republic of China , DRC and Kenya. As the borders are porous with substantial crossborder social and economic activities, further transmission cannot be excluded. Viraemic patients travelling pose a risk for the establishment of local transmission especially in countries where adequate vectors and susceptible human populations are present.
:: For DRC, a field investigation conducted in April concluded that there is a high risk of local transmission of yellow fever in the country. Given the limited availability of vaccines, the large Angolan community in Kinshasa, the porous border between Angola and DRC and the presence and the activity of the vector Aedes in the country, the situation needs to be monitored with extreme attention.

.
Disease Outbreak News (DONs)
:: Yellow fever – Uganda 2 May 2016
:: Yellow fever – Democratic Republic of the Congo 2 May 2016

.
Yellow fever – REGULAR PRESS BRIEFING BY THE INFORMATION SERVICE
UNOG [Geneva] Information Service 6 May 2016
…Mr. Jasarevic said that the outbreak of yellow fever which had started in December 2015 in Angola was of particular concern to WHO, as for the first time in a very long time there had been transmission of the virus in the capital, Luanda, and in other major urban centers. Local transmission, not related to travel from Angola, had also been confirmed in two cases in the Democratic Republic of the Congo. Exported cases from Angola had been recorded in China and Kenya. A large-scale vaccination campaign was continuing in Angola. The International Coordinating Mechanism (composed of the WHO, UNICEF; MSF and ICRC) had dispatched more than 11 million vaccines to Angola, with the last 2.4 million expected to arrive today and on 10 May. More than 7 million people had been vaccinated in Luanda and in the Huambo and Benguela provinces. The WHO is aiming to have more than 80 per cent of people vaccinated order to contain transmission. Some 2.2 million doses of the vaccine were on their way to the Democratic Republic of the Congo and were scheduled to arrive on 11 May. Uganda was also experiencing a yellow fever outbreak, but this outbreak was not believed to be linked to the one in Angola.

WHO had set up incident management teams in Angola, Democratic Republic of the Congo, and also in Geneva, working with the WHO regional office to accelerate efforts to combat the outbreak. WHO was also supporting Ministires of Health in Angola and DRC to coordinate the health response in the areas of immunization, to ensure rapid detection and laboratory confirmation of suspect cases, to implement integrated vector control activities and to establish and reinforce community-led social mobilization activities. Moreover, WHO was working with neighboring countries such as Namibia and Zambia to strengthen cross-border surveillance to reduce the spread of infection. A travel advisory had been issued to inform travellers that yellow fever vaccination was required. People leaving the country at exit points to neighboring countries were now being asked to produce proof of vaccination against yellow fever.

As of 4 May, 2,148 suspected cases of yellow fever had bene reported in Angola, with 277 deaths. Among those cases, 641 had been laboratory-confirmed. In the DRC, the Government had officially declared a yellow fever outbreak on 23 April, and as of 4 May the country had reported 5 probable cases and 39 laboratory-confirmed cases. Out of the 39, 37 had been imported from Angola and 2 were due to local transmission. In China, there had been 11 confirmed cases which had been travel-related, and in Kenya, 2 confirmed cases.

In response to questions, Mr. Jasarevic said that the outbreak had started in late December 2015. The majority of the cases in the DRC had been linked to the Angola outbreak through travel, but now, there were two confirmed cases of local transmission by the Aedes mosquito. There was no shortage, but rather a limited supply of vaccines. In the world, there were four manufacturers with an annual production of up to 80 million doses. There were 48 countries in Africa and in Latin America which were considered endemic and used routine immunization (this had been the case of Angola since 1997), which accounted for about 30 million doses. However, a significant proportion of the population was not being vaccinated, and mass vaccination was used whenever there was an outbreak, accounting for another 30 to 35 million doses. Finally, a stockpile of vaccines was managed by the international group composed of the WHO, UNICEF; MSF and ICRC, releasing vaccines whenever there were outbreaks. WHO was working with the manufacturer to see how production could be increased. Two out of the four manufacturers would be able to increase production in the coming years. Demand had been fuelled by the introduction of the yellow fever initiative.

Mr. Jasarevic also clarified that there was no evidence to support a link between the Angola and Uganda outbreaks. Local transmission versus travel-related transmission was determined by looking at epidemiological history and at the virus itself in the lab, but further details on this would be provided by the WHO during the 10 May press conference. From an epidemiological point of view it was important to know where the outbreak had started.