Africa's (i.e. currently in Angola, DRC) yellow fever epidemic
Angola's front line against yellow fever
More than 300 people have so far died in the current yellow fever outbreak in Angola.
------------------------
In the green and shaded gardens of the Americo Boavida Hospital in Angola's capital, Luanda, women in colourful printed dresses wait patiently for visiting hours to begin.
It is one of the biggest hospitals in the city, serving almost two million people.
Malaria is the most common killer here, but since December last year they have had to counter another, potentially more dangerous, mosquito-borne virus: Yellow fever.
In its 16 June report, the World Health Organization (WHO) said that 345 people are reported to have died from yellow fever in the last seven months among more than 3,000 cases in Angola.
Not since 1971 has there been such a serious outbreak, and the reasons why it has happened now are complex and many.
Not everyone who has the yellow fever virus experiences symptoms.
------------------
Dr Fortunato Silva, the clinical director at Americo Boavida, says that this outbreak is more worrying not only in relation to the number of cases, but also the number of deaths.
He thinks some of the reasons for this may include the virus becoming more virulent, immunity levels amongst the population dropping and most critically, people not vaccinating as they should.
"Ninety patients have been hospitalised with fever, jaundice and haemorrhaging, since 23 February," Dr Silva said.
"There have been 33 deaths, which is a very high mortality rate. All of them had tested negative for malaria."
Angola's health system is well regarded, and there are established countrywide vaccination and awareness programmes.
Since 1989, babies have been vaccinated against yellow fever at the age of nine months, and children cannot attend school unless they have a valid yellow fever certificate.
Despite this, Dr Silva says, something is not working, and there are questions that need to be answered in terms of public health strategies.
About 15% of people who have yellow fever experience severe symptoms.
-------------------------
Dr Francisco Songane, the representative in Angola for the UN children's fund, Unicef, describes what is happening as "a major crisis".
He says critical time was lost between samples being taken, tests being run, and results finally arriving three weeks later.
By the time confirmation of yellow fever came, it had spread from the densely populated area of K30, part of the capital's Viana district, and then across the entire city.
The spread of yellow fever
Angola - 345 reported deaths, 3,137 suspected cases
Democratic Republic of the Congo - 71 reported deaths, 1,044 suspected cases (not all linked to Angola)
Kenya - two suspected cases (travellers returning from Angola)
China - 11 suspected cases (travellers returning from Angola)
(Source: WHO)
--------------------
Dr Songane says that though measures were immediately put in place, in a city such as Luanda, where there are "huge neighbourhoods... a sea of so many houses, so populated, the virus spread very quickly".
And to compound the already serious outbreak, there was a global shortage of the vaccine to contend with. And vaccines must be administered within 10 days of the outbreak being identified.
"The timeline was not being met," he says. "And the shortage of vaccine meant that by then it had spread beyond Luanda."
The shortage now means that the WHO now recommends cutting the standard dose of yellow fever vaccine by 80%. The smaller dose would provide immunity for at least 12 months, it says.
Further adding to the crisis was the widespread use of fake yellow fever certificates, because, as Dr Songane explains "there were also misconceptions that the vaccine will kill you, that you will get a disease.
"There is a need to counter this and get the message to the people that you can do good for yourself, your community, your neighbourhoods.
"Fake certificates will not protect you. That's the message."
Nearly all of Luanda's population has now been vaccinated, and the ministry of health is in a race against time to get enough of the vaccine manufactured for the rest of the country.
What is yellow fever?
§ Caused by a virus that is transmitted to humans by mosquitoes
§ Difficult to diagnose and often confused with other diseases or fevers
§ Presence of yellow fever antibodies can be detected by blood tests
§ Most people recover after the first phase of infection that usually involves fever, muscle and back pain, headache, shivers, loss of appetite, and nausea or vomiting
§ About 15% of people face a second, more serious phase involving high fever, jaundice, bleeding and deteriorating kidney function
§ Half of those who enter the "toxic" phase usually die within 10 to 14 days - The rest recover
(Source: WHO)
---------------------------
Angola strictly enforces international regulations on travellers coming in and out of the country, and Dr Songane says that whilst hard lessons have been learned, every country must now enforce these regulations.
Vaccines take six months to produce and if there is another serious outbreak, global supplies will not be able to keep up with the demand.
But it is too late to prevent its spread beyond Angola's borders.
Neighbouring Democratic Republic of Congo has declared a localised yellow fever epidemic in three provinces, including the capital Kinshasa. Cases related to the outbreak in Angola have also surfaced in Kenya and China.
The mosquito that carries the virus, aedes aegypti, is found in most of the country, but it is prevalent in Luanda, made worse now by uncollected refuse.
Angola is one of Africa's largest oil producers, and nearly 70% of the government's income derives from oil.
In the boom years the country invested heavily in infrastructure projects and social welfare, but now with the collapse in the price of oil, basic services like garbage collection have stopped.
Rotting rubbish can be see piling high along with sewage running through crowded neighbourhood streets.
Dr Songane argues that it is urgent that a way is found to solve the issue of the rubbish piling up.
Rubbish and sewage in the streets in some parts of Luanda have made containing the virus harder.
---------------------
"People cannot continue to live in these conditions," he says.
"This has become a rich and beautiful place for this mosquito to bite, and it's made worse because it bites during the day. [The rubbish] is in the streets and people are being exposed every day."
Only some of those who carry the yellow fever virus get the symptoms, but the rest, who may be unaware that they are carriers, can be bitten by the mosquito and therefore help spread the virus.
Dr Songane says the outbreak is not yet under control. He is aware that much needs to be done, but there is no sense of panic.
It is only when transmissions stop, he says, "that we can breathe. It's not over until it's over".
SOURCE 1.
----------------------
Congo [i.e. Democratic Republic of Congo] almost runs out of yellow fever vaccine amid epidemic
Local residents say they missed out on immunization
Congo has almost run out of yellow fever vaccine in Kinshasa, in the same week that the government declared an epidemic of the disease in the packed capital and two other provinces.
Some local people have complained they were denied immunization due to the shortage, despite queueing for a shot.
(The rest of the article is here.)
-----------------------
OP: I am not suggesting that the current yellow fever epidemic is at the same scale as the recent Ebola epidemic in Western Africa. Because it isn't and it hopefully won't be. But I think it is worth remembering the failures at many levels associated with the Ebola epidemic.
Here is an editorial from the New England Journal of Medicine.
------------------------
Beyond the Ebola Battle - Winning the War against Future Epidemics
The battle to contain and ultimately defeat the Ebola epidemic of 2014-2015 has been vividly described.1-3 Caught off guard from the start and hindered by myriad coordination, communication, and other problems, a combination of local and international teams fought back with determination, courage, and eventually the deployment of substantial resources to stem the contagion and save lives. Yet more than 11,000 people died, and local economies were brought to a halt. The battle was won, but at immense cost.
With the immediate crisis over, the world’s attention has moved on. Ebola has vanished from the headlines and seemingly from policymakers’ to-do lists. Attention has shifted to Zika and other competing priorities. Yet it would be a huge mistake to turn away and declare the war over, for West Africa remains vulnerable to a resurgence of Ebola. There will undoubtedly be new outbreaks; the only question is how well they will be contained.
The capabilities and infrastructure required to prevent, identify, and respond to infectious-disease outbreaks are well understood. They include disease surveillance and escalation, case detection and diagnosis, contact tracing and isolation, clinical care and infection control, community engagement, and communication. Yet low-income countries like Guinea, Sierra Leone, and Liberia need support to put these capacities in place and to sustain them. They have neither the money nor the human resources to do it all themselves.
The imperative to reinforce public health preparedness and response capabilities is not unique either to West Africa or to Ebola. Zika has revealed similar weaknesses in Latin America and the Caribbean, as has MERS (Middle Eastern respiratory syndrome) in the Middle East and Asia. But while we scramble to mobilize resources in response to new outbreaks, we skimp on building better defenses.
Stronger public health capabilities at a national level are the essential first line of defense against potential pandemics, as we and other members of the National Academy of Medicine Commission on a Global Health Risk Framework for the Future have argued.4 The commission has called for rigorous and transparent benchmarking of such capabilities, concrete plans for filling the gaps, and adequate and sustainable financing.
Some observers contend that benchmarking the poorest countries is pointless, since we already know that the gaps are huge. But benchmarking will help governments and donor partners establish priorities and track progress. Transparent benchmarking will enable due credit to be given to countries that are making progress and inspire a sense of urgency about those where gaps persist. Moreover, deficiencies in pandemic preparedness extend beyond the poorest countries. Many middle-income countries fall short on this front, as do some countries with advanced economies. Benchmarking will enable civil society to hold governments accountable and will sharpen debates about domestic fiscal priorities.
Our commission argued that pandemic preparedness and response should be treated as an essential tenet of human and economic security, not just as a health issue, and set out the case for greater investment. Nearly 100 million people were killed in the 20th century by the “Spanish Flu” epidemic of 1918-1919 and the HIV-AIDS epidemic. Examining only direct economic costs, we estimated that annual expected losses from potential pandemics exceed $60 billion per year. Fan et al. have since provided estimates incorporating the economic costs of deaths, which range as high as $490 billion per year.5 The world has grossly underinvested in efforts to prevent and mitigate infectious-disease risks, as compared with other major threats to global security. The commission proposed an investment of $4.5 billion per year - not a small sum but not out of reach, and only a fraction of what we stand to lose if we continue to neglect preparedness. The largest component of this investment, as much as $3.4 billion per year, would comprise investments in upgrading national public health systems.
The problem is that until the outbreak happens and people begin dying, there is limited political attraction to spending money on it; we hesitate to invest in preventing and preparing for something that may not happen. Like fire engines with flashing lights and loud sirens rushing to a conflagration, an effective response strategy can make good politics. Yet we need to invest in the equivalent of fire-retardant furnishings, strict building codes, and the installation of smoke sensors and commercial sprinkler systems. It is the painstaking building of perhaps unglamorous capabilities related to disease surveillance, diagnostics, emergency preparedness, and infection-control protocols that will save the most lives and minimize economic disruption.
Many of the lives lost in the Ebola epidemic in West Africa could have been saved if Guinea, Sierra Leone, and Liberia had been better prepared. We know what needs to be put in place. And though the funding requirements are substantial, the case for global security and economy is compelling: it is so much more cost-effective to invest in preparedness than to spend in response. If, in a few years, there is another Ebola outbreak that once again kills several thousand people, we will have no excuse.
SOURCE 2.
---------------------
Additional links:
(1) On yellow fever:
-Because of the global vaccine shortage, U.N. health experts have recommended cutting the standard dose in certain situations/emergencies.
-The WHO on yellow fever.
-Many news stories have been posted about this, such as here, here, here, and here.
-The Centers for Disease Control in the United States has a travel notice about this.
(2) On the WHO's and the international community's failures with regards to the Ebola epidemic:
-'Slow International Response to Ebola Epidemic Cost Thousands of Lives: MSF'.
-'Critics Say Ebola Crisis Was WHO's Big Failure. Will Reform Follow?'
-'Has The World Learned The Wrong Lessons From The Ebola Outbreak?'
(3) The response of several African countries to Ebola has also been criticized:
-'Nigerian virologist delivers scathing analysis of Africa's response to Ebola'
(4) Some African countries managed to effectively contain the spread of Ebola:
-'How Did Nigeria Quash Its Ebola Outbreak So Quickly?'
(5) Some have argued/pointed out that ordinary Africans did a lot to end the Ebola epidemic. (OP agrees and feels that there is something really racist and paternalistic in the way the west and the international community seem to assume that ordinary Africans, despite being on average poorer than we are in the west, are incapable of thinking through and finding solutions to problems.)
-See here and here (i.e. both written by the same author).
OP: This post has a lot of information (I seem to do that, LOL), but I hope it is useful. :)
More than 300 people have so far died in the current yellow fever outbreak in Angola.
------------------------
In the green and shaded gardens of the Americo Boavida Hospital in Angola's capital, Luanda, women in colourful printed dresses wait patiently for visiting hours to begin.
It is one of the biggest hospitals in the city, serving almost two million people.
Malaria is the most common killer here, but since December last year they have had to counter another, potentially more dangerous, mosquito-borne virus: Yellow fever.
In its 16 June report, the World Health Organization (WHO) said that 345 people are reported to have died from yellow fever in the last seven months among more than 3,000 cases in Angola.
Not since 1971 has there been such a serious outbreak, and the reasons why it has happened now are complex and many.
Not everyone who has the yellow fever virus experiences symptoms.
------------------
Dr Fortunato Silva, the clinical director at Americo Boavida, says that this outbreak is more worrying not only in relation to the number of cases, but also the number of deaths.
He thinks some of the reasons for this may include the virus becoming more virulent, immunity levels amongst the population dropping and most critically, people not vaccinating as they should.
"Ninety patients have been hospitalised with fever, jaundice and haemorrhaging, since 23 February," Dr Silva said.
"There have been 33 deaths, which is a very high mortality rate. All of them had tested negative for malaria."
Angola's health system is well regarded, and there are established countrywide vaccination and awareness programmes.
Since 1989, babies have been vaccinated against yellow fever at the age of nine months, and children cannot attend school unless they have a valid yellow fever certificate.
Despite this, Dr Silva says, something is not working, and there are questions that need to be answered in terms of public health strategies.
About 15% of people who have yellow fever experience severe symptoms.
-------------------------
Dr Francisco Songane, the representative in Angola for the UN children's fund, Unicef, describes what is happening as "a major crisis".
He says critical time was lost between samples being taken, tests being run, and results finally arriving three weeks later.
By the time confirmation of yellow fever came, it had spread from the densely populated area of K30, part of the capital's Viana district, and then across the entire city.
The spread of yellow fever
Angola - 345 reported deaths, 3,137 suspected cases
Democratic Republic of the Congo - 71 reported deaths, 1,044 suspected cases (not all linked to Angola)
Kenya - two suspected cases (travellers returning from Angola)
China - 11 suspected cases (travellers returning from Angola)
(Source: WHO)
--------------------
Dr Songane says that though measures were immediately put in place, in a city such as Luanda, where there are "huge neighbourhoods... a sea of so many houses, so populated, the virus spread very quickly".
And to compound the already serious outbreak, there was a global shortage of the vaccine to contend with. And vaccines must be administered within 10 days of the outbreak being identified.
"The timeline was not being met," he says. "And the shortage of vaccine meant that by then it had spread beyond Luanda."
The shortage now means that the WHO now recommends cutting the standard dose of yellow fever vaccine by 80%. The smaller dose would provide immunity for at least 12 months, it says.
Further adding to the crisis was the widespread use of fake yellow fever certificates, because, as Dr Songane explains "there were also misconceptions that the vaccine will kill you, that you will get a disease.
"There is a need to counter this and get the message to the people that you can do good for yourself, your community, your neighbourhoods.
"Fake certificates will not protect you. That's the message."
Nearly all of Luanda's population has now been vaccinated, and the ministry of health is in a race against time to get enough of the vaccine manufactured for the rest of the country.
What is yellow fever?
§ Caused by a virus that is transmitted to humans by mosquitoes
§ Difficult to diagnose and often confused with other diseases or fevers
§ Presence of yellow fever antibodies can be detected by blood tests
§ Most people recover after the first phase of infection that usually involves fever, muscle and back pain, headache, shivers, loss of appetite, and nausea or vomiting
§ About 15% of people face a second, more serious phase involving high fever, jaundice, bleeding and deteriorating kidney function
§ Half of those who enter the "toxic" phase usually die within 10 to 14 days - The rest recover
(Source: WHO)
---------------------------
Angola strictly enforces international regulations on travellers coming in and out of the country, and Dr Songane says that whilst hard lessons have been learned, every country must now enforce these regulations.
Vaccines take six months to produce and if there is another serious outbreak, global supplies will not be able to keep up with the demand.
But it is too late to prevent its spread beyond Angola's borders.
Neighbouring Democratic Republic of Congo has declared a localised yellow fever epidemic in three provinces, including the capital Kinshasa. Cases related to the outbreak in Angola have also surfaced in Kenya and China.
The mosquito that carries the virus, aedes aegypti, is found in most of the country, but it is prevalent in Luanda, made worse now by uncollected refuse.
Angola is one of Africa's largest oil producers, and nearly 70% of the government's income derives from oil.
In the boom years the country invested heavily in infrastructure projects and social welfare, but now with the collapse in the price of oil, basic services like garbage collection have stopped.
Rotting rubbish can be see piling high along with sewage running through crowded neighbourhood streets.
Dr Songane argues that it is urgent that a way is found to solve the issue of the rubbish piling up.
Rubbish and sewage in the streets in some parts of Luanda have made containing the virus harder.
---------------------
"People cannot continue to live in these conditions," he says.
"This has become a rich and beautiful place for this mosquito to bite, and it's made worse because it bites during the day. [The rubbish] is in the streets and people are being exposed every day."
Only some of those who carry the yellow fever virus get the symptoms, but the rest, who may be unaware that they are carriers, can be bitten by the mosquito and therefore help spread the virus.
Dr Songane says the outbreak is not yet under control. He is aware that much needs to be done, but there is no sense of panic.
It is only when transmissions stop, he says, "that we can breathe. It's not over until it's over".
SOURCE 1.
----------------------
Congo [i.e. Democratic Republic of Congo] almost runs out of yellow fever vaccine amid epidemic
Local residents say they missed out on immunization
Congo has almost run out of yellow fever vaccine in Kinshasa, in the same week that the government declared an epidemic of the disease in the packed capital and two other provinces.
Some local people have complained they were denied immunization due to the shortage, despite queueing for a shot.
(The rest of the article is here.)
-----------------------
OP: I am not suggesting that the current yellow fever epidemic is at the same scale as the recent Ebola epidemic in Western Africa. Because it isn't and it hopefully won't be. But I think it is worth remembering the failures at many levels associated with the Ebola epidemic.
Here is an editorial from the New England Journal of Medicine.
------------------------
Beyond the Ebola Battle - Winning the War against Future Epidemics
The battle to contain and ultimately defeat the Ebola epidemic of 2014-2015 has been vividly described.1-3 Caught off guard from the start and hindered by myriad coordination, communication, and other problems, a combination of local and international teams fought back with determination, courage, and eventually the deployment of substantial resources to stem the contagion and save lives. Yet more than 11,000 people died, and local economies were brought to a halt. The battle was won, but at immense cost.
With the immediate crisis over, the world’s attention has moved on. Ebola has vanished from the headlines and seemingly from policymakers’ to-do lists. Attention has shifted to Zika and other competing priorities. Yet it would be a huge mistake to turn away and declare the war over, for West Africa remains vulnerable to a resurgence of Ebola. There will undoubtedly be new outbreaks; the only question is how well they will be contained.
The capabilities and infrastructure required to prevent, identify, and respond to infectious-disease outbreaks are well understood. They include disease surveillance and escalation, case detection and diagnosis, contact tracing and isolation, clinical care and infection control, community engagement, and communication. Yet low-income countries like Guinea, Sierra Leone, and Liberia need support to put these capacities in place and to sustain them. They have neither the money nor the human resources to do it all themselves.
The imperative to reinforce public health preparedness and response capabilities is not unique either to West Africa or to Ebola. Zika has revealed similar weaknesses in Latin America and the Caribbean, as has MERS (Middle Eastern respiratory syndrome) in the Middle East and Asia. But while we scramble to mobilize resources in response to new outbreaks, we skimp on building better defenses.
Stronger public health capabilities at a national level are the essential first line of defense against potential pandemics, as we and other members of the National Academy of Medicine Commission on a Global Health Risk Framework for the Future have argued.4 The commission has called for rigorous and transparent benchmarking of such capabilities, concrete plans for filling the gaps, and adequate and sustainable financing.
Some observers contend that benchmarking the poorest countries is pointless, since we already know that the gaps are huge. But benchmarking will help governments and donor partners establish priorities and track progress. Transparent benchmarking will enable due credit to be given to countries that are making progress and inspire a sense of urgency about those where gaps persist. Moreover, deficiencies in pandemic preparedness extend beyond the poorest countries. Many middle-income countries fall short on this front, as do some countries with advanced economies. Benchmarking will enable civil society to hold governments accountable and will sharpen debates about domestic fiscal priorities.
Our commission argued that pandemic preparedness and response should be treated as an essential tenet of human and economic security, not just as a health issue, and set out the case for greater investment. Nearly 100 million people were killed in the 20th century by the “Spanish Flu” epidemic of 1918-1919 and the HIV-AIDS epidemic. Examining only direct economic costs, we estimated that annual expected losses from potential pandemics exceed $60 billion per year. Fan et al. have since provided estimates incorporating the economic costs of deaths, which range as high as $490 billion per year.5 The world has grossly underinvested in efforts to prevent and mitigate infectious-disease risks, as compared with other major threats to global security. The commission proposed an investment of $4.5 billion per year - not a small sum but not out of reach, and only a fraction of what we stand to lose if we continue to neglect preparedness. The largest component of this investment, as much as $3.4 billion per year, would comprise investments in upgrading national public health systems.
The problem is that until the outbreak happens and people begin dying, there is limited political attraction to spending money on it; we hesitate to invest in preventing and preparing for something that may not happen. Like fire engines with flashing lights and loud sirens rushing to a conflagration, an effective response strategy can make good politics. Yet we need to invest in the equivalent of fire-retardant furnishings, strict building codes, and the installation of smoke sensors and commercial sprinkler systems. It is the painstaking building of perhaps unglamorous capabilities related to disease surveillance, diagnostics, emergency preparedness, and infection-control protocols that will save the most lives and minimize economic disruption.
Many of the lives lost in the Ebola epidemic in West Africa could have been saved if Guinea, Sierra Leone, and Liberia had been better prepared. We know what needs to be put in place. And though the funding requirements are substantial, the case for global security and economy is compelling: it is so much more cost-effective to invest in preparedness than to spend in response. If, in a few years, there is another Ebola outbreak that once again kills several thousand people, we will have no excuse.
SOURCE 2.
---------------------
Additional links:
(1) On yellow fever:
-Because of the global vaccine shortage, U.N. health experts have recommended cutting the standard dose in certain situations/emergencies.
-The WHO on yellow fever.
-Many news stories have been posted about this, such as here, here, here, and here.
-The Centers for Disease Control in the United States has a travel notice about this.
(2) On the WHO's and the international community's failures with regards to the Ebola epidemic:
-'Slow International Response to Ebola Epidemic Cost Thousands of Lives: MSF'.
-'Critics Say Ebola Crisis Was WHO's Big Failure. Will Reform Follow?'
-'Has The World Learned The Wrong Lessons From The Ebola Outbreak?'
(3) The response of several African countries to Ebola has also been criticized:
-'Nigerian virologist delivers scathing analysis of Africa's response to Ebola'
(4) Some African countries managed to effectively contain the spread of Ebola:
-'How Did Nigeria Quash Its Ebola Outbreak So Quickly?'
(5) Some have argued/pointed out that ordinary Africans did a lot to end the Ebola epidemic. (OP agrees and feels that there is something really racist and paternalistic in the way the west and the international community seem to assume that ordinary Africans, despite being on average poorer than we are in the west, are incapable of thinking through and finding solutions to problems.)
-See here and here (i.e. both written by the same author).
OP: This post has a lot of information (I seem to do that, LOL), but I hope it is useful. :)