Vaccine Campaigns to Begin in Angola, DRC to Curb Yellow Fever Outbreaks
August 16, 2016
As the ongoing outbreak of yellow fever disease in some of East African countries becomes aggressive, the World Health Organization said Tuesday it will start emergency vaccination campaigns in Angola and the Democratic Republic of Congo to stem the spread of the current outbreak before it become a pandemic crisis.
The emergency campaign, which will begin this week, is one of the largest preventive campaigns ever attempted in Africa. The goal is to use the vaccination campaigns to get people who are potentially at risk or at a higher risk of contracting the disease vaccinated to spur up their immune system against the disease as a means of preventing expansion of the current outbreak.
The disease has already killed 400 people and left thousands more sickened.
According to the United States Centers for Disease Control and Prevention, yellow fever disease is caused by a virus that is spread to people by the bite of an infected mosquito. The disease is more common in tropical areas such as South America and Africa, but has been found the in United States and other part of the world.
The severity of the current El Nino, a result of climate change effects, has contributed to the rise in the yellow fever cases in 2016 due to a higher than usual density of the mosquitoes that transmit the disease.
The current yellow fever outbreak in Angola was first reported in late January, but has declined since July with no new reported cases.
In general, countries that are endemic to the disease experience sporadic outbreaks. But the recent outbreaks have been explosive and have rapidly exhausted the usual global emergency stockpile of 6 million vaccine doses managed by the ICG partnership (WHO, UNICEF, MSF and IFRC), the WHO said.
WHO said it is currently working with the health ministries in the two African countries affected by the diseases as well as other global health partners to get 17 million new people vaccinated against the disease.
The health organization said the campaigns are crucial to stopping the spread of the yellow fever outbreak and it is urgent to get people vaccinated before the rainy season begins in September.
According to the CDC, the yellow fever vaccine is a live-attenuated virus vaccine, available since the 1930s, that has to be stored cold to maintain its efficacy.
Vaccination locations have been set-up around cities, rural areas and cross border regions to reach hard to reach areas of in Angola and DRC.
Following recommendations from the international community after the 2014-2015 Ebola crisis to create a unify WHO’s standard, processes and emergency operational center as well as regional response centers, WHO instituted a new Health Emergencies Program, part of the organization’s efforts designed to deliver rapid, predictable and comprehensive support to communities and countries like Angola and DRC as they deal with, prepare for and recover from emergencies or any hazardous situation to human health, such as disease outbreaks, natural or man-made disasters or conflicts.
The new mandate is aimed to help strengthen the organization’s response to health emergencies across the full risk management cycle of prevention, preparedness, response and early recovery will be used in this campaign efforts.
As part of that international community recommendations, the WHO, in late June named Dr. Peter Salama as the new Executive Director for the new WHO’s Health Emergencies Program.
Dr. Salama, a former UNICEF Regional Director for Middle East and North Africa and Global Emergency Coordinator for the crises in Syria, Iraq and Yemen, began his new job at the WHO in late July.
Dr. Salama also brings experience in the field having served in Africa as the UNICEF’s Country Representative in Ethiopia and Zimbabwe, as the Global Coordinator for Ebola, and as Chief of Global Health, which will come in very handy as WHO and partners try to navigate the choppy waters of cultural barriers and beliefs of African communities that could impede the success of the current emergency vaccination campaigns in Angola and DRC.
The WHO said the success of the emergency campaign hinges on the purchase and shipment of specialized 0.1ml syringes, approximately 17.3 million syringes, to ensure the right amount is used for every vaccination.
In addition to essential supplies such as cooling systems and ice packs to keep vaccines cold and usable, vehicle to transport teams and supplies to vaccination sites, 41,000 health workers and volunteers are needed for the campaign in Kinshasa and along the Angola-Democratic Republic of the Congo border.
Guillaume Queyras, who is responsible for WHO’s Operations Support and Logistics noted that the quantity of the syringes needed was not available on the open market, so they made a special order to manufacture these syringes.
“Supply of the syringes usually takes more than 2 months. Given this emergency situation, manufacturers worked with us to speed up production and deliver the syringes on time in the country,” he added.
The Brazilian government and manufacturer The Immunobiological Technology Institute (Bio-Manguinhos) are working with the WHO to make the syringes available.
In general, emergency campaign planning for such mass vaccination of this magnitude can take up to six months of preparation and planning, but due to impending rainy season in September, there is an urgency to get as many people vaccinated as soon as possible.
WHO and partners, including Gavi the Vaccine Alliance, Médecins sans Frontières (MSF), US-Centers for Disease Control, International Federation of the Red Cross (IFRC) and UNICEF are working closely together on the planning and logistics needed for the campaign.
WHO said Gavi has already provided access to almost 19 million doses of the vaccine for Angola and DRC since January. So far, 13 million people in Angola and more than 3 million in the DRC have received vaccination since January. However, 14 million more people still need to be reached.
Understanding the challenges posed by the large number of people that are still needed to be vaccinated, limited supplies of the vaccine, and a 6-month minimum manufacturing process, the WHO and the Health ministers of Angola and DRC said it will be implementing a new dose sparing strategy known as fractional dosing, by using one-fifth of the standard vaccine dose as a short-term emergency measure, to reach as many people as possible.
The fractional dosing method, recommended by WHO’s Strategic Advisory Group of Experts on Immunization (SAGE), will protect people from the yellow fever disease during this outbreak and will prevent it from spreading further, but, it does not permit people to travel internationally, the WHO said.
The method was approved after experts reviewed existing evidence that lower doses is safe and effective against the disease for at least 12 months, and likely much longer.
William Perea, Coordinator for the Control of Epidemic Diseases Unit at WHO said ″protecting as many people as possible is at the heart of this strategy. With a limited supply we need to use these vaccines very carefully.”
WHO is also assisting the DRC and Central African Republic in as the countries respond to a cholera outbreak in the provinces of Equateur, Tshopo and Mongala provinces along with the CAR cities of Djoujou, Damara and Bangui .
WHO’s representative to CAR, Dr. Michel Yao, said the cholera outbreak in villages along the river bordering DRC’s Equateur province in Oubangui river area “simply compounds the already worrisome health security needs for the people in the CAR who have already suffered so much from the effects of a protracted humanitarian crisis due to war and displacement.”
The CAR’s Emergency Operational Center has activated a cholera control command center and treatment center run in collaboration with WHO and the country’s Ministry of Health and Sanitation and other humanitarian partners and taskforces on the ground to treat infected patients.
Dr Yao said there is urgent need for additional resources in CAR to enhance disease surveillance as well as support to restore health services in a country with many public health threats.
“The continuing crisis in the country including insecurity in some areas has exacerbated existing challenges with disease surveillance, which is essential to enable early detection and an efficient response to outbreaks such as cholera,” warned Dr. Yao.
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