Yellow Fever - Africa: Angola update
A yellow fever epidemic in Angola has killed at least 250 people since the end of December [2015] and continues to spread, stretching limited resources, doctors and officials said Tuesday [15 Mar 2016].
The head of the Luanda paediatrics hospital, Mateus Campos, said 27 children died there on Monday alone [14 Mar 2016], with 900 suspected cases turning up each day. "We don't have
the human resources to cope," Campos added.
Health ministry spokeswoman Adelaide de Carvalho told AFP that the ministry registered 76 suspect cases and 10 deaths in 3 days alone this month [March 2016], but gave no overall toll.
A week ago, the World Health Organisation put the death toll at 250, but some doctors believe the situation may be far worse.
There is no specific treatment for yellow fever, a viral hemorrhagic disease transmitted by infected mosquitoes and found in tropical regions of Africa and Latin America's Amazon region.
Authorities launched a mass vaccination campaign in February [2016], and the government urged residents to sterilise stagnant water before drinking it.
Luanda remains the worst hit area, with 9 of every 10 deaths registered in the city over the last days. Critics such as surgeon Maurilio Luyela have blasted authorities for failing to upgrade public health facilities or pay doctors good wages. "Doctors who graduate from
university don't join the public health sector because there isn't enough money to pay them," he told journalists.
Yellow fever vaccinations are routinely recommended for travellers to Angola, though the country had not previously seen a significant outbreak since 1986.
World Health Organization figures show there are an estimated 130 000 cases of yellow fever reported yearly, causing 44 000 deaths worldwide each year, with 90 percent occurring in Africa.
The situation in Angola is far from being under control. Although an active vaccination effort is ongoing in the Luanda area, many new cases continue to occur. It takes approximately 10 days after immunization for protective immunity to result. This lag time may be a contributing factor in the occurrence of these new cases. Although advising residents to drink only sterilized water is a good preventive measure for enteric infections, this will have minimal effect in halting YF virus transmission or reducing vector mosquito populations. The vector mosquito, presumably _Aedes aegypti_, can breed in any water catchment in and around houses. Vector control requires elimination of those breeding sites or their treatment with an approved larvicide.
YELLOW FEVER - AFRICA: ANGOLA, LEBANESE EXPATS, FAKE CARDS SUSPECTED
Former MP Dr. Ismail Sukkarieh publicly criticized the Health Ministry Monday [14 Mar 2016] for not taking vaccination against yellow fever seriously enough, despite a number of Lebanese expats living in high-risk regions such as West Africa.
Sukkarieh's statement comes after at least 3 Lebanese expats died of the disease in Angola in the last week.
He argued that the ministry ought to be the official and sole authority providing its citizens with the preventative vaccine.
In his statement, Sukkarieh also claimed that some travellers to Africa were given fraudulent certificates for the vaccination, without actually receiving the treatment.
Local TV network Al-Manar identified the 3 dead citizens [by name].
"Every person travelling, especially to tropical areas like Africa, which has dangerous diseases, should take certain vaccines, including the vaccine against yellow fever," Sukkarieh told The Daily Star. "The [Health] Ministry [should] register the people vaccinated, their passport number and the country of destination and, at the end of the year, this information [should be] referred to the World Health Organization," Sukkarieh added.
The WHO defines yellow fever as "an acute viral hemorrhagic disease transmitted by infected mosquitoes." Although difficult to diagnose, the WHO estimates that nearly 50 percent of those affected may die of the disease without adequate treatment. Yellow fever does not have a particular treatment, but rather "[symptomatic and] supportive treatment" to combat dehydration, respiratory failure and fever, according to the WHO website. Preventative measures to combat mosquito bites, including vaccination prior to exposure and mosquito control (such as bed nets), can help alleviate the risk of catching the disease.
Although the Lebanese affected were residing in Angola when they caught the disease, Sukkarieh argued, "[they] travelled from here. The vaccine is valid for a lifetime. If they were vaccinated, they wouldn't have had it." He went on to say: "What is needed is for the Health Ministry to carry out its role and provide the vaccine."
This situation should be investigated. If, in fact, fake yellow fever (YF) vaccination cards are being sold, the practice should be halted at once. Not only are individuals not protected and run the risk of being infected, and in this case dying, but individuals infected in Angola could transport the virus to other parts of the world. If those places have vector mosquitoes present, there is the possibility of initiating ongoing transmission leading to an outbreak
AFRICA: KENYA ex ANGOLA
Kenya has increased surveillance for yellow fever after a patient died at Kenyatta National Hospital [KNH] while being treated for the disease.
The Ministry of Health has also asked Kenyans to be on the lookout for any unusual symptoms of diseases and report cases to the nearest health facility.
According to a statement from the ministry, the patient, a 31-year-old man, had travelled to Angola, which is dealing with a yellow fever outbreak and where he contracted the disease.
"He had been unwell for 4 days before arriving in the country and presented to a private health facility in Eastleigh with fever, joint pains, blood-stained stool and vomitus on the day of arrival," said Health Cabinet Secretary Dr Cleopa Mailu in a statement.
The CS said that when the clinician at the Eastleigh clinic suspected that the patient had haemorrhagic fever, he (the patient) was transferred to KNH where he later developed confusion, renal and liver failure.
"Laboratory investigations conducted at the Kenya Medical research Institute (KEMRI) tested positive for yellow fever antibodies and negative for Ebola and Marburg," added Dr Mailu.
The man later died as a result of multiple organ failure.
As a result, Dr Mailu said that the ministry has "stepped up surveillance, preparedness and response measures to secure Kenya from the yellow fever virus. This has been necessitated by the index case and the continuing outbreak in Angola."
Kenya is classified as a low-risk country for yellow fever infection, with the last outbreak having occurred in 1992. "However, we remain cognisant of the risks posed through importation of cases from travellers, as this case demonstrates," said Dr Mailu.
He added: "There is currently no evidence of local transmission of the virus, and the patient acquired the infection before arriving into the country."
The minister said ministry officials are now screening travellers who come from or transit through yellow fever risk countries, checking to see whether they have been vaccinated against the disease.
"Since the beginning of March [2016], 2718 passengers have been screened at JKIA [Jomo Kenyatta International Airport] alone, and 6 people from the affected country were denied entry due to lack of proof for yellow fever vaccination."
In addition, an alert has also been sent to all counties, hospitals and points of entry (POEs) including measures to be taken to identify possible cases early.
Yellow fever is caused by the yellow fever virus, which is transmitted by the bite of an infected mosquito.
Once contracted, the virus incubates in the body for 3-6 days, followed by illness whose symptoms include fever, muscle pain with prominent backache, headache, shivers, loss of appetite, and nausea or vomiting.
Vaccination is the single most important measure for preventing yellow fever. The virus is endemic in tropical areas of Africa and Latin America.
