Response to the Yellow Fever Outbreak in the WHO African Region: What has been done? Dr Ambrose Talisuna, WHO-Regional Office for Africa-AFRO Brazzaville-Congo

Presentation outline Introduction Yellow Fever Risk Factors Current Yellow Fever Outbreak Global Response Framework and Plan Key Challenges Medium to Long Term Strategy

Introduction Yellow Fever (YF) is an acute viral haemorrhagic disease transmitted, in urban areas, by the Aedes aegypti mosquito Approximately 15% of clinical cases develop severe disease Case fatality rate can be up to 50% in patients with severe disease

Yellow Fever – Risks 1/3 YF virus ecological zones mapped using potential risk of transmission, based on: reported cases serological evidence presence of the Aedes aegypti vector In Africa, 34 countries in West, Central & East Africa are endemic for YF

Yellow Fever - Risks 2/3 Over 100 million people in West Africa were vaccinated using mass preventive campaigns This has not happened in Central and East Africa – thus susceptible population

Yellow Fever - Risks 3/3 Major risks for large-scale urban outbreaks include: Increasing urbanization in endemic areas low levels of population immunity high densities of the Aedes aegypti mosquito vector Complicated by constrained global supply of the safe, effective YF vaccine

Spread to another big city, Kinshasa in DR Congo by March 2016 Yellow Fever - Current Situation The biggest urban YF outbreak in recent decades emerged in Angola on 05 Dec 2015 Spread to another big city, Kinshasa in DR Congo by March 2016 COUNTRY Total confirmed, probable, and suspected cases of yellow fever Total confirmed cases of yellow fever Comment Angola 3818 879 Delayed response DRC 2051 76 Good response China (Imported) 11 Kenya (Imported) 2 1 Uganda 91 3 Quick and robust response

Yellow Fever Control Strategy Immediate priority is to stop the outbreaks in Angola and DRC, through: Reactive vaccination Pre-emptive vaccination strategy to cover the entire population Conduct preventive YF vaccination in Central and East Africa Ensure all countries to provide YF vaccine as part of the routine Expanded Immunization Programme (EPI)

Rationale for Global Response 1/2 Continued evidence of ongoing transmission despite high volume of vaccine shipped to Angola Expansion of geographical area of confirmed local transmission in Kinshasa with increased risk for further spread locally and internationally Risk of continued importation of cases to other urban areas - cases in Kenya and China linked to Angolan Outbreak

Rationale for Global Response 2/2 IHR-Emergency Committee recommended: strengthening interventions in affected countries enhancing preparedness in neighbouring countries Other ongoing outbreaks in other areas e.g. Uganda created competition for access to limited vaccine availability

WHO and Partners Strategic Response Framework 1/2 WHO and partners developed a Strategic Response Framework to guide the international response to the yellow fever outbreak Further, the WHO and partners developed a Joint Operational Plan, estimated at USD 72, 352, 864 Key components of the operational plan include: Stop the outbreak in Kinshasa by using a dose sparing (fractionate dose) strategy - approximately 10 million target population Conduct pre-emptive vaccination in a 75-100 Km belt spanning the border between Angola and the DR Congo using the full dose strategy for 6-7 million people

WHO and partners Strategic Response Framework 2/2 Other components of the operational plan are: Preventing morbidity and reducing mortality through early case detection and strengthening surveillance Preventing international spread through: Better coordination Reinforcing control screening at major points of entry (PoEs)-Luanda, Kinshasa, Matadi, and Lubumbashi Risk assessment and preparedness in other neighbouring countries Prioritizing research

Surveillance and risk assessment Vaccination (Reactive & pre-emptive) GOAL: End YF Outbreaks in Affected Countries and Limit international Spread Surveillance and risk assessment Vaccination (Reactive & pre-emptive) Case management Vector control Social mobilization and risk communication Dose sparing and research Preparedness at risk countries Activities Objective 1 End outbreaks in currently affected countries Objective 2 Reduce morbidity and reduce mortality Objective 3 Prevent international spread Objective 4 Implement priority research to (improve access to vaccine & diagnostics Strategic Objectives

Consideration for Risk modelling Scenario Modelling to Prioritize Vaccine Allocation Heat map: risk of spread Risk ranked from 1 to 5.5 = highest risk Angola Democratic Republic of the Congo Consideration for Risk modelling Incidence Recent vaccination activities Vector distribution Past occurrence of yellow fever Population movement patterns Angola–DRC border corridor 100 km belt spanning border between Angola and DRC Economic drivers including mining and trade result in large volumes of local, regional, and international migration

Funding Needed to Support the YF Vaccination Campaign (USD) For preventive vaccination only, does not include scale up for other interventions

HR Scale-up Plan-Angola & DRC Cadre of Personnel  Angola DRC Field Coordinators 5 6 Epidemiologists 39 Entomologists Social Mobilization experts 12 Logisticians 3 Risk Communications 2 Vaccination coordinators Vaccination experts Data Managers Vaccination logistician 10 18 Admin support Total 95 62

Key Challenges Though important gains in vaccination have been achieved with more than 18 million doses of vaccine delivered to Angola and DR Congo, there is urgent need to accelerate the vaccination campaigns Inadequate funds for field operational activities Limited global stockpiles of YF vaccine [None-the-less, Vaccine manufacturers have pledged to increase vaccine production to replenish the limited emergency stockpile]

Operational Challenges

Medium to Long Term Strategy Plan for preventive YF vaccination campaign in Central and East Africa All countries at risk to introduce YF vaccination into routine Expanded Immunization Programme (EPI) To strengthen integrated vector management in the African Region, given the re-emergence of arboviruses such as YF, dengue, Zika and Chikungunya,

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