1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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)

9. 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

10. 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

11. 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 Km belt spanning the border between Angola and the DR Congo using the full dose strategy for 6-7 million people

12. 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

13. 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

14. 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

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

16. 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

17. 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]

18. Operational Challenges

19. 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,

20. Thank You