Sudan Yellow Fever Update: WHO

 

Credit CDC Yellow Book

 

# 6765

 

 

Five weeks ago Yellow Fever was confirmed in Sudan after several weeks of reports of a `mysterious illness’ that had claimed several dozen lives (see WHO: Yellow Fever Outbreak In Sudan).

 

Yellow fever (aka Yellow Jack) is a viral disease transmitted by the Aedes mosquito (and others). A relatively safe and effective vaccine is available and travelers to parts of equatorial Africa and South America are often advised to get it.

 

Today the World Health Organization has updated the situation in Sudan, including details on a planned mass vaccination campaign.

 

 

Yellow fever in Sudan - update

6 December 2012 - As of 4 December, a total of 732 suspected cases of yellow fever, including 165 deaths have been reported in 33 out of 64 localities in Darfur. Laboratory results have confirmed yellow fever by IgM ELISA test and PCR in 40 clinical samples. Tests were conducted at the National Public Health Laboratory in Khartoum, with support from the US Naval Medical Unit 3 (NAMRU-3), WHO Collaborating Center for Emerging Infectious Diseases.

 

Currently, the Federal Ministry of Health is organizing an emergency mass vaccination campaign against yellow fever. The first phase of the campaign began on 21 November 2012, to cover 2.2 million people, and the second phase of the campaign is planned for this month, to cover an additional 1.2 million at risk population.

 

The vaccination campaign is being supported by the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG¹), GAVI Alliance, ECHO, Central Emergency Response Fund (CERF), Sudan Common Humanitarian Fund (CHF), and non-governmental organizations working where the campaign is being carried out.

 

A comprehensive assessment of the outbreak is ongoing, to obtain additional epidemiological, laboratory and entomological information to understand the evolution of the outbreak and the risk of the epidemic.

WHO has activated the Global Outbreak Alert and Response Network (GOARN) and is deploying additional experts including an entomologist, virologists and an epidemiologist to support the ongoing response in the country.

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¹ The YF-ICG is a partnership that manages the stockpile of yellow fever vaccines for emergency response on the basis of a rotation fund. It is represented by United Nations Children's Fund (UNICEF), Médecins Sans Frontières (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC) and WHO, which also serves as the Secretariat. The stockpile was created by GAVI Alliance.

 

 

The CDC’s 2012 Yellow Book describes the clinical presentation of Yellow Fever this way:

 

Asymptomatic or clinically inapparent infection is believed to occur in most people infected with YFV. For people who develop symptomatic illness, the incubation period is typically 3–6 days.

 

The initial illness presents as a nonspecific influenzalike syndrome with sudden onset of fever, chills, headache, backache, myalgias, prostration, nausea, and vomiting. Most patients improve after the initial presentation.

 

After a brief remission of hours to a day, approximately 15% of patients progress to a more serious or toxic form of the disease characterized by jaundice, hemorrhagic symptoms, and eventually shock and multisystem organ failure. The case-fatality ratio for severe cases with hepatorenal dysfunction is 20%–50%.

 

On November 29th the CDC’s Traveler’s Health division issued an Outbreak Notice for Yellow Fever in Sudan, with the following recommendations (excerpt).

 

How Can Travelers Protect Themselves?

Travelers can protect themselves from yellow fever by getting vaccinated against yellow fever and by preventing mosquito bites.

• Get yellow fever vaccine.
  • CDC recommends that all travelers 9 months of age or older receive a yellow fever vaccine if they are traveling to areas south of the Sahara Desert. The vaccine is not recommended for people traveling only to the Sahara Desert or the city of Khartoum. (See map.)   
  • Visit a yellow fever vaccination (travel) clinic to get your vaccine.
    • You should receive this vaccine at least 10 days before your trip
    • After you receive the vaccine, your doctor or nurse should give you a signed and stamped “International Certificate of Vaccination or Prophylaxis” (ICVP).
    • One vaccine will last 10 years.
• Prevent mosquito bites
  • Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.
  • Use an insect repellent with one of the following active ingredients. Higher percentages of active ingredient provide longer protection.
    • DEET
    • Picaridin (also known as KBR 3023, Bayrepel, and icaridin)
    • Oil of lemon eucalyptus (OLE) or PMD
    • IR3535 (Avon Skin So Soft Bug Guard Plus)
  • Always use insect repellent as directed.
    • If you are also using sunscreen, apply sunscreen first and insect repellent second.
    • Reapply as directed.
  • Follow package directions for using repellent on children
• If you feel sick and think you might have yellow fever
  • Talk to your doctor or nurse  immediately if you develop a fever during or soon after travel
  • Get lots of rest, and drink plenty of liquids.
  • Use acetaminophen to reduce pain and fever. Do not take pain relievers that contain aspirin or nonsteroidal anti-inflammatory medications such as ibuprofen
  • By avoiding mosquito bites, you are less likely to spread the disease to others.
  • Seek health care immediately if you have cold, clammy skin; confusion; shortness of  breath; swelling in the face; and weakness

 

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WHO: Yellow Fever Outbreak In Sudan

 

Source Lancet Infect Dis. 2011;11:622-32 via CDC

 

# 6681

 

For three weeks the newshounds on FluTrackers (among others) have been keeping track of a disease outbreak  in Sudan that has claimed several dozen lives.

 

Today, the World Health Organization’s regional office for the Eastern Mediterranean has posted the following notice (h/t Ronan Kelley on FluTrackers), indicating they’ve been notified of a yellow fever outbreak in that country.

 

Yellow fever hits Central and South Darfur

29 October 2012 – Sudan’s Federal Ministry of Health has notified the World Health Organization (WHO) of a yellow fever outbreak in seven localities in Central and South Darfur. Since the first week of October, a total of 84 suspected cases, including 32 deaths, have been reported from the districts of Azoom, Kass, Mershing, Nertiti, Nyala, Wadi Salih and Zalingei.

 

The Federal Ministry of Health has said that the immediate priority is to control the vector, reinforce the disease surveillance system and raise public awareness of prevention and control of this disease. Preparations for a mass vaccination campaign are underway to vaccinate the at-risk population in Darfur.

 

Yellow fever is spread by mosquitoes. There is no specific treatment for yellow fever, only supportive care to treat dehydration and fever, and blood transfusion, if and when needed. It is a preventable disease with symptoms and severity varying from case to case. Protective measures such as the use of bednets, insect repellent and long clothing are considered the best methods to contain an outbreak.

 

Vaccination is the single most important measure for preventing yellow fever.

 

The Federal Ministry of Health, WHO and other health partners are working on the ground to ensure timely containment of the outbreak.

 

Yellow fever (aka Yellow Jack) is a viral disease transmitted by the Aedes mosquito (and others). There is a relatively safe, and effective, vaccine available and travelers to parts of equatorial Africa and South America are often advised to get it.

 

The CDC’s 2012 Yellow Book describes the clinical presentation this way:

 

Asymptomatic or clinically inapparent infection is believed to occur in most people infected with YFV. For people who develop symptomatic illness, the incubation period is typically 3–6 days.

 

The initial illness presents as a nonspecific influenzalike syndrome with sudden onset of fever, chills, headache, backache, myalgias, prostration, nausea, and vomiting. Most patients improve after the initial presentation.

 

After a brief remission of hours to a day, approximately 15% of patients progress to a more serious or toxic form of the disease characterized by jaundice, hemorrhagic symptoms, and eventually shock and multisystem organ failure. The case-fatality ratio for severe cases with hepatorenal dysfunction is 20%–50%.

 

In the 18th and 19th century Yellow fever caused major epidemics in Europe and in the United States, up the Atlantic seaboard and as far north as New England (Boston was hard hit in 1780, and Philadelphia saw several thousand deaths in 1793).

 

Yellow Fever has been cited as one of the primary reasons why the French abandoned their attempt to build a Panama canal in the late 1800’s, as the combined burden of Yellow Fever and Malaria reportedly claimed the lives of more than 20,000 construction workers.

 

 

For more on the fascinating history of `Yellow Jack’, I would point you to Ian York’s excellent Mystery Rays blog, where he gives us some terrific background in:

 

Yellow fever, stasis, and diversification

The deadliest, most awe-inspiring of the plagues

The good old days

 

While currently not a threat in Europe and the United States, yellow fever is on the radar screens of some epidemiologists as climate change, and the spread of suitable vectors, continue.

 

This from Eurosurveillance in 2010, and it is an excellent overview of the issue.

 

Eurosurveillance, Volume 15, Issue 10, 11 March 2010

 

Yellow fever and dengue: a threat to Europe?

P Reiter

The introduction and rapidly expanding range of Aedes albopictus in Europe is an iconic example of the growing risk of the globalisation of vectors and vector-borne diseases.

The history of yellow fever and dengue in temperate regions confirms that transmission of both diseases could recur, particularly if Ae. aegypti, a more effective vector, were to be re-introduced.  The article is a broad overview of the natural history and epidemiology of both diseases in the context of these risks.

 

 

You can find more information on yellow fever at these websites:

 

http://www.cdc.gov/yellowfever/

http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/yellow-fever.htm

http://www.who.int/topics/yellow_fever/en/

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CDC: 2012 Yellow Book Online

 

 

# 5684

 

 

Every two years the CDC publishes their `Yellow Book’, a reference for those who advise international travelers about health risks. While written primarily for Health Care providers, the yellow book is a tremendously valuable resource for all.

 

You find it chock full of maps, charts, and advice and information on everything from Amebiasis to Yersiniosis, and scores of infectious diseases in-between. 

 

For those who will refer to it often, a 640 page hard copy is available from the Oxford University Press for $45.00.  You can also order a copy from online booksellers such as Amazon and Barnes & Noble.

 

But for casual users, or those on a budget, the text of the the 2012 Yellow Book is available online on the CDC’s  Traveler’s Health website.

 

• Table of Contents
• About the Yellow Book

 

According to a recent CDC Press release, new to the 2012 edition are:

• Updated maps on the distribution of dengue, a mosquito-borne disease usually found in the tropics, which has been increasing internationally and was seen in the southern Florida in 2009 for the first time in 75 years.
• What to expect if you're traveling during an international disease outbreak
• Larger and more detailed maps for yellow fever and malaria, which can sometimes affect only certain parts of countries.
• Tips for travel to mass gatherings such as the Hajj pilgrimage and sporting events like Olympics or World Cup
• Prevention of traveler's diarrhea – it's not only what you eat and drink, but also other factors including how your food is prepared and where you eat.

So, whether you are planning a trip to some exotic locale, or are simply interested in reading about some of the pathogens you might encounter in your travels, the CDC’s Yellow Book makes a terrific resource.

 

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