Announcement

**Pathfinder** · December 17, 2019, 10:31 AM

WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES
Week 50: 9 - 15 December 2019
Data as reported by: 17:00; 15 December 2019
...
Yellow fever Mali

15 Cases
5 Deaths
33% CFR

EVENT DESCRIPTION

On 5 December 2019, the Ministry of Health in Mali declared
a yellow fever outbreak after three cases were confirmed from
Koulikoro (n=1) and Sikasso (n=2) regions. The index case in
this outbreak is a 15-year-old unvaccinated girl from a village in
Kati district, Koulikoro region, who presented, on 3 November
2019, with fever and jaundice to a health centre in Nana-K?nieba
health area. She was initially diagnosed and treated for malaria
following a positive malaria rapid diagnostic test. Due to poor
response to treatment and subsequent consultations to other
health facilities, a differential diagnosis of yellow fever was made
and a sample was sent for testing.

During the same period, two additional case-patients, both Cote
d’Ivoire nationals living in Mali, were confirmed with yellow
fever in isolated events. One of the case-patient, a 25-year-old
male from a village in Manankoro health area, Sikassso region
presented with fever and jaundice to a local health facility on
1 November 2019 and later died on 8 November 2019 after
developing haemorrhagic symptoms. The other case-patient was
a 17-year-old male from Bouguimi district, Sikassso region who
became ill on 4 November 2019, subsequently went into a coma
and died on 11 November 2019 after poor response to treatment
at a local health facility.

Blood samples from the three case-patients were sent to
the yellow fever regional reference laboratory at the Institute
Pasteur Dakar and tested positive on 2 December 2019 by
immunoglobulin M (IgM) and polymerase chain reaction (PCR).
The index case was reportedly not vaccinated against yellow
fever and she had no travel history outside the Nana-Keneba and
Sirakoro axis in Kati District. Meanwhile, the vaccination status
for the other two case-patients was unknown and they reportedly
travelled back and forth between Mali and Cote d’Ivoire.
Following the notification of the three initial cases, further
epidemiologic investigations identified 12 additional cases,
including three deaths. Between 1 September and 8 December
2019, a total of 15 yellow fever cases (including three confirmed
cases, twelve suspected cases) with five deaths were recorded.
There were two deaths among the confirmed cases, resulting in
a case fatality ratio of 67% among confirmed and 33% among
all cases.

The age group of the cases was between 1 and 33 years and the
male to female ratio is 2:1. Among the reported symptoms, fever,
jaundice and vomiting were the most common. Samples have
been collected for laboratory testing and the vaccination status
for those suspected cases are still pending.

PUBLIC HEALTH ACTIONS

On 5 December 2019, the Government of Mali officially
declared a yellow fever outbreak in the two regions of Sikasso
and Koulikoro.

An Emergency Operations Centre for Public Health
Coordination of the outbreak in the regions of Sikasso and
Koulikoro and the affected districts was set up and activated
in Bamako.

A multidisciplinary rapid response team was deployed to conduct
investigations in the affected districts of Sikasso and Koulikoro regions. A
plan to conduct an in-depth entomological survey is underway.

Enhanced epidemiological surveillance including active case finding in both
affected districts has been strengthened through the dissemination of yellow
fever case definitions.

A comprehensive response plan is being developed with the specific
objectives including preparation for an ICG request to conduct a yellow fever
reactive mass vaccination campaign.

Provision of risk communication capacity through involvement of relevant
stakeholders. Public communication and awareness efforts on yellow fever
(signs, symptoms and vaccinations) including prevention measures.

A joint investigation team (WHO Country Office and MoH) was deployed on
3 December 2019 to characterize the risk and develop an intervention plan.
Field investigations indicate vaccination coverage under 80% in Kati and 88%
in Manakoro Districts.

SITUATION INTERPRETATION

Mali is among the West African countries at risk of yellow fever epidemics. Several
efforts have been made in the fight against yellow fever through the introduction of
yellow fever vaccine into routine immunisation in 2002, carrying out reactive mass
vaccination campaigns between 2004 and 2007 as well as conducting preventive
mass vaccination campaigns in 2008 in the southern part of country targeting about
5.8 million people. However, coverage for yellow fever vaccine remains suboptimal,
with WHO-UNICEF estimating the national coverage for 2018 at 67%. Thus, pockets
of unprotected population with low immunity may persist, leading to the potential of
new cases. Koulikoro region borders the capital Bamako (an urban city with more
than two million inhabitants), increasing the potential risk of the disease spread and
escalation of the outbreak. As two of the confirmed cases are from neighbouring
Cote d’Ivoire and live near the border, it is important to investigate the situation
around the border with Mali.

403 Forbidden

https://apps.who.int/iris/bitstream/handle/10665/330150/OEW50-16122019.pdf

**Shiloh** · December 26, 2019, 07:58 PM

Source: https://www.who.int/csr/don/26-decem...fever-mali/en/ Yellow fever – Mali

Disease outbreak news 26 December 2019

From 3 November through 8 December 2019, three laboratory confirmed cases of yellow fever including two deaths (case fatality rate = 67%) were detected through the national surveillance system in Mali. The first case-patient was a 15-year-old girl from a village in Kati district, Koulikoro region, Mali. The second and third case were in 17 and 25-year-old men, nationals from Cote d'Ivoire, living in the district of Bouguimi, Sikasso region, Mali. All three cases tested positive for yellow fever by Immunoglobulin M (IgM) and reverse-transcriptase polymerase chain reaction (RT-PCR) on 3 December 2019 at Institute Pasteur Dakar (IPD). The first case was not vaccinated against yellow fever and had no travel history outside of Kati District. Meanwhile, the vaccination status for the other two cases was unknown.

Additionally, there were nine suspected and three probable cases reported from the Bouguimi district, including three deaths among the probable cases.

The age of the suspected, probable and confirmed cases ranges between 1 to 33 years, and the male to female ratio is 2:1. Among the reported symptoms, fever, jaundice and vomiting were the most common. Eight health areas of Bouguimi health district have been affected, with Manankoro (four cases) and Mafel? (three cases) reporting the highest number. One suspected case is pending for confirmation at the Institute Pasteur Dakar laboratory.

On 5 December 2019, the Government of Mali officially declared a yellow fever outbreak in two regions of Sikasso and Koulikoro. Public health response

Setting up of an Emergency Operations Centre (EOC) for public health coordination of the outbreak in the regions of Sikasso, Koulikoro and the affected districts. In addition, EOC has been activated in Bamako city.
A multidisciplinary rapid response team was deployed to conduct investigations in the affected districts of Sikasso and Koulikoro regions. A plan to conduct an in-depth entomological survey is underway.
Enhanced epidemiological surveillance, including active case finding in both the affected districts has been strengthened.
A comprehensive response plan is being developed with the specific objectives including preparation for an International Coordination Group (ICG) request to conduct a yellow fever reactive mass vaccination campaign.
Provision of risk communication capacity through involvement of relevant stakeholders. Public communication and awareness efforts on yellow fever (signs, symptoms and vaccinations) including prevention measures.
On 3 December 2019, a joint investigation team (WHO Country Office and Ministry of Health) was deployed to characterize the risk and develop an intervention plan. Field investigations indicate vaccination coverage under 80% in Kati and 88% in Manakoro districts.

WHO risk assessment

Although population immunity in the southern regions of Mali has benefited from large-scale preventive mass vaccination campaigns in 2008 (5.8 million people protected) combined with nationwide children routine immunization since 2002, the overall national routine immunization coverage for yellow fever in 2018 was estimated to be 67%, with estimates nearly 80% in the non-desert areas (including the recently-affected Koulikoro and Sissako regions).This is below herd immunity thresholds and may indicate the presence of pockets of low immunity in the country. Kati district in Koulikoro region is located proximal to the capital city Bamako, an urban city with more than 2 million inhabitants, and Bouguimi district in Sikasso region borders with Cote d’Ivoire.

The high population movements within Mali, and across borders increases the risk of national and regional spread and that may have diluted the population immunity. The geographical distribution of the virus, coupled with suboptimal vaccination coverage, the presence of susceptible populations presents a risk of amplification. Furthermore, the protracted humanitarian crisis and concomitant ongoing outbreaks of epidemic-prone diseases (measles, dengue) may impact the response due to competing limited resources.

Based on available information, WHO assesses the overall risk as high at the national level, moderate at the regional level, and low at the global level. WHO advice

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes and has the potential to spread rapidly and cause serious public health impact. There is no specific treatment, although the disease is preventable using a single dose of yellow fever vaccine, which provides immunity for life. Supportive care to treat dehydration, respiratory failure and fever and antibiotic treatment for associated bacterial infections is recommended

Mali is high priority country for Eliminate Yellow Fever Epidemic (EYE) strategy. Vaccination is the primary intervention for prevention and control of yellow fever. In urban centres, targeted vector control measures are also helpful to interrupt transmission. WHO and partners will continue to support local authorities to implement interventions necessary to control the current outbreak.

WHO recommends vaccination against yellow fever for all international travellers more than 9 months of age going to areas south of the Sahara Desert in Mali. The vaccine is contraindicated in children aged less than 6 months and is not recommended for those aged 6–8 months, except during epidemics when the risk of infection with yellow fever virus may be very high. Other contraindications for yellow fever vaccination are severe hypersensitivity to egg and severe immunodeficiency. Caution is recommended before vaccinating people aged above 60 years against yellow fever.

WHO does not recommend vaccination for travellers whose itineraries are limited to areas within the Sahara Desert. Vaccination is recommended, if indicated, for pregnant or breastfeeding women travelling to endemic areas when such travel cannot be avoided or postponed. Mali requires as a condition of entry a yellow fever vaccination certificate for all travellers aged one year or over.

Yellow fever vaccines recommended by WHO are safe, highly effective and provide life-long protection against infection. In accordance with the IHR (2005), Third edition, the validity of the international certificate of vaccination against yellow fever extends to the life of the person vaccinated with a WHO approved vaccine. For both existing or new certificates, revaccination or a booster dose of yellow fever vaccine cannot be required of international travellers as a condition of entry into a State Party, regardless of the date their international certificate of vaccination was initially issued.

On 1st July 2019, WHO updated the areas at-risk of yellow fever transmission and the corresponding recommendations for vaccination of international travelers. The list of countries at-risk, and revised recommendations for vaccination against yellow fever are available on the WHO website: International travel and health (ITH).

WHO encourage its Member States to take all actions necessary to keep travellers well informed of risks and preventive measures including vaccination. Travelers should also be made aware of yellow fever signs and symptoms and instructed to seek rapid medical advice should they develop signs of illness. Travellers returning to Mali who may be infected with possible high levels of the virus in the blood may pose a risk for the establishment of local cycles of yellow fever transmission in areas where the competent vector is present.

WHO does not recommend any restrictions on travel or trade to Mali on the basis of the information available on this outbreak.

For more information on yellow fever, please see:

Announcement

Mali - Ministry of Health declares a yellow fever outbreak

Mali - Ministry of Health declares a yellow fever outbreak

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