Uganda: 2020 Yellow Fever

[Shiloh]

Source: https://www.monitor.co.ug/News/Natio...vm3/index.html

Three dead as yellow fever outbreak is confirmed in Northern Uganda
Friday January 24 2020

The Ministry of Health has confirmed an outbreak of yellow fever in Northern Uganda after three people died in Moyo and Buliisa Districts.

While addressing a joint news conference with officials from the World Health Organisation (WHO) at the Ministry of Health headquarters in Kampala this morning, Health Minister Dr Jane Ruth Aceng said laboratory tests confirmed four cases after they were reported from the two districts.

She says the two people who died in Moyo were timber traders suspected to have contracted the disease in South Sudan where they were operating. While the one who died in Buliisa was a DR Congo-based milk dealer...

[Shiloh]

Source: https://www.afro.who.int/news/press-...stricts-uganda
Press Statement on Yellow Fever in Moyo and Buliisa districts in Uganda






Kampala, 27 Januarry 2020:- The Ministry of Health would like to inform the public of the confirmation of an outbreak of Yellow Fever in Moyo District in West Nile region and Buliisa District in Hoima region.
In Moyo District, there are two confirmed cases, both are males aged 18 and 21 years. The two cases were dealing in cutting and trading timber between Uganda and South Sudan. On 2 January 2020, the two cases travelled from South Sudan to Moyo.
Upon arrival, they got ill and on 3 January 2020, they were admitted at Logobo Health Center III in Moyo District. They were later referred to Moyo General Hospital with symptoms of fever, vomiting, diarrhea, fatigue, headache, abdominal and joint pain, confusion and unexplained bleeding.
Unfortunately, they later died in the isolation ward of Moyo General Hospital. Blood samples were withdrawn and sent for testing at the Uganda Virus Research Institute (UVRI). Results from UVRI confirmed Yellow Fever infection.
In Buliisa, there are also two confirmed cases. A 37-year old male and his 38-year old wife. The husband was a cattle farmer trading in milk between Uganda and the Democratic Republic of Congo (DRC). On 31 October 2019, he visited Buliisa Hospital with a headache, vomiting, and abdominal pain and received supportive treatment. He died on 4 November 2019 at Buliisa Hospital. At this time, there was little suspicion, however, his blood sample was withdrawn and sent to UVRI for testing. On 10 December 2019, the sample tested positive for Yellow fever virus. This prompted our teams to follow up with investigations, samples were collected from seven of his contacts, including his wife. On 22 January 2020, the wife tested positive for Yellow Fever virus. The other 6 samples tested negative. She is alive and well.
The district health teams of Moyo and Buliisa have initiated investigations. In addition, the Ministry of Health and the World Health Organization (WHO) have dispatched Rapid Response Teams to Moyo and Buliisa Districts to support: investigations, active search for cases, community mobilization and sensitization.
The Ministry of Health has requested for the Yellow Fever vaccines from the International Coordination Group that manages Global Stockpiles of Yellow Fever and Meningitis vaccines. We anticipate that within the next two weeks, vaccines will be available and vaccination will commence in Moyo and Buliisa districts.
Ministry of Health has also applied to GAVI and WHO for the inclusion of the Yellow Fever vaccination into the routine immunisation schedule. Having faced 4 outbreaks, Uganda now qualifies to introduce Yellow Fever vaccine as a long term measure to prevent Yellow Fever outbreaks.
Yellow fever is a disease transmitted through bites of mosquitoes infected by the Yellow Fever virus (flavirvirus). Symptoms include: high fever, headache, general body aches, fatigue, vomiting, blood in urine or stool and or yellow discoloration of skin and or eyes.
The Ministry of Health appeals to the general public to observe the following;

• All travellers in and out of the country MUST be vaccinated against Yellow Fever. Travelers are urged to comply with this travel requirement to ensure that the risk of spread of yellow fever through international travel is minimized.
• The population are advised to always sleep under a mosquito net
• Report any suspected cases to the nearest health facility

In conclusion, The Ministry of Health re-echoes its call to the public to cooperate with officials during the investigation and response to the outbreaks. The Ministry would also like to re-assure Ugandans and all other residents that with the experience and expertise available in the country, the disease will be contained.
We appeal to the public to remain calm and vigilant and report any suspected cases to the nearest health facility or call our toll-free number 0800-203-033
HON. ACENG JANE RUTH
MINISTER OF HEALTH

[Pathfinder]

WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES
Week 5: 27 January - 2 February 2020
Data as reported by: 17:00; 2 February 2020
...
Yellow fever Uganda

5 Cases
3 Deaths
60% CFR

EVENT DESCRIPTION

On 24 January 2020, the Ministry of Health in Uganda declared an
outbreak of yellow fever in two separate districts, namely Moyo in
West Nile region and Buliisa in the western region.

In the latest event in Moyo District, test results of two specimens
released by the Uganda Virus Research Institute (UVRI) on 22 January
2020 were positive for yellow fever virus infection by polymerase
chain reaction (PCR). This event initially involved two young men
aged 18 and 21 years, both South Sudan refugees living in Moyo
District, who travelled to South Sudan-Uganda border between 31
December 2019 and 1 January 2020 for timber logging. On their
return to Moyo on 2 January 2020, the 21-year-old developed a
febrile illness, followed by the 18-year-old the next day. The two
case-patients presented to the local health facility (Logobo Health
Centre III) on 3 January 2020 and were subsequently referred to
Moyo General Hospital on 5 January 2020, with the cardinal clinical
features of mental disorientation, vomiting (coffee grounds) and
passing melaena stools. The case-patients died on 5 and 6 January
2020, and post-mortem blood specimens were collected and
shipped to the UVRI for testing, and yellow fever was subsequently
confirmed.

Retrospectively, it has been established that two women died in
early January 2020 in the same community with haemorrhagic
manifestations. Both women were buried without testing and
are now being classified as probable yellow fever cases. A blood
specimen collected from the husband of one of the deceased women
has tested positive for yellow fever at the UVRI.

In an earlier event in Buliisa District, two cases of yellow fever were
confirmed between December 2019 and January 2020. This event
involved a couple – a 37-year-old man and a 38-year-old female
– who were cattle farmers, with the man frequently selling milk
between Uganda and Democratic Republic of the Congo. The man
fell ill and presented to Buliisa Hospital on 31 October 2019 with
symptoms of headache, vomiting, and abdominal pain. He received
supportive treatment but died on 4 November 2019 at Buliisa
Hospital. His post-mortem blood specimen tested positive for yellow
fever virus infection on 10 December 2019 at UVRI. This event
prompted an investigation in December 2019 and blood specimens
were collected from seven close contacts on 20 December 2019 and
sent to the UVRI. The wife to the deceased tested positive for yellow
fever virus on 22 January 2020, and she is alive and well. The other
six samples tested negative.

In total, five laboratory confirmed yellow fever cases have been
reported in Moyo (n=3) and Buliisa (n=2) districts, including three
deaths (two in Moyo and one in Buliisa). Additionally, two probable
and eight suspected cases have been recorded in Moyo Districts,
and the test results of the suspected cases are being awaited.

PUBLIC HEALTH ACTIONS

The Ministry of Health and WHO have dispatched rapid response
teams to Moyo District to support investigations, active case
search, community mobilization and sensitization.

A team of field epidemiologists from the Ministry of Health and
Makerere University School of Public Health have been deployed
to Buliisa District, where they are investigating the outbreak,
conducting an active search, mentoring health workers in yellow
fever detection and reporting.

Samples collected from suspected cases were shipped and are
being tested at the arboviral laboratory in the UVRI.

A community yellow fever case definition has been provided to
community members who are advised to report any alert cases
to the health facility or contact a hotline for further assistance if
needed.

Risk communication is being conducted in the affected districts
to sensitize the populations on preventive measures against
yellow fever.

A yellow fever vaccination campaign is planned in both affected
districts.

The Ministry of Health has applied to GAVI (the Vaccine Alliance)
and WHO for inclusion of yellow fever vaccination into the routine
immunization schedule as a long-term measure to prevent yellow
fever outbreaks.

SITUATION INTERPRETATION

Uganda is designated as a high-risk country for yellow fever in the
“Eliminate Yellow Fever Epidemics (EYE)” strategy, with a history of
recent outbreaks in 2010, 2016 and 2019. The affected communities
have largely been rural, with documented sylvatic transmission. In
the current outbreak, the affected districts are located close to the
borders with South Sudan and Democratic Republic of the Congo, and
the presence of the yellow fever vector in the affected areas, as well
as frequent population movements between the countries, presents
the potential for international spread of the outbreak. Urgent measures
need to be taken to contain this outbreak through reactive vaccination
exercises and enhanced surveillance. Additionally, the country needs
to fast-track the process of introducing yellow fever vaccine into the
routine immunization programme as a long-term preventive measure.

https://apps.who.int/iris/bitstream/...0102022020.pdf

[Shiloh]

Source: https://www.who.int/csr/don/21-febru...ver-uganda/en/
Yellow fever – Uganda

Disease Outbreak News
21 February 2020



From 4 November through 14 February 2020, eight laboratory confirmed cases of yellow fever in Buliisa (3), Maracha (1) and Moyo (4); including four deaths (CFR 50%), were detected through the national surveillance system.

On 10 December 2019, the Ministry of Health (MoH) was notified by the Uganda Virus Research Institute (UVRI) Regional Reference Laboratory of a case of yellow fever confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR). The case was a 37-year-old male with suspected viral haemorrhagic fever (VHF). His occupation was cattle farming with a history of travel to trade milk between Kizikya cell, Buliisa district in Uganda and the Democratic Republic of Congo (DRC). On 30 October 2019, he presented to hospital with symptoms of fever and headache of a five-day duration. His symptoms worsened with vomiting, abdominal pain and epistaxis and he died on 4 November 2019. During an in-depth investigation in December, eight samples were collected from close contacts, including family members and neighbours, and tested for yellow fever. On 22 January 2020, UVRI notified the MoH of a second case of yellow fever confirmed by serological testing (IgM and PRNT) in Buliisa with connection to the index case and with similar occupation. The other samples collected during investigation were negative for yellow fever.

Two other confirmed cases of yellow fever were identified in Moyo district in West Nile region which shares a border with South Sudan. The cases were aged 18 and 21 years, traded timber between Uganda and South Sudan and spent time in both countries. Onset of illness for both cases was 3 January 2020 and they were admitted at a Health Center in Moyo District. They were later referred to a General Hospital with symptoms of fever, vomiting, diarrhoea, fatigue, headache, abdominal and joint pains, confusion and unexplained bleeding. The cases deteriorated and died in the hospital on 5 and 6 January 2020. Results from UVRI confirmed yellow fever infection by RT-PCR performed at UVRI.

Subsequently, Moyo district notified a second cluster of suspected and confirmed yellow fever infection in a different village. The confirmed case in the suspected cluster was a 59-year-old patient who presented with symptoms including unexplained bleeding and fever on 22 January and died on 23 January 2020. A blood sample collected tested positive for yellow fever by RT-PCR at UVRI. His death was preceded by the death of two of his family members in early January with similar symptoms.

The Minister of Health of the Government of Uganda declared an outbreak of yellow fever on 23 January 2020.

Subsequent to the declaration of an outbreak, three additional cases were confirmed in Buliisa (1), Moyo (1) and Maracha (1). Detailed investigations of these cases are ongoing. Public health response

National rapid response teams have been deployed to Moyo and Buliisa districts to conduct further investigations, and initiate outbreak response. Other response activities include: enhanced surveillance and active case finding in all districts in the north-west region, and entomological surveys in the affected districts of Buliisa and Moyo. Cross-border notification with South Sudan in reference to the cases in Moyo district has been done. Investigations are ongoing in DRC and South Sudan and WHO AFRO is supporting coordination.

The Ministry of Health is planning a reactive campaign, approved by the International Coordinating Group on Vaccine Provision for Yellow Fever Control. This reactive campaign will target approximately 1.7 million people to stop transmission and prevent imminent risk of the outbreak spreading in the north-west part of country particularly in Buliisa, Koboko, Maracha, Moyo and Yumbe districts. To achieve sustained protection across the country, the MoH is preparing to apply for the introduction of yellow fever vaccination into the routine immunization programme in 2021 and implementation of preventive mass vaccination campaigns nationally. WHO risk assessment

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. Uganda is classified as a high-risk country in the “Eliminate Yellow Fever Epidemics” (EYE) initiative, with history of recent outbreaks in 2019, 2018, 2016 and 2011. Epidemic spread of yellow fever is a risk in Uganda as the estimated overall population immunity is low (4.2%), and attributable to past reactive vaccination activities in focal districts that are not affected by the current outbreak.

Due to the negligible population immunity in the affected districts, the detection of yellow fever cases is concerning. The affected districts share international borders with both DRC and South Sudan; and are marked by frequent population movements and high interconnectivity. Population immunity for yellow fever in the cross-border areas is also low and the forest biome between countries is continuous, indicating that there is a risk of international spread. Close monitoring of the situation with active cross-border coordination and information sharing is needed as the possibility of cases in neighbouring countries and risk of onward spreading to DRC and South Sudan cannot be completely excluded. WHO advice

Vaccination is the primary means for prevention and control of yellow fever and provides immunity for life. In urban centres, targeted vector control measures are also helpful to interrupt transmission. The country plans to introduce yellow fever vaccination into the routine immunization program and complete preventive mass vaccination activities to rapidly boost population immunity. Expedited planning and implementation of these activities to protect the population will help avert risk of future outbreaks.

WHO recommends vaccination against yellow fever for all international travellers aged 9 months and above going to Uganda as there is evidence of persistent or periodic yellow fever virus transmission. Yellow fever vaccination is safe, highly effective and provides life-long protection. However yellow fever vaccination is not recommended for infants aged 6 to 8 months, except during epidemics when the risk of yellow fever virus transmission may be very high. The risks and benefits of vaccination in this age group should be carefully considered before vaccination. The vaccine should be used with caution during pregnancy or breastfeeding. However, pregnant or breastfeeding women may be vaccinated during epidemics or if travel to a country or area with risk of transmission is unavoidable. Uganda also requires, as a condition of entry, a valid yellow fever vaccination certificate for travellers aged 1 year and above.

In accordance with the International Health Regulations (2005) Third Edition, the international certificate of vaccination against yellow fever is valid from 10 days after vaccination and throughout the life of the person vaccinated. A single dose of WHO approved yellow fever vaccine is sufficient to confer sustained immunity and life-long protection against yellow fever disease. A booster dose of the vaccine is not needed and is not required of international travellers as a condition of entry.

WHO encourages its Member States to take all actions necessary to keep travellers well informed of risks and preventive measures including vaccination. As a general precaution, WHO also recommends avoidance of mosquito bites. The highest risk for transmission of yellow fever virus is during the day and early evening. Travellers should be made aware of the signs and symptoms of yellow fever and instructed to rapidly seek medical advice if experiencing signs and symptoms suggestive of yellow fever infection. Viraemic returning travellers may pose a risk for the establishment of local cycles of yellow fever transmission in areas where a competent vector is present.

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

For more information on yellow fever:

• WHO yellow fever fact sheet
• WHO strategy for yellow fever epidemic preparedness and response
• WHO list of countries with vaccination requirements and recommendations for international travellers
• Global Strategy to Eliminate Yellow Fever Epidemics (EYE), document for SAGE – 26 September 2016
• A Global strategy to Eliminate Yellow Fever Epidemics (EYE) 2017-2026, WHO 2018
• WHO Database for pre-qualified vaccines
• Vaccine Position Papers
• International Travel and Health