WHO: Yellow Fever ? Democratic Republic of the Congo (11 April 2016)

[Shiloh]

Source: http://www.who.int/csr/don/11-april-2016-yellow-fever-drc/en/
[h=1]Yellow Fever ? Democratic Republic of the Congo[/h] Disease Outbreak News
11 April 2016

On 22 March 2016, the National IHR Focal Point of the Democratic Republic of Congo (DRC) notified WHO of cases of yellow fever (YF) in connection with the outbreak currently occurring in Angola.
From early January to 22 March 2016, a total of 151 suspected cases of YF, including 21 deaths (CFR: 14%), were reported by the national surveillance system. Of the 151 suspected cases, 9 were confirmed by serology (IgM) at the Institute National Biomedical Research (INRB) in Kinshasa. Given possible cross-reactions with other arboviruses, IgM positive samples were sent to the Pasteur Institute of Dakar for confirmation where 4 tested positive for the infection. Of the 4 cases confirmed in Dakar, 3 were imported from Angola and were detected in the areas of Nsona-Pangu, Kimpese and Kitona in Kongo Central province (formerly, Bas-Congo), DRC. This province shares borders with Angola.
[h=3]Public health response[/h] The Ministry of Health of DRC has activated the National Committee for outbreak management to respond to this event. Undertaken activities include the establishment of coordination mechanisms, social mobilization and community engagement, strengthening surveillance through the training of health workers, dissemination of case definitions, screening and sanitary controls at Points of Entry and screening of refugees? vaccination status. Other activities are targeting the vaccination of all individual travelling to Angola, strengthening vector control and case management.
With support from WHO and partners, the country has developed a contingency plan to improve the country's preparedness for a possible response to cases imported from Angola. A field visit of a national multidisciplinary team in Kongo central is planned in order to organize in-depth investigations of cases and enhance the preparation of the reactive immunization strategy.
[h=3]WHO risk assessment[/h] DRC is located in a geographical area known to be YF endemic and autochthonous cases are regularly reported. Since January 2016, autochthonous suspected cases have been recorded in the provinces of Bas-Uele, Equateur, Kasai central, and Tshuapa.
The report of yellow fever infection in travellers returning from Angola, however, highlights the risk of international spread of the disease. At this stage, the available information does not suggest the establishment of a cycle of transmission in DRC. Nevertheless, the presence of the competent vector (the Aedes aegypti mosquito), the high proportion of individuals susceptible to the infection, and the intensity of population movements from and to Angola pose a serious risk of further spread of the disease in DRC.
WHO continues to monitor the epidemiological situation and conduct risk assessment based on the latest available information.
[h=3]WHO advice[/h] WHO urges Members States especially those where the establishment of a local cycle of transmission is possible (i.e. where the competent vector is present) to strengthen the control of immunisation status of travellers to all potentially endemic areas.
WHO does not recommend any travel or trade restriction to DRC based on the current information available.

 

[Ronan Kelly]

Situation Epid?miologique de la Fi?vre Jaune
Situation au 27/04/2016
1. Points saillants :
a. Dix sept (17) cas de fi?vre jaune IgM positifs en RDC sont confirm?s par PCR ou s?roneutralisation
par l’Institut Pasteur de Dakar (IPD) depuis janvier 2016. Vingt cinq (25) ?chantillons de cas
probables (IgM positif au Labo INRB) sont en attente de confirmation par l’IPD.
b. Deux (2) cas probables autochtones (1 ? Kinshasa et 1 au Kongo Central) sont en attente de
confirmation ? l’IPD.
c. Seize (16) cas confirm?s sont des cas import?s d’Angola. Ces cas sont rapport?s dans les provinces
du Kongo central (13) et de Kinshasa (3).
d. Un des cas confirm?s est un cas selvatique enregistr? dans la zone de sant? de Mompono (Province de
la Tshuapa)
e. L’?pid?mie a ?t? el?v?e au grade 2 par l’OMS selon le cadre de r?ponse aux urgences (ERF).
f. Les pr?paratifs pour la campagne de vaccination de riposte sont en cours et une requ?te a ?t? soumise
? l’ICG le 26 avril 2016.

2. Situation ?pid?miologique :


A la date du 26 avril 2016, 453 cas suspects et 45
d?c?s ont ?t? notifi?s par le syst?me de la
surveillance int?gr?e de la maladie et de la
r?ponse au niveau du pays dans 89 zones de
sant?. 42 cas ont ?t? confirm?s IgM positif ?
l’INRB. Parmi ces cas, 17 ont ?t? confirm?s par
l’IPD par PCR ou seroneutralisation.
Seize (16) cas confirm?s par l’IPD sont import?s
d’Angola. Ces cas sont rapport?s dans les
provinces du Kongo central (13 cas) et Kinshasa
(3 cas). Un (1) cas confirm? par l’IPD est un cas
selvatique notifi? ? Mompono, Province de la
Tshuapa.
Deux cas autochtones IgM (+) ? l’INRB, notifi?s
dans les ZS de Matadi, Kongo Central et Ndjili,
Kinshasa, sont en attente de confirmation au
niveau de l’IPD. Deux cas IgM (+) ? l’INRB
dans les zones de sant? de Limete et Kikimi sont
en cours d’investigation pour classification
(import? ou autochtone).

...
http://reliefweb.int/sites/reliefweb...ril%202016.pdf

Google translation;

Epidemiological Situation of Yellow Fever
Situation on 27/04/2016
1. Highlights:
at. Seventeen (17) cases of yellow fever IgM positive in DRC are confirmed by PCR or virus neutralization
by the Pasteur Institute in Dakar (IPD) since January 2016. Twenty five (25) cases of samples
probable (positive IgM INRB Lab) are awaiting confirmation by the IPD.
b. Two (2) aboriginal probable cases (1 in Kinshasa and one in Kongo Central) are awaiting
confirmation to the IPD.
c. Sixteen (16) confirmed cases are imported cases from Angola. These cases are reported in the provinces
Kongo Central (13) and Kinshasa (3).
d. A confirmed case is a sylvatic cases recorded in Mompono health zone (Province
Tshuapa)
e. The epidemic has been elevated to Grade 2 by WHO by response to emergencies framework (ERF).
f. Preparations for the response vaccination campaign are underway and a request was submitted
ICG April 26, 2016.

2. Epidemiological situation:


As of April 26, 2016, 453 suspected cases and 45
deaths have been reported by the system
integrated disease surveillance and
response at the country level in 89 areas
health. 42 cases have been confirmed positive for IgM
INRB. Of these, 17 were confirmed by
IPD PCR or neutralization.
Sixteen (16) cases confirmed by the IPD are imported
Angola. These cases are reported in the
central provinces of Kongo (13 cases) and Kinshasa
(3 cases). One (1) case confirmed by the IPD is a case
sylvatic notified Mompono, Province of
Tshuapa.
Two indigenous cases IgM (+) to INRB, notified
ZS in Matadi Kongo Central and Ndjili,
Kinshasa, are awaiting confirmation
level of IPD. Both IgM (+) to INRB
in health areas are Limete and Kikimi
under investigation for classification
(Imported or indigenous).
...

 

[Shiloh]

Source: http://www.who.int/csr/don/02-may-2016-yellow-fever-drc/en/ [h=1]Yellow fever ? Democratic Republic of the Congo[/h] Disease Outbreak News
2 May 2016

On 22 March 2016, the National IHR Focal Point of the Democratic Republic of Congo (DRC) notified WHO of cases of Yellow Fever (YF) in connection with the outbreak currently occurring in Angola (see DON posted 13 April 2016).
From early January to 22 March, a total of 453 suspect cases of YF, including 45 deaths were reported by the national surveillance system.
Further investigations identified 41 cases potentially related to the Angola outbreak. These cases were confirmed by laboratory testing at the Institute National of Biomedical Research (INRB) in Kinshasa. Of these 41 cases, 16 have also been confirmed by the regional reference laboratory, Pasteur Institute (IP) in Dakar: 13 of the cases were detected in Kongo Central province (formerly Bas-Congo) and 3 cases reported from Kinshasa. Kongo Central province shares a long, porous border with Angola.
Laboratory testing for the other 25 probable cases is pending at IP Dakar. Of these pending cases, two are identified as probable cases of autochthonous transmission ? one from Kinshasa, and one from Matadi (in Kongo Central province). Investigations are ongoing and complementary testing at IP Dakar is pending.
An investigation team with the support of a virologist from IP Cameroon conducted an outbreak investigation from 7-18 April to assess the presence of local transmission and the risk of amplification. The conducted entomological survey found a high density of Aedes aegypti mosquito larvae, samples of which have also been sent to IP Dakar for infectivity investigation. High entomological density indicates that the risk for amplification of disease is very high.
The Government officially declared an outbreak of Yellow Fever on 23 April 2016.
[h=3]Public health response[/h] The Ministry of Health of DRC has activated the National Committee for outbreak management to respond to this event.
Key response activities include:

• establishment of coordination mechanisms
• social mobilization and community engagement
• case management
• strengthening surveillance through the training of health workers
• dissemination of case definitions
• screening and sanitary controls at Points of Entry and screening of refugees? vaccination status
• reactive vector control activities and sensitization of all health facilities (public, private, and traditional practitioners)
• vaccination of all individuals travelling to Angola.

Technical support is required to improve the laboratory capacities in terms of diagnosis, especially to avoid delay in laboratory confirmation of cases and improve surveillance.
With support from WHO and partners, the country has developed a contingency plan to improve the country's preparedness for a possible response to a larger YF outbreak. The plan is to vaccinate 8 health zones with at least 2 districts in Kinshasa and the six districts of Kongo Central where laboratory confirmed cases were identified (a total of nearly 2 million persons). If local transmission is laboratory confirmed, then other districts would be targeted accordingly.
[h=3]WHO risk assessment[/h] The situation in DRC is concerning and must be monitored with the highest vigilance. DRC is located in a geographical area known to be YF endemic and autochthonous cases are regularly reported in the whole country. Since January 2016, autochthonous suspected cases have been recorded in the provinces of Bas-Uele, Equateur, Kasai central and Tshuapa. The last outbreaks were reported in Kasai n Oriental in 2013 and in Province Oriental and Katanga in 2014.
YF was introduced in the routine EPI in Kinshasa in 2003. According to available data, most of the Capital?s districts (71%) had insufficient YF vaccination coverage (<80%) between 2012-2014. The country, with the support of WHO and partners, needs to implement adequate control measures especially reactive vaccination campaigns in order to avoid geographical spread within the country and to bordering countries.
Given the large Angolan community in Kinshasa, the presence and the activity of the vector Aedes spp, the potential establishment of local cycle of transmission in DRC in general and in Kinshasa in particular (the population of Kinshasa Province is estimated at 12.9 million) are of real concern and need to be monitored with extreme attention.
The last investigation highlighted the high risk of local transmission; made evident by factors such as high entomologic indices, movement of people between Angola and DRC, and the regular importation of viraemic cases from Angola.
The report of Yellow Fever infection in travellers and workers returning from Angola also highlights the risk of international spread of the disease.
[h=3]WHO advice[/h] There is urgent need to strengthen the Yellow Fever vaccination requirements for travellers in accordance to IHR (2005). Yellow Fever can easily be prevented by immunization provided vaccination is administered at least 10 days before travel. WHO urges Member States especially those where the establishment of a local cycle of transmission is possible (i.e. where the vector Aedes aegypti mosquitoes is present) to ensure that travellers to or from countries with current Yellow Fever transmission are vaccinated against Yellow Fever.
WHO does not recommend any general restriction of travel and trade with DRC on the basis of the information currently available on this outbreak. The vaccination of each person before going to the affected areas, observation of measures to avoid mosquito bites, awareness of symptoms and signs, as well as early care seeking practice are essential measures for the prevention of the disease.