Yellow Fever Outbreak in Angola Situation Report 04 March 2016

YELLOW FEVER OUTBREAK IN ANGOLA SITUATION REPORT 04 MARCH 2016

Summary  A cluster of cases with signs of hemorrhagic fever was identified on December 30, 2015 from the district of Viana in Luanda Province. The cases were confirmed as yellow fever by the regional yellow fever reference laboratory at the Institute Pas- teur-Dakar. A WHO mission of yellow fever experts confirmed a high risk of expansion of the outbreak to other districts of Luanda. The number of suspected cases increased significantly from mid January to mid February 2016. The case trend has begun to decrease after a mass vaccination response campaign was initiated in Viana district on February 2nd. On Feb- ruary 19th the next phase of the campaign began in Belas district and on February 29th in the districts of Cazenga and Cacuaco. Currently 58% of target population has been vaccinated.

 For blood samples collected from suspect YF cases, 2 to 4 weeks had been required for laboratory confirmation causing delays in the timely investigation of new cases in other areas. This time has been reduced with the increased capacity now in place at the national laboratory. To date all the confirmed YF cases are epidemiologically linked to Luanda and the investigation teams in the field have not identified local transmission outside Luanda.

 A multidisciplinary team of technical staff from WHO headquarters and the Regional office for Africa (AFRO) as well as from other International Partners (UN Agencies, CDC Atlanta, MSF, Cuban Cooperation) continue to provide technical assistance in different areas including social mobilization, logistics, epidemiology, laboratory, entomology, etc. Effective partner collaboration ensures that coordinated and efficient support are provided to MOH to enhance the response to the I. Surveillance  During the last 24 hours 36 new suspected cases and 6 deaths were reported nationally. Luanda continues to be the main location for newly reported cases. The CFR remains high in Viana, Huambo and Kwanza Sul.

 Newly confirmed cases have been notified in the districts of Ekunha (Huambo province) and Humpata (Huila province) both imported from Viana/Luanda before or soon after the start of the vaccination campaign.

 With the technical improvement of the National laboratory a committee was created to carry out the final

classification of suspect cases based on laboratory Cases results. This committee is issuing a daily list of co- firmed cases.

 Two investigation teams are being deployed this week- end to Bie and Benguela to investigate newly confirmed cases in those provinces.

 The team deployed to Cuanza Sul investigated a suspected IgM + case in Seles district. The entomological evaluation in Amboim district found a high index of Aedes aegypti in- festation. A rapid IEC survey about YF found that about 2/3 of the interviewed people had some knowledge of the transmission mechanism of YF (66/96) and 56% of these people had received the information from TV. YF outbreak Immunization response Angola, As of 3rd Mar 2016

Yellow Fever Epidemiology SIAs

Pronvince Districs SAIs starting Confirmed ONSET 1st case ONSET last case target vaccinated % Status date

Viana 16 05-déc-15 29-janv-16 1 500 381 02-févr-16 1 704 173 114% Completed Belas 3 15-janv-16 29-janv-16 1 047 423 19-févr-16 1 215 956 116% Cases/deaths Cumulated cases Cazenga 4 18-janv-16 02-févr-16 848 034 29-févr-16 298 500 35% Luanda Sambizanga 1 23-janv-16 23-janv-16 156 551 07-mars-16 na Maianga 1 28-janv-16 28-janv-16 645 936 07-mars-16 na Cacuaco 0 867 748 29-févr-16 272 130 31% Sus- Sus- CFR LUANDA Icolo e Bengo 0 73 405 TBD na Ingombota 0 87 530 07-mars-16 na districts Deat Deat K. Kiaxi 0 625 530 07-mars-16 na pect pect Rangel 0 24 670 07-mars-16 na Samba 0 132 954 07-mars-16 na Kissama 0 424 154 TBD na Outros (Hospitais) 0 156 115 TOTAL LUANDA 25 6 434 316 3 646 874 57% BIE Kuito 1(linked to luanda) 30-janv-16 30-janv-16 426 780 TBD na BENGUELA Lobito 1(linked to luanda) 29-janv-16 29-janv-16 326 044 TBD na Huambo 1 (linked to Luanda) 20-janv-16 20-janv-16 TBD na HUAMBO 669 671 Ekunha 1 (linked to Luanda) 03-févr-16 03-févr-16 79 334 TBD na KUANZA SUL Amboim 1 (linked to Luanda) 23-janv-16 23-janv-16 236 339 TBD na CABINDA Cabinda 1 (linked to Luanda) 25-janv-16 25-janv-16 601 892 TBD na Lubango 1 (linked to Luanda) 09-févr-16 09-févr-16 83 267 TBD na HUILA Humpata 1 (linked to Luanda) 09-févr-16 09-févr-16 83 267 TBD na TOTAL OUT OF LUANDA 8 1 753 770 0 0% TOTAL 33 8 188 086 3 646 874 45%

I. Response  Mass vaccination campaigns have started in the districts of Cumulated vaccinated by district up to 02 March 2016; Province of Luanda Cacuaco and Cazenga. Vaccination continues to be provided in health facilities in Viana and Belas districts.

 Improvement in security and organization of the campaign in Cazenga

 Increased number of vaccination teams in Cazenga but quality and performance are still a challenge.

 Timely distribution of vaccines needs to be improved *Ongoing campaigns CASE INVESTIGATION AND LABORATORY

A laboratory specialist from the Institute Pasteur Dakar (IPD) has arrived and is working at the National Laboratory to perform a serological differential IgM test for Dengue, West Nile, Zika, Chikungunya and Crimea—Congo. This test, to- gether with PCR, will permit a more rapid confirmation of cases and facilitate timely investigation and implementation of response measures in areas with newly identified transmission.

COORDINATION— At the last National Coordination meeting chaired by the Minister of Health, the National Public Health Director presented the National Plan of Action.

SOCIAL MOBILIZATION (SM)

 Production of three radio and TV Spots to be broadcast nationally

 A meeting with traditional healers was chaired by the National Director of Public Health in Luanda

 Technical assistance is being provided to the MOH to produce a weekly press release about the outbreak

GAPS AND CHALLENGES

 During a vaccination campaign micro planning exercise for the remaining districts of Luanda, a gap of US$ 177,000 for operational costs was identified; WHO proposed to fill that gap.

 Further support for data entry is necessary to ensure a more timely analysis of epidemiologic data

 Health personnel from the Angolan armed forces who are providing significant vaccination services in support of the campaign will not be available after March 12th and other vaccinators must be identified to replace them

 More cold chain equipment is needed for the increased number of vaccination teams STRATEGIC ANALYSIS

 Use of the lessons learned from the previous campaigns in Viana and Belas districts in order to improve the mass vaccination campaigns in the remaining districts.  Improve the selection criteria for the recruitment of the vaccination teams to ensure a better quality campaign.  Need to enhance social mobilization activities to identify problems and facilitate community participation and improve knowledge about the disease WHO SUPPORT

The ongoing technical support provided by the Dakar Referral Laboratory specialist is critical to ensure the local confirmation of cases and accelerate the response/interventions in areas with new cases. Logistic support is ongoing for issues related to waste management. PARTNERS SUPPORT

CDC continues supporting laboratory and epidemiological activities. Training of nurses for case management by MSF in hospitals with high CFR is ongoing . NGO Medicus Mundi is exploring possible areas of cooperation. RESOURCE MOBILIZATION

The WHO/AFRO Regional Director has committed to meeting the critical needs necessary to organize appropriate response activities including a high quality vaccination response campaign.