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World Health Organization Organisation Mondiale De La WORLD HEALTH ORGANISATION MONDIALE ORGANIZATION DE LA SANTÉ MEETING OP THE SCIENTIFIC GROUP ON ORIGINAL: ENGLISH YELLOW FEVER RESEARCH IN EAST AFRICA Geneva, 29-31 October 1963 REPORT TO THE DIRECTOR-GENERAL MH0/PA/30.f^ f/ CONTENTS List of participants Provisional agenda Introduction Report on surveys carried out in Ethiopia . , . The studies at the Manera field station . Discussion on the findings at the Manera field station, 1962-63 . Refrigeration of specimens for transport Yellow fever in the Sudan Experiments with three yellow-fevef* vaccines by scarification Mass vaccination in Ethiopia . Quarantine problems in Ethiopia . Report of a possible new outbreak Suggestions for the 1963-64 studies in Ethiopia Recommendations . Annex I - Epidemiological and serological study, 1962-1963 campaign Annex II - Serological study Annex III - Entomological study Annex TV - Programme for the 1963-64 campaign Annex V - Vaccine studies . - 2 - LIST OF PAjmciPAwrs Dr P. Bres, Institut Pasteur de Dakar, 36 Avenue Pasteur, Dakar, Senegal Dr F. B. Hylander, Senior Adviser, Ministry of Public Health, P.O. Box 1240, Addis Ababa, Ethiopia Dr R. Panthier, Institut Pasteur, 25 rue du Do-jteur Ro'jx, Paris, Prance (Chairman) Dr M. H. Satti, Director of Research, îhe StacK Medical Research Laboratories, P.O. Box 287, Khartoum, Sudan Dr Ch. Sérié, Institut Pasteur d'Ethiopie, P.O. Box 1242, Addis Ababa, Ethiopia Dr M. C. 'Williams, East Africa Virus Research Institute, P.O. Box 49, Entebbe, Ugeinda (Rapporteur) Secretsiriat Dr W. Chas. Cockburn, Chief, Virus Diseases, WHO (Joint Secretary) Dr A. C. Saenz, Medical Officer, Virus Diseases, WHO (Joint Secretary) - 3 - PROVISIONAL AGENDA 1. Opening address by representative of the Director-General 2. Appointment of Chairman 3. Appointment of Rapporteur 4. ^ Report on the studies carried out in Ethiopia since the last meeting of the Scientific Group (Dr Sérié) 5. Report on entomological, virological and serological tests carried out by collaborating laboratories (Dr Panthier, Dr Williams, Dr Bres) 6. Discussion of items 4 and 5 7. Yellow-fever studies in Sudan (Dr Satti) 8. Tests of experimental vaccines (Dr Sérié) 9. Proposed future studies 10. Other business - 4 - INIRODUCTION • - • ' The Scientific Group on Yellow Fever Research in East Africa met for the third time m Geneva from 29-31 'October 19^3• The serological and entomological surveys carried out in several areas of Ethiopia and the intensive epidemiological and ecological studies carried out in Manera were reviewed and discussed. Plans for future studies to be made in 1963-64 were discussed. \ Dr C. Raska, Director of the Division of Communicable Diseases, welcomed the participants on behalf of the Director-General, stressing the importance of these studies in Ethiopia for the clarification of epidemiological and ecological problems in yellow fever as v/ell as in other arthropod-borne virus infections. Dr R. Panthier was elected Chairman and Dr M. C. Williams was elected Rapporteur ; The provisional agenda was adopted. Dr F. B. Hylander conveyed to the members of the Group the greetings of the Minister of Health of Ethiopia. REPORT ON SURVEYS CARRIED OUT IN ETHIOPIA Details of the geographical, epidemiological, serological and entomological studies can be seen in annexes 1, 2 and 3» Dr Sérié started his presentation of these papers by reviewing previous work and the historical background of the epidemiological work on yellow fever in Ethiopia. In analysing the present situation, he pointed out that in Assab Group B virus antibodies were present, but Ae'des aegypti and other Aedes mosquitos were absent. Culex simiens was the only common mosquito. In the Awash valley Group A and Group B antibodies were found but antibodies to yellow-fever virus did not occur. In the Blue Nile Valley, in the upper region, the only antibodies detected in significant numbers were those of Ekinyamwera virus, but in the lower part of the valley, near the Sudan frontier and the confluence of the Didessa river, both Group A and Group B antibodies were found. Nothing, however, suggested the presence of yellow fever. - 5 - In Sidamo-Borena, in the south, mass vaccination had recently been carried out. The serological tests confirmed the success of this programme. At Gandima, where vaccination had not been done, it was thought that yellow fever had been active. In the Ogaden area where previous work by Smlthburn & Mahaffi had found several yellow-fever positive sera in Dagabour, only one positive serum was found at this place, but the sera from the area as a whole contained very few arbovirus antibodies. Dr Sérié then analysed the results of the work of different laboratories on sera collected in I96I-62, which had all been brought together for the first time. He pointed out the agreement of results from different laboratories using the same antigen, but when different strains of yellow-fever virus were used an obvious difference occurred between the epidemic area from which virus strains had been isolated and the areas where epidemics had not been recorded. The Couma strain of yellow fever appeared to be more easily neutralized than the standard French neuro­ tropic yellow-fever virus. In discussion it was decided to take the Assab region first and to review the other regions from the periphery to the epidemic area. The consensus of opinion for Assab was that a Group B virus other than yellow fever was responsible for the Group B antibodies. The problem of isolating virus in this rather remote area was , discussed, and it seemed that the short period during and after the rains would be the best time for such work. In the Awash area it was felt that the high level of Group A and Group B viruses indicated a rich arbovirus activity, but that yellow fever did not occur. In the Blue Nile the absence of arbovirus activity in the upper reaches with the occurrence of Bunyamwera was remarkable, but might have been associated with the height (I8OO-I5OO m). In the lower area there was no evidence of yellow fever, which was surprising as in the Sudan the 1959 epidemic had been confirmed by neutrali­ zation tests and histopathological studies. In Ethiopia the epidemic was apparently confined to the lower areas bordering the Sudan but did not reach the high altitudes. - 6 - Dr Satti mentioned the results of a study by Dr Theiler on sera from an outbreak of paralysis which occurred 200 miles north of the Blue Nile in the Sudan at Kakoom. The sera showed a high incidence of West Nile and Zika virus antibodies, but only one serum showed a pattern of yellow-fever infection. It appeared therefore that yellow fever had not occurred in the area to a significant degree. In the valleys of the Baro and Ghilo where no cases of yellow fever had occurred the serological results were different from the epidemic area. The differences between the results with Couma and French neurotropic strains of yellow-fever virus were discussed and it was f und impossible to decide whether yellow fever occurred in the area or not. It was felt that these differences v.'ere important and that specialized labora­ tories should be asked to carry out further studies. The lower Didessa Valley results were discussed. They were thought to be similar to the lower Blue Nile Valley results, but in Amalta and adjacent villages, • higher up the valley, it was thought that definite yellow-fever positive sera had been found and the possibility of spread from the Omo Valley was considered. The Sldomo-Borena area was reviewed in three parts, firstly the area on the Kenya border, v/here mass vaccination had been made. Serologically the success of the programme was confirmed. To the east no yellow fever or arbovirus activity occurred. In the west in Gandima and another village, both of which had not been vaccinated, there was a very high proportion of yellow-fever positive sera, and it was thought that this indicated an outbreak of yellow fever. About the Ogaden area there was little discussion and no explanation was given for the positive yellow-fever sera from Dagabour. ^ Dr Sérié said that in the epidemic zone of the Omo Basin where there had been, from 1961 to 1962, approximately 200 000 cases and more than 30 000 deaths due to yellow fever, the serum results showed that Zika virus was present as well as yellow- fever virus. In discussion the question of where the epidemic originated was considered It was expressed that some evidence pointed to the area near Akobo to the west, but the general opinion was that there were no definite indications about this. - 7 - In answer to a question Dr Sérié explained that the sera from the epidemic area were collected from cases or from the family of a person who had died. In the non- epidemic areas efforts were made to collect sera from children and young adults, but in some areas local difficulties prevented this. THE STUDIES AT THE MANERA FIELD STATION Dr Sérié outlined the construction of the field station at Manera, the place where previous work had led to the isolation of a number of yellow-fever strains from man and Aëdes simpsoni. An air-lift was necessary to get everything to this isolated area. The geographical featiares were mentioned and it was noted that some villages had high yellow-fever antibody rates whereas others had no yellow-fever antibodies. Zika antibodies were found, but they did not correlate with yellow-fever antibodies. The reasons for this are unknown. Virus isolation during the year from l62 pools led to the isolation of one strain of yellow-fever virus from a pool of Aëdes africanus, two strains of an as-yet unidentified virus from two pools of Eretmapodites species, two strains recently isolated from Aëdes dentatus, and one from Culex species.
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