Monday 25th March 2019
https://www.afro.who.int/news/south-sudan-launches-yellow-fever-vaccination-campaign-stop-outbreak-sakure-nzara-county

South Sudan launches Yellow Fever vaccination campaign to stop outbreak in Sakure, Nzara county Gbudue State 
 
Yambio, 25 March 2019 – The Ministry of Health with support from the World Health Organization (WHO) and partners launched a reactive yellow fever (YF) vaccination campaign in Sakure, Nzara County Gbudue State to vaccinate 19,578 individuals aged 9 months to 65 years against YF.

The vaccination campaign follows the declaration of a yellow fever outbreak on 29 November 2019, where a total of three laboratory confirmed cases with no deaths have been reported after investigations were carried out in Sakure payam.

In December 2018, a team comprising of epidemiologists, a public health officers, entomologists; laboratory specialists as well as risk communication experts carried out detailed epidemiological, laboratory, and entomological investigations to determine the magnitude of the outbreak, identify the vectors, assess the risk of an epidemic, and to initiate control measures to interrupt transmission and prevent further spread of the disease.

The reactive YF vaccination is part of the global strategy to Eliminate Yellow Fever Epidemics (EYE) by 2026, said Dr Olushayo Olu, WHO Representative for South Sudan. It serves to protect high-risk populations against the YF virus in the immediate term and will serve as a bridge towards the introduction of yellow fever vaccine into the routine immunization system in the long term.

YF is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The "yellow" in the name refers to the jaundice that affects some patients. Symptoms of yellow fever include fever, headache, jaundice, muscle pain, nausea, vomiting and fatigue. A small proportion of patients who contract the virus develop severe symptoms and approximately half of those die within 7 to 10 days.

YF has an incubation period of 3-6 days following infection. Many people do not experience symptoms, but when these do occur, the most common are fever, muscle pain with prominent backache, headache, loss of appetite, and nausea or vomiting. In most cases, symptoms disappear after 3 to 4 days.

South Sudan last experienced a yellow fever outbreak in May 2003, in Imatong region of Torit County, with a total of 178 cases with 27 deaths (CFR 15%) in Imatong and Ikotos districts, Torit County.

With funding from Gavi, the Vaccine Alliance, European Union Humanitarian Aid (ECHO) and the United States Agency for International Development (USAID), South Sudan secured a total of 21 800 doses from the Global emergency yellow fever vaccine stockpile of the International Coordination Group (ICG) on vaccine provision.

For Additional Information or to Request Interviews, Please contact:

Ms Jemila M. Ebrahim
Communications Officer
Mobile: +211 921 647 859
Email: ebrahimj@who.int
Date: Wed 20 Mar 2019
Source: ReliefWeb [edited]
<https://reliefweb.int/report/sudan/sudan-set-protect-over-8-million-people-its-largest-ever-yellow-fever-vaccination-drive>

The Federal Ministry of Health, in collaboration with the World Health Organization (WHO), Gavi, the Vaccine Alliance, and UNICEF, has launched a large-scale mass vaccination campaign in Sudan to vaccinate more than 8.3 million people 9 months to 60 years of age against yellow fever in the states of Blue Nile, Gezira and Sennar during 10-29 Mar 2019.

The campaign represents a crucial step in protecting a large portion of the population and reducing the risk of severe and deadly yellow fever outbreaks in the country. It is the 3rd and final drive thatSudan is undertaking to protect populations at risk and prevent yellow fever epidemics, pending the implementation of infant immunization as routine practice.

The campaign forms a critical part of Sudan's ongoing work to protect all populations against yellow fever epidemics, in alignment with the global Eliminate Yellow fever Epidemics (EYE) Strategy. The country plans to complement these yellow fever mass campaigns and ensure long-term protection through the introduction of yellow fever vaccination into routine immunization in the coming months.

"We acknowledge the commitment of the health authorities in Sudan to avail cash and fuel during this economic crisis to ensure that their people, especially children, are protected with a quality vaccine which will contribute to health security and making the world safer," said Dr. Naeema Al-Gasseer, WHO Representative in Sudan.

"Yellow fever vaccination is the most important tool we have to prevent yellow fever outbreaks. The vaccine will be freely available to any eligible person and will provide life-long protection against the disease. While protecting yourself against mosquito bites is important to reduce the risk of many diseases, only vaccination can eliminate the risk of yellow fever outbreaks," she added.

Yellow fever is a viral disease that is transmitted by certain types of mosquito. Infection can cause fatal illness, including jaundice, and death, and can spread rapidly, locally and internationally, especially in urban areas. However, the disease can be prevented by a single dose of a highly effective and safe vaccine. This campaign aims to boost protection in the general population and will target all eligible people.

Sudan is at high risk for the spread of yellow fever due to a combination of climate and ecological factors, and because there are still areas of low population immunity. Recent years have seen global changes in the epidemiology of yellow fever, with outbreaks occurring in areas that were not previously assessed as being at high risk.

"We are observing a changing nature in yellow fever disease dynamics. It is very important that every eligible person in this campaign receives the vaccine to protect themselves, their families and their communities," said Professor Dr. Babkir Kabaloo, Undersecretary of the Federal Ministry of Health.

"The current campaign represents one of the final phases in the Ministry's efforts to protect the entire nation against yellow fever outbreaks. This campaign will cover Blue Nile, Gezira, and Sennar states. In the coming months, the remaining states of Khartoum, Northern and River Nile will also be covered, completing the protection of the entire Sudanese population," he added.

Sudan's health authorities and partners are working to introduce yellow fever vaccine in the national immunization schedule in the near future. This will help ensure the protection of the whole population and generations to come against this fatal but preventable disease.
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[It is good to see this ambitious yellow fever (YF) vaccination campaign drawing to a close. Incorporating YF vaccine into routine childhood vaccination schedules is prudent and if successful will eliminate the need for intensive, country-wide campaigns to deal with outbreaks. YF is no stranger to Sudan. Between 3 Oct and 24 Nov 2013, a total of 44 confirmed cases of YF were reported, including 14 deaths. A total of 12 localities in West and South Kordofan were affected by that outbreak. There was a large YF outbreak in the Darfur state in 2012-2013. In 2012, the World Health Organisation (WHO) said that more than 840 people were infected with YF in Darfur and that the epidemic affected 35 of 64 localities in the region since September 2012. The total recorded cases of YF in Greater Darfur hit 849 with a 20% death toll during an epidemic in 2012 (see WHO Disease Outbreak News <http://who.int/csr/don/2012_12_03/en> as reported by ProMED post http://promedmail.org/post/20130125.1513849, as noted at the time by Mod.JW). Mounting campaigns in the face of these types of outbreaks is inefficient, logistically difficult, and costly -- financially and in terms of human lives. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Sudan: <http://healthmap.org/promed/p/96>]
Date: Wed 6 Mar 2019
Source: Relief web, report from Medair [edited]
<https://reliefweb.int/report/south-sudan/severe-measles-outbreak-threatens-thousands-south-sudan>

More than 75,000 measles vaccines have been airlifted to South Sudan's Gogrial West County in response to an outbreak declared by the State Ministry of Health. There are 98 suspected measles cases, with one death reported. Medair, an international humanitarian organisation, has mobilized an emergency response team to vaccinate children under 5 years of age in an area where the population is estimated at over 400 000 people. The campaign is expected to be conducted from 7-17 Mar 2019.

Responding to this measles outbreak is made even more urgent by high levels of global acute malnutrition (GAM) among children in Gogrial West County. "This is an area where the population is incredibly vulnerable," said Jennifer Turner, health manager with Medair's emergency response team. "Children who are malnourished are more at risk of being infected with measles, and the complications are often more severe. The food insecurity in this region is rated at a "crisis" level."

To reach so many children with vaccinations over a short period of time, Medair will train and deploy more than 800 people from the affected communities who will work steadily for 10 days. Teams of 8 will head out each day carrying a supply of vaccines, which must be kept cold despite daytime temperatures of 40 deg C [104 deg F]. During shipping, storage, and distribution, the ice packs will be frozen using generator power and, where available, solar-powered vaccine fridges. All vaccines and supplies must be transported by air from Juba.

Medair South Sudan's emergency response team is always available to respond to healthcare emergencies. In 2018, the team completed 23 emergency interventions in health, nutrition, water, and sanitation, and the distribution of critical items.
Date: Fri 21 Dec 2018
Source: WHO Regional Office for Africa [edited]
<http://www.afro.who.int/news/situation-update-yellow-fever-outbreak-south-sudan?country=876&name=South%20Sudan>

Situation update on the yellow fever outbreak in South Sudan
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The yellow fever outbreak in South Sudan was declared on 29 Nov 2018 in Sakure payam, Nzara county, Gbudwe state.

Since the reporting of the outbreak, the Ministry of Health and partners have scaled up preparedness and response activities to mitigate and control possible spread. These activities entailed conducting follow up epidemiological; entomological; and laboratory investigations in addition to providing supportive clinical care to symptomatic cases by national rapid response team.

As of 19 Dec 2018, only one confirmed yellow fever case and 2 presumptively yellow fever positive cases have been reported from Sakure payam, Nzara county, Gbudwe state. Sakure payam is located at the border with Democratic Republic of Congo (DRC) a rural setting with households and farms located close to forested areas (with the risks of yellow fever transmission and cross-border spread). The population of Sakure payam is estimated to be 16 759 people with most engaged in farming and cross-border trade with DRC.

According to Dr Wamala Joseph, WHO Epidemiology, the assessment of the types of mosquito in Sakure, Nzara, and Yambio towns, revealed no evidence of yellow fever carrying mosquitoes (the _Aedes_ species). He noted that the number of the mosquitoes found in the 3 places was below the required levels to cause yellow fever outbreaks. This he said is attributed to the prevailing dry season and hence the greatly reduced breeding and mosquito populations at this time of the year.

The population in South Sudan is regarded as vulnerable to yellow fever outbreaks since the vaccine is not integrated into the national routine vaccination schedule. In addition, the last major yellow fever vaccine reactive campaign was implemented in 2003 following the Imatong mountains yellow fever outbreak in Torit and Ikotos counties.

These findings highlight the need for the country to rapidly catch up on WHO Eliminate Yellow Fever Epidemics (EYE), a strategy premised on 3 pillars that include: protecting vulnerable populations through yellow fever vaccination; preventing international spread of yellow fever; and containing outbreaks rapidly through enhanced surveillance and laboratory capacities and establishing national yellow fever vaccine stockpiles.

With the contribution from donors, South Sudan is able to conduct active surveillance for yellow fever and other diseases. These include the European Commission's Humanitarian Aid and Civil Protection department (ECHO) for Early Warning And Response Network (EWARN) support, United States Agency for International Development (USAID) for Integrated Disease Surveillance and Response (IDSR), and GAVI vaccine alliance for the assessment of capacities for yellow fever and testing.

Yellow fever is a viral infection transmitted by infected mosquitos, which can be deadly but easily prevented by a safe and effective vaccine. The disease has re-emerged as a public health threat in many parts of Africa and South America, due to several factors including climate change, rapid urbanisation, and increasing population movements.
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[The risk of a yellow fever (YF) outbreak seems minimal at this time, with just one confirmed case and 2 presumptive cases and no evidence of mosquito vectors in the affected area. The statement that YF virus vector mosquito populations decline during the dry season is not always the case. Because water availability may be reduced, in some cases there may be a tendency to store additional water in and immediately around the house, providing breeding sites for YF virus vectors such as _Aedes aegypti_. Increasing surveillance and YF vaccine coverage in South Sudan are prudent preventive measures. - ProMED Mod.TY]

[Maps of South Sudan:
<https://upload.wikimedia.org/wikipedia/commons/b/b0/28_States_of_South_Sudan.png>
and <http://healthmap.org/promed/p/64770>.]
Date: Mon, 10 Dec 2018 14:05:06 +0100

Nairobi, Dec 10, 2018 (AFP) - South Sudan will vaccinate key health workers against Ebola close to the border with the Democratic Republic of Congo, which faces a new epidemic, the World Health Organization said Monday.   The ministry of health's vaccination campaign, with cooperation from the WHO, will target healthcare and frontline workers in the high-risk states of Juba, Yei, Yambio and Nimule, the UN agency said in a statement.   South Sudan is one of several countries bordering the vast DRC, where the new outbreak of the highly contagious viral disease had since August claimed 271 lives by December 6, according to Congolese Health Minister Oly Ilunga Kalenga.

A total of 2,160 doses of the experimental vaccine rVSV-ZEBOV have been allocated to South Sudan for a programme starting on December 19. This trial vaccine is not yet licenced but is considered safe and provided "under the compassionate-use guidelines in response to the ongoing Ebola outbreak in DRC", the WHO said.   Like neighbouring Uganda, where similar measures have been taken for health personnel, South Sudan has declared a state of alert because of the risk that Ebola may be carried into its territory. At present, no cases have been reported, according the WHO.   The experimental vaccine first went on trial during the terrible epidemic of Ebola that ravaged parts of West Africa between the end of 2013 and 2016, at a cost of more than 11,300 lives. The disease spreads through contact with bodily fluids from other people or infected animals.

The vaccine was created by Canadian public health specialists at the National Microbiology Laboratory and is considered highly effective by the WHO, but it works only against the Ebola virus-Zaire strain, confirmed in the outbreak in the DRC.   South Sudan has been torn by civil war for five years in a conflict that has left nearly 400,000 dead. More than four million people -- about a third of the population -- have fled.   The main belligerents signed a peace accord in September, but the work of humanitarian organisations remains complicated and dangerous.   Participants in the vaccination programme have been trained on rVSV-ZEBOV and undertaken a simulation exercise. Meanwhile, the Ebola preparedness contingency plan covers measures ranging from screening travellers, community engagement and provision for safe and dignified funerals, the WHO said.
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