How to show yel­low fever the ‘red light’ – Ex­perts

Weekly Trust - - News -

Maria clutched her eleven­month-old daugh­ter with re­lief as they came out of Kubwa Gen­eral Hospi­tal, Abuja. Both of them had just been vac­ci­nated against yel­low fever. She told Daily Trust Satur­day that a friend had called ear­lier about an out­break across the coun­try, and ad­vised her to go for vaccination. “I im­me­di­ately rushed to the hospi­tal, and I have also called my hus­band to do same, so that when the dis­ease reaches this town, we will be pro­tected,” she said.

About 30 kilo­me­ters away, in an­other part of the Fed­eral Cap­i­tal Ter­ri­tory (FCT), Madam Zainab Luka was search­ing fran­ti­cally for teams of yel­low fever vac­ci­na­tors in her neigh­bour­hood in Jik­woyi. She caught up with them at a pri­mary school where Daily Trust ob­served the ex­er­cise. She told the vac­ci­na­tors, al­most out of breath, that fel­low traders in the nearby mar­ket told her about the dis­ease, and she didn’t want to risk any­thing.

Ibrahim Umaru, who re­sides in Garam vil­lage in Niger State said he walked up to a vaccination point un­der a tree in the vil­lage , got vac­ci­nated and got his card with­out any is­sues. He said the news of an­other break in Edo state got him wor­ried and he felt he needed to pro­tect him­self.

Yel­low fever is a vi­ral haem­or­rhagic dis­ease spread through the bite of in­fected mosquitoes.

“The in­fec­tion in its early stages presents as fever, malaise and is fol­lowed by jaun­dice (yel­low­ness of the eyes) from which the in­fec­tion gets its name within two weeks of in­fec­tion,” said Ex­ec­u­tive Di­rec­tor of the Na­tional Pri­mary Health­care De­vel­op­ment Agency (NPHCDA), Dr Faisal Shuaib. He said one pos­i­tive case of yel­low fever is con­sid­ered an epi­demic.

Nige­ria is one of the en­demic coun­tries for yel­low fever, and has been ex­pe­ri­enc­ing spo­radic out­breaks since Septem­ber 12 last year when the first case was con­firmed in a seven-year-old child in Oke Owa Com­mu­nity, Ifelo­dun Lo­cal Gov­ern­ment Area of Kwara State.

Last week, cases of the dis­ease were recorded in Edo State. Two per­sons died when the dis­ease hit Igieduma, Ehor and other neigh­bour­ing vil­lages in Uhun­m­wode LGA of Edo State. It has also been re­ported in Esan West and Esan Cen­tral LGAs of the state. Find­ings by Daily Trust Satur­day re­vealed that a case has been recorded in Niger State, and an­other in Bakassi in Cross River State.

The Nige­ria Cen­tre for Dis­ease Con­trol (NCDC) said that a yel­low fever out­break is cur­rently ac­tive in Nige­ria and that from the on­set of the out­break in Septem­ber 12, 2017, a to­tal of 3,456 sus­pected yel­low fever cases have been re­ported as at 11th No­vem­ber.

NCDC said con­firmed cases have been recorded in 27 Lo­cal Gov­ern­ment Ar­eas across 14 states. They are Kwara, Kogi, Kano, Zam­fara, Kebbi, Nasarawa, Niger, Katsina, Edo, Ek­iti, Rivers, Anam­bra, Fed­eral Cap­i­tal Ter­ri­tory, and Benue States. The cen­tre said that nine cases tested pos­i­tive for yel­low fever in Edo State and that con­fir­ma­tory re­sults are be­ing awaited from the WHO Re­gional Ref­er­ence Lab­o­ra­tory in Dakar, Sene­gal.

Ac­cord­ing to Dr Faisal Shuaib of the Na­tional Pri­mary Health­care De­vel­op­ment Agency (NPHCDA), cur­rently, there are over 1,640 sus­pected cases line-listed with 41 con­firmed from the WHO Re­gional Ref­er­ence Lab­o­ra­tory. He added that fed­eral gov­ern­ment through the Fed­eral Min­istry of Health, the Na­tional Pri­mary Health­care De­vel­op­ment Agency (NPHCDA), and the Na­tional Cen­tre for Dis­ease Con­trol (NCDC) in col­lab­o­ra­tion with im­ple­ment­ing part­ners has mounted a com­bined out­break and pre­ven­tive re­sponses in Kogi, Kwara, Zam­fara, Kebbi, Niger and Borno states.

Also the fed­eral gov­ern­ment with sup­port from the World Health Or­ga­ni­za­tion (WHO) and other part­ners is presently vac­ci­nat­ing about 26.2 mil­lion peo­ple in the coun­try against yel­low fever un­der its se­cond phase of the big­gest yel­low fever vaccination cam­paign.

Nige­ria is one of the 50 part­ners pur­su­ing the Elim­i­nate Yel­low Fever Epi­demics (EYE) strat­egy which was launched by WHO Di­rec­tor-Gen­eral, Dr Te­dros Ad­hanom Ghe­breye­sus in Abuja in April this year. The coun­try is par­tic­i­pat­ing in the on­go­ing pre­ven­tive mass vaccination cam­paign (PMVC) un­der the strat­egy with sup­port from Gavi - Vac­cine Al­liance, UNICEF and other part­ners. Ex­perts have said Nige­ria has to do more to im­ple­ment this strat­egy .

Prof Oye­wale To­mori, a vi­rol­o­gist and chair, Na­tional Lab­o­ra­tory Tech­ni­cal Work­ing Group (NLTWG) said yel­low fever out­breaks keep re­oc­cur­ring in the Nige­ria be­cause the coun­try has not fully done what is rec­om­mended. He said coun­tries in West Africa that have brought yel­low fever un­der con­trol have im­ple­mented strate­gies to Elim­i­nate Yel­low Fever Epi­demics (EYE). He said the Elim­i­nate Yel­low Fever Epi­demics (EYE) calls for firstly pro­tect­ing at-risk pop­u­la­tions - for chil­dren through rou­tine im­mu­niza­tion (RI), and for oth­ers who have never re­ceived yel­low fever vaccination or been ex­posed to out­break, con­duct a Pre­ven­tive Mass Vaccination Cam­paign (PMVC).

Pro­fes­sor To­mori said Nige­ria has not met the set stan­dard for yel­low fever con­trol, and that is why re­oc­cur­rences hap­pen, “and will con­tinue to have for some years to come,” he said.

The pro­fes­sor of vi­rol­ogy said Nige­ria’s yel­low fever rou­tine cov­er­age has re­mained be­low 50% since 2015, adding that this means since 2016 be­tween five mil­lion to seven mil­lion Nige­rian chil­dren are yet to re­ceive yel­low fever vac­cine and are sus­cep­ti­ble to the dis­ease.

Ac­cord­ing to him, the coun­try has enough yel­low fever doses to meet the de­mands of rou­tine im­mu­niza­tion, but our health sys­tem is un­able to vac­ci­nate the chil­dren. “How­ever, if the Na­tional Emer­gency Rou­tine Im­mu­niza­tion Co­or­di­na­tion Cen­tre (NERICC) pro­gramme is sus­tained, we are likely to meet the tar­get of 80%-90% cov­er­age, not just for yel­low fever but also for other rou­tine im­mu­niza­tion vac­cines.”

Dr Seth Berkley, CEO of Gavi, said there is need to fo­cus on best long-term so­lu­tion such as im­prov­ing rou­tine im­mu­ni­sa­tion cov­er­age which re­mains very low and pre­vent­ing out­breaks from hap­pen­ing in the first place.

Pro­fes­sor To­mori, also the Chair, Ex­pert Re­view Com­mit­tee (ERC) said large pock­ets of peo­ple all over Nige­ria are still unim­mu­nized against yel­low fever, adding “a rather in­sen­si­tive sur­veil­lance sys­tem and a lab­o­ra­tory process that still must trans­port her sam­ples to Dakar, Sene­gal and wait for days, if not weeks, for con­fir­ma­tion of lab­o­ra­tory re­sults, and our de­pen­dence on ex­ter­nal sources for the re­quired yel­low fever vac­cine needed to pro­tect our peo­ple is re­spon­si­ble. And if noth­ing pos­i­tive is done, we will be sub­jected to larger and more fre­quent out­breaks.”

“We are, through poor en­vi­ron­men­tal san­i­ta­tion, lit­er­ally breed­ing death agents in our back­yards,” said Prof To­mori.

The vi­rol­o­gist ad­vised that the coun­try needs to im­prove dis­ease sur­veil­lance and de­tec­tion, have a lab­o­ra­tory sys­tem that frees us from hav­ing to send our sam­ples out­side the coun­try for con­fir­ma­tion, and free­dom from de­pend­ing on the sup­ply of yel­low fever vac­cines. “In 1985, Nige­ria not only com­pleted the di­ag­no­sis of the yel­low fever out­break lo­cally, we also pro­duced the ini­tial batch of yel­low fever vac­cine doses we needed for the out­break. It is not only a dis­grace but a great hu­mil­i­a­tion that 33 years later, we are in the sorry state we are now.”

Min­is­ter of Health, Prof Isaac Ade­wole said aside vaccination , other meth­ods of pre­ven­tion in­clude us­ing in­sect re­pel­lent, sleep­ing un­der a long-last­ing in­sec­ti­cide treated net, en­sur­ing proper san­i­ta­tion and get­ting rid of stag­nant wa­ter or breed­ing space for mosquitoes.

With ad­di­tional data from Has­sana Yusuf

Chil­dren dis­play­ing their cards after vaccination against yel­low fever dur­ing the se­cond phase of the big­gest ever yel­low fever vaccination cam­paign in five states and the Fed­eral Cap­i­tal Ter­ri­tory or­gan­ised by the fed­eral gov­ern­ment , WHO and other partn

A girl re­ceiv­ing vaccination against yel­low fever dur­ing the se­cond phase of the big­gest ever yel­low fever vaccination cam­paign in five states and the Fed­eral Cap­i­tal Ter­ri­tory or­gan­ised by the fed­eral gov­ern­ment , WHO and other part­ners. NPHCDA

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