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