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Expert fears "catastrophe" as Darfur yellow fever death toll hits 107

Source: Thomson Reuters Foundation - Wed, 14 Nov 2012 01:30 PM
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NAIROBI (AlertNet) – The death toll from a yellow fever outbreak in west Sudan hit 107 on Tuesday and a medical expert, noting that mass vaccination is not scheduled to begin until next month, warned of a “pending catastrophe” if the disease spreads beyond Darfur.

There have been 107 deaths out of 358 suspected cases of yellow fever in Darfur since the end of September, the World Health Organization (WHO) reported on Tuesday.

“This is a terribly serious situation,” Paul Reiter, professor of medical entomology at the Pasteur Institute in Paris, told AlertNet.  “If things really were to start moving rapidly, we really would not be able to do very much. It all balloons very quickly… We have very little means at our disposal for combating an epidemic in the case of yellow fever.”

Yellow fever is a viral infection that is transmitted by mosquitoes in tropical regions. The majority of patients in Darfur have experienced fever, bleeding and vomiting, according to the WHO.

War has ravaged Darfur since rebels took up arms in 2003, saying the central government had neglected the region. Conflict has continued despite the presence of the world's largest peacekeeping operation, the United Nations-African Union Mission in Darfur (UNAMID), and humanitarian workers have often been attacked.

There is no specific treatment for yellow fever, only supportive care to treat dehydration and fever, and blood transfusion if needed. Vaccination is the main preventative measure.

PIPELINE PROBLEM

WHO is waiting for vaccines to be imported from the International Coordinating Group on Yellow Fever Vaccine Provision, which manages the global pool of the vaccine, before it can start a mass vaccination campaign in Darfur.

“Logically speaking, we will be talking about three weeks to a month,” Anshu Banerjee, the WHO representative in Sudan, told AlertNet. “One week for the vaccine to arrive. One week for the vaccine to get to Darfur, then the training.”

Sudan requested 3.6 million doses of the vaccine but is being given only 2.4 million.

There are regular shortages in the global supply of the yellow fever vaccine due to unpredictable demand and its relatively short shelf life.

“If more vaccine had been available I am sure they would have released more vaccine,” said Banerjee. “There is a pipeline problem in the sense that the vaccine that is available at the moment cannot be easily replenished with new vaccine.”

GLOBALISATION OF VIRUSES

The news that a man in the Sudanese capital, Khartoum, is being treated for yellow fever has raised fears in the media. The government announced that there would be a mass vaccination campaign in Khartoum.

“The problem, however, is that there is no vaccine yet available for Khartoum,” Banerjee said.

He said there was no need to begin vaccinating people in Khartoum because there had been no transmission of the disease within the city. The man who is being treated for yellow fever in Khartoum caught the disease while in Darfur.

Reiter is less confident.

“If the person has been in Khartoum for any length of time and if he has been in contact with mosquitoes, then, whether he’s been treated or not, there still is the possibility that transmission will occur,” he said.

People who have yellow fever can infect mosquitoes which bite them in the early stages of the disease because they have high levels of the virus in their blood, he said. This is how viruses travel from one country to another.

“There’s so much mobility of pathogens nowadays," Reiter said. "It’s one of the really big emerging problems.”

For example, millions of people fell sick with the chikungunya virus when it spread from Kenya to Mauritius, India and Italy between 2004 and 2007, carried by infected travellers, he said.

“If transmission becomes epidemic in Khartoum then the world is open to catastrophe... More than 2.5 billion people throughout the tropics and subtropics would be at risk,” Reiter said in a post on Nov. 11.

The WHO said it is actively searching for new cases and has trained more than 200 medical staff in controlling and responding to the disease. Seven isolation centres have been set up in Darfur and blood bank units are being strengthened.

 “For the moment, I think we are dealing with the situation,” the WHO’s Banerjee said.

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