Sudan Launches Yellow Fever Vaccination Campaign Among Ethiopian Refugees and Host Communities

Unfortunately, There is no Cure for Yellow Fever at the Moment. It is Only the Symptoms that Can be Treated.

Based on WHO’s Classification for Yellow Fever Endemic Countries in Africa, Sudan is Classified As one of 31 high-risk African Countries.

Haffiya Abdalla

Health authorities in Sudan began implementing yellow fever vaccination campaign activities recently in priority states as part of a broader vaccination campaign against yellow fever, cholera, and polio targeting 100 000 people, including host communities and recently arrived Ethiopian refugees.  

Last month, over 77 000 Ethiopian refugees were reached with yellow fever and cholera vaccines in Kassala and Gedaref states in the eastern part of Sudan through fixed and temporary sites and mobile vaccination teams. 
Networks of community volunteers were also established to raise community awareness of yellow fever and cholera symptoms, transmission, and preventive measures.

Since the beginning of the conflict in the Tigray region of northern Ethiopia in November 2020, 63,000 Ethiopian refugees have arrived in Kassala and Gedaref states, fleeing the increasing levels of violence in their country. 
Additional outreach and vaccination activities are currently underway in other states, including catch-up vaccination campaigns for children in host communities. 

These activities are being carried out by the Federal Ministry of Health and supported by WHO, UNICEF, and Gavi, the Vaccine Alliance, in line with the “WHO Global Strategy to Eliminate Yellow Fever Epidemics, 2017–2026”. Sudan is at high risk of yellow fever spread due to a combination of climatic and ecological factors, and because there are still areas of the population with low immunity.

Sudan has a high presence of the Aedes aegypti mosquito that can transmit yellow fever to human populations. The risk of yellow fever is also particularly high in neighboring countries such as Chad, Central African Republic, Ethiopia, Eritrea, and South Sudan, and is exacerbated by cross-border population movement.

These factors have previously resulted in at least 4 recent outbreaks of yellow fever in Sudan, which is the only country in WHO’s Eastern Mediterranean Region in the yellow fever zone. 

There is currently no treatment for yellow fever although proper care management to treat dehydration, fever, and liver and kidney failure improves survival rates.

Vaccination remains the most important measure for preventing this fatal disease. One single dose of the yellow fever vaccine offers lifetime protection. 

In the last few years, Sudan has strengthened its commitment to assuring equitable access to vaccination, and includes refugees, migrants and displaced communities in its vaccination campaigns under an innovative approach.
By organizing multi-antigen vaccination campaigns, including for yellow fever, health authorities have efficiently reached populations in need and reduced their risk of becoming ill with preventable diseases. 

Protecting its populations against yellow fever has always been a public health priority for Sudan. In 2019, after a 5-year nationwide campaign, health authorities successfully reached more than 30 million people from 9 months to 60 years of age living in Sudan’s 18 states with the yellow fever vaccine. 

This year, Sudan plans to introduce the yellow fever vaccine into its national immunization schedule as per WHO recommendations that all endemic countries should do so. This is a remarkable achievement given the ongoing challenges of the COVID-19 vaccination roll-out and other public health activities, including circulating vaccine-derived poliovirus type 2. 

The “Global strategy to eliminate yellow fever epidemics” has been developed by a coalition of partners (Gavi, UNICEF and WHO) to address yellow fever’s changing epidemiology, resurgence of mosquitoes and the increased risk of urban outbreaks and international spread.

This global, comprehensive long-term strategy (2017–2026) targets the most vulnerable countries, while addressing global risks by building resilience in urban centers and preparedness in areas with the potential for outbreaks and ensuring a reliable vaccine supply

Yellow fever is a disease caused by a virus that is spread through mosquito bites.

Symptoms take 3–6 days to develop and include fever, chills, headache, backache, and muscle aches. About 15% of people who get yellow fever develop serious illnesses that can lead to bleeding, shock, organ failure, and sometimes death.

According to officials, 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

2012 Yellow Fever Outbreak in Darfur

In late 2012, a yellow fever outbreak occurred in the Darfur region of Sudan that was the largest yellow fever epidemic to strike Africa in two decades.

On 10 January 2013, the Sudan Federal Ministry of Health and the World Heath Organization (WHO) reported that there had been 847 suspected cases since 2 September 2012, including 171 deaths, for an estimated case fatality rate of 20%.

According to reports, about 10,000 workers from the gold mines of Jebel Amer fled to Nyala, the capital of South Darfur, after more than 60 deaths in the gold mining area.

One newspaper reported: “The spread of the disease in South Darfur is a disaster and the epidemic requires organizations and the international community to address the disease and provide enough vaccines to vaccinate all citizens of the state.”  

Hundreds of patients had accumulated at the Nyala Teaching Hospital, some sleeping outside, and there was a shortage of medical personnel and supplies. By early December, the number of deaths had reached 164.

Vaccination Campaign

On 13 November, the government of Sudan requested help from the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG) in starting a mass vaccination campaign.

Besides the WHO, the YF-ICG consists of representatives of the United Nations Children’s Fund (UNICEF), Médecins sans Frontières (MSF), and the International Federation of Red Cross and Red Crescent Societies (IFRC). The United Nations–African Union Mission in Darfur (UNAMID) airlifted the first batches of vaccines from Khartoum to Darfur on 18 November. Mass vaccination began on 20 November. Efforts were also undertaken to eliminate mosquitoes.

A team from the Naval Medical Research Unit Three (NAMRU-3) and the WHO Collaborating Center was deployed from Cairo to help collect and test samples and train local personnel. The vaccination campaign, from late November 2012 through early January 2013, covered more than 3 million people and halted the outbreak.

Based on the WHO’s classification for yellow fever endemic countries in Africa, Sudan is classified as one of 31 high-risk African countries. As no cure yet exists, the yellow fever vaccine is the most important tool to control this fatal yet preventable disease.

WHO recommends that all endemic countries should include the yellow fever vaccine into their routine immunization programmes, and Sudan plans to introduce the yellow fever vaccine into its national routine immunization schedule as of July 2020.

How to Treat and Prevent Yellow Fever while Traveling to Africa

Is there a cure for Yellow fever? Unfortunately, there is no cure for yellow fever at the moment. It is only the symptoms that can be treated.

The good news is that the vaccine works almost 100% in preventing the disease – as long as you take the shots 10 days before contact with an infected mosquito.

This vaccine can only be administered by health facilities that have been identified and approved by the World Health Organization and Centre for Disease control.

It is only such facilities that have the original/genuine yellow fever vaccination cards or certificates from the World Health Organization.

A traveler needs to be vaccinated at least ten days before traveling to areas known to have yellow fever cases before maximum protection can take effect. The traveler should have their vaccination card with them because they could be asked for it any time.

Travelers should also ensure that they sleep under a mosquito net whenever traveling to any of the counties we shall discuss later on.

The Yellow Fever Vaccination Certificate

The recent outbreak of yellow fever in Angola has forced many African countries to enforce strict rules regarding traveling with yellow fever vaccination certificates.

This is due to the possibility of someone with the virus entering their country and attracting resident mosquitoes which can then start spreading the virus to their citizens and travelers. The checks are therefore to protect not only their citizens but also tourists/travelers.

Who needs a yellow fever vaccination card?

The yellow fever endemic counties are Venezuela, Uganda, Trinidad and Tobago, Togo, Suriname, Sudan, South Sudan, Senegal, Peru, Paraguay, Panama, Nigeria, Niger, Mauritania, Mali, Liberia, Sierra Leone, Kenya, Guinea-Bissau, Guinea, Ghana, Gambia, Gabon, French Guiana, Ethiopia, Equatorial Guinea, Ecuador, Democratic Republic of the Congo, Côte d’Ivoire, Congo, Chad, Colombia, Central African Republic, Cameroon, Burundi, Burkina Faso, Brazil, Bolivia, Benin, Argentina and Angola.

Based on the WHO’s classification for yellow fever endemic countries in Africa, Sudan is classified as one of 31 high-risk African countries.

As no cure yet exists, the yellow fever vaccine is the most important tool to control this fatal yet preventable disease.                                            
People should prevent mosquito bites. Mosquito bites are most prevalent during the day and night. Use insect repellent, wear long-sleeved shirts and pants, treat clothing and gear, and get vaccinated before traveling if vaccination is recommended.

People should know that a safe and effective yellow fever vaccine has been available for more than 80 years. A single dose provides lifelong protection for most people. The vaccine is a live, weakened form of the virus given as a single shot.

The yellow fever vaccine should be given cautiously to people older than 60 years, and it should not be given at all to people with certain immune-suppressing conditions. Seniors should discuss their detailed travel plans with their doctors and, if necessary, alternatives to vaccination. Anyone with a severe (life-threatening) allergy to any component of the vaccine should not get it.

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