On 14 Nov 2009, The Ministry of Health (MoH) in the Central African
Republic [CAR] reported 4 suspected cases of yellow fever [YF],
including 3 deaths. The cases were found through regular yellow fever
surveillance in the Sub-Prefecture of Yaloke-Bossembelle, Prefecture
of Ombella Mpoko and in the Sub-Prefecture of Bagamongone, Prefecture
of La Lobaye.
The index case was reported in the Sub-Prefecture of
Yaloke-Bossembelle. He was an 18-year-old man, a cattle breeder. On 6
Sep [2009], he presented with fever, headache, jaundice and
haemorrhagic signs. The patient was hospitalized in the health centre
of Yaloke, where he died on 14 Sep [2009]. In the following days, 2
additional cases were reported with the same severe clinical
presentation, and both died. In Bagamongone, a small town 20 km [12.4
miles] from Yaloke, another case was reported during the same period.
The 3 cases were positive for yellow fever IgM at the National
Laboratory in the Institute Pasteur of Bangui. The regional reference
laboratory at Institut Pasteur in Dakar, Senegal, also confirmed that
neutralization tests found specific antibodies against yellow fever
[virus], thus confirming the cases to be yellow fever. Other
haemorrhagic fevers were excluded by specific tests. During the
outbreak investigation conducted by the Ministry of Health, serum
samples were collected from 80 of “contacts” of the cases. [YF is not
transmitted by contact, but by mosquitoes. What is meant here is
people exposed to mosquitoes in the same localities as the cases. -
Mod.JW] All these serum samples were sent to the Institute Pasteur of
Bangui for investigation, and were IgM negative by ELISA test.
Entomological studies showed a limited presence of mosquito vectors of
sylvatic yellow fever.
These cases follow 2 yellow fever outbreaks in Basse Kotto and Ombella
Mpoko Prefectures earlier in 2009. In 2008, 4 reported events resulted
in reactive mass vaccination campaigns. Cases had occurred in the
sub-prefectures of Bozoum in April 2008, Boda in August 2008, Bimbo
and Briac in October 2008 [see ProMED archives below]. An assessment
of yellow fever virus circulation in humans & non-human primates and
vectors was carried out in 2009 by a group of experts of the Yellow
Fever Partnership. Laboratory testing for the study is underway.
Emergency mass vaccination against yellow fever is planned for a
population of 327 877 in affected regions for early December 2009.
Vaccines have been provided from the global emergency vaccine
stockpile, managed by the International Coordinating Group for Yellow
Fever Vaccine Provision (YF-ICG) with funding from the GAVI Alliance.
The Central African Republic is not part of a group of 12 endemic
countries in Africa where preventive mass vaccination campaigns are
ongoing since 2007. However, with these events since 2008, the Central
African Republic is now considered to be at high risk of further
outbreaks.
Source: World Health Organization Global Alert and Response [edited]
<http://www.who.int/csr/don/2009_12_01/en/index.html>
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