News Scan for Apr 20, 2016

Yellow fever vaccine
Europe interrupts malaria

Angola extends yellow fever vaccine drive as experts warn of global risk

The yellow fever vaccination campaign in Angola will be extended from Luanda province, the center of the ongoing outbreak, to more than 2 million people in Huambo and Huila provinces over the next few weeks, according to a press release yesterday from the World Health Organization (WHO).

Local transmission of yellow fever has been confirmed in five provinces beyond Luanda, including Huambo and Huila. About 1 million people in the latter provinces have been vaccinated already. The new vaccination program will target people in five densely populated areas in the provinces, says the WHO.

The count of suspected cases of yellow fever in Angola since December stands at 1,908, with 617 of them confirmed, says the release; 250 deaths have been reported.

Nearly 6 million residents of Luanda province have received vaccinations, depleting stores of vaccine, but the emergency stockpile was recently replenished to the tune of 10 million available doses, says the WHO.
Apr 19 WHO press release
Apr 14 CIDRAP News scan on Angola outbreak

In related news, a commentary from an international group of authors published online Apr 14 in The Lancet warns of the possibility of global spread of the emerging epidemic of yellow fever and continued shortages of vaccine.

The spread of other diseases transmitted by Aedes aegypti mosquitoes, including dengue, chikungunya, and Zika, underscores the threat posed by yellow fever, say the authors. Of particular concern are the high case-fatality rates for yellow fever in comparison with these other diseases and the potential for the disease to spread into Asia.

Regarding vaccine, "Overall, supply falls short of demand nearly every year and this is accentuated during emergencies such as that in Angola," they say, pointing out that the six manufacturers of yellow fever vaccine produce about 80 million doses a year, and their ability to ramp up production is limited.

The authors’ recommend using lower doses of vaccine, which, they say, have been shown in clinical trials to stimulate immunity at one tenth the normal strength. However, a dosage change has not been accepted by regulatory bodies. They suggest that the WHO consider recommending the lower dose (0.1 mL) using the Emergency Use Assessment and Listing (EUAL) procedure.

"Invoking the EUAL now, rather than waiting for a major yellow fever vaccine shortage to occur, and stronger surveillance and vector control, could potentially avoid the need to declare a Public Health Emergency of International Concern (PHEIC), and better ensure our global health security," they conclude.
April 14 Lancet commentary


Europe becomes first WHO region to interrupt malaria transmission

Locally acquired malaria cases in Europe have decreased from more than 90,000 to 0 over the past 20 years, making the WHO European Region the first to interrupt malaria transmission, according to a WHO press release today.

Europe reported 90,712 malaria cases in 1995, and 2015 was the first year in which no country reported a locally acquired case. The achievement is partly a result of strong political commitment to instituting surveillance and strengthening healthcare systems in eastern and central Europe where Plasmodium species infect local Anopheles mosquito populations, the WHO said.

Regional malaria detection and cross-border collaborations implemented after the 2005 Tashkent Declaration spurred countries toward the goal of eliminating the disease. "This is a major milestone in Europe's public health history and in the efforts to eliminate malaria globally," Zsuzsanna Jakab, PhD, WHO Regional Director for Europe, said.

In July, countries at risk of malaria reintroduction will meet in Ashgabat, Turkmenistan, to discuss preventive strategies. Currently, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Russia, and Uzbekistan are in the preventive phase of malaria elimination. Turkey reported an interruption in transmission in 2014 and 2015, and Tajikistan reported no cases for the first time in 2015, the WHO said.
Apr 20 WHO press release

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