Appeal History:
Disaster Relief Emergency Fund (DREF): CHF 50,672 was initially allocated from the Federation’s DREF to support Cruz Vermelha de Angola (CVA) to respond to yellow fever outbreak. Two additional allocations were made bringing the total amount of DREF to CHF 173,653.
This Emergency Appeal was launched on 5 July 2016 seeking a total of CHF 1,443,961 to support a scale up of social mobilization activities around the expanded nationwide vaccination campaign, community based surveillance, vector control and environmental sanitation and National Society Capacity building.
Operations update no. 1 was issued on 28 July 2016.
The Emergency Appeal since its launch in July has received pledges from the Canadian Government through the Canadian Red Cross Society and the Japanese Red Cross Society. The IFRC, on behalf of the Cruz Vermelha de Angola would like to extend many thanks to all partners for their generous contributions.
A. Situation analysis
Description of the disaster
The largest outbreak of yellow fever in 30 years in Angola is currently ongoing. The outbreak was detected in Luanda, Angola in late December 2015, with the first cases being lab confirmed on 19 January 2016. An immediate response was launched by the Angolan Ministry of Health and its partners. Despite initial efforts, the outbreak rapidly increased in size and scale, spreading across the country and resulted in exportation of cases to at least four other countries. This exportation has resulted in confirmed local transmission in Democratic Republic of Congo (DRC), including the capital city of Kinshasa. The response to the yellow fever outbreak in Angola is complicated by both the limited vaccine supply and the ongoing outbreaks in DRC. Exported cases from Angola are already reported in three countries: DRC (88 Emergency Appeal Operation Update Angola: Epidemic (Yellow Fever) cases), Kenya (2 cases) and People’s Republic of China (11 cases). The risk for further cross border transmission, extension of the outbreak in Angola and DRC, as well as the potential spread of yellow fever to even more countries increases the complexity and urgency of the response to the outbreak in Angola and the surrounding countries.
Angola
The Yellow Fever outbreak is diminishing in intensity as result of massive vaccination campaign. As of the 21 July and according to the WHO’s Situation Report, there have been a total of 3,748 suspected cases (879 laboratory confirmed) and 364 deaths (CFR 9.7%) reported among suspected cases. Laboratory confirmed cases have been reported in 16 of Angola`s 18 provinces and in 80 out of 125 districts.
Currently, transmission has been documented in 45 districts and 12 provinces of Angola’s 18 provinces. Based on the census data for these districts the population identified for vaccination was 13,309,786. Independent monitoring undertaken by the Centre for Disease Control (CDC) indicated that the population data to calculate vaccine coverage may have been heavily underestimated, which may explain ongoing transmission in areas thought to be a 100% covered by vaccination. The population data for coverage has since been expanded to 15,289,549 people now being targeted.
Vaccination response has been occurring since late January. Selected areas of Luanda started a mop-up campaign to address pockets of low coverage detected by independent monitoring activities. As of the 15 July almost 85% of the population of Angola had been vaccinated (13,025,874). In recent weeks, suspect cases have begun to decline suggesting the vaccination campaign is having the desired effect of breaking transmission.
No case has been confirmed since the last week of June, but confirmation of cases is slow. To help address these issues a ‘mop up’ campaign was implemented in Luanda between July 15 and 22, as well as additional vaccination in new areas identified with cases of local transmission, or at risk for further spread. A new campaign is scheduled to start 10 August 2016. Approximately 3 million doses will be vaccinated. It will be the largest campaign so far in geographical terms, covering simultaneously 18 districts and requiring a strong and coordinated social mobilization.
Observations, points of concern
- There are three districts of major concern where the vaccination campaign has not been fully implemented yet.
Those are located in three provinces (Cuanza Sul, Cuando Cubango, Cuanza Norte) that have previously reported local transmission. - High risk of spread to neighbouring countries and through important transport hubs within Angola continues. As the borders are porous with substantial cross border social and economic activities, further transmission cannot be excluded. Viraemic travelling patients pose a risk for the establishment of local transmission, especially in countries where adequate vectors and susceptible human populations are present.
- Risk of establishment of local transmission in other provinces where no autochthonous cases are reported.
- Inadequate surveillance system capable of identifying new foci or areas of cases emerging.
- The initial, unconfirmed analysis of the latest mop-up campaign in Luanda indicates that while in some areas the campaign was very successful, there are still pockets that have below optimal coverage. CDC is compiling a lessons learnt report from one of the districts where innovative social mobilization strategies were tested.