Angola is experiencing its first epidemic of yellow fever in approximately 30 years; and at least 1,562 suspected and confirmed cases — including 225 deaths — have been reported in at least six of the 18 provinces in the country due to the ongoing outbreak, which was first reported in the capital city of Luanda in December of 2015.
Worst Yellow Fever Outbreak in 30 Years for Angola: Could You Be Affected?
“Such outbreaks usually occur in tropical rainforests,” explained Sergio Yactayo — who is an advisor on epidemic diseases at the World Health Organization — in this article. “With the majority of cases reported in the capital city Luanda, the situation is more dangerous and difficult to contain because the disease can spread easily from one person to another. We are already seeing cases spread to a number of provinces outside Luanda.”
The Ministry of Health in Angola is working with the World Health Organization, United Nations International Children’s Emergency Fund, Centers for Disease Control and Prevention, CORE Group, Médicins Sans Frontières, Medicos del Mundo, the National Red Cross of Angola, local community based organizations, and approximately 65 experts in epidemiology, vector control, community engagement and other areas to control the outbreak in the affected provinces throughout the country. They have been conducting an emergency vaccination campaign in Luanda Province where — since early February — approximately 5.7 million people have been vaccinated as of Thursday, March 24, 2016 with vaccines from the emergency stockpile of the International Coordination Group.
Although efforts have been valiant and effective enough to help somewhat reduce the epidemic, the combination of a shortage of the yellow fever vaccine globally; a completely depleted emergency stockpile of vaccinations; and high prices for the yellow fever vaccine globally are presenting some formidable challenges to the effort. An additional 1.5 million doses of yellow fever vaccine are needed to vaccinate the population at risk in Luanda province alone.
Angola is one of 34 countries in Africa where yellow fever occurs; and vaccination against the disease is recommended.
What is Yellow Fever?
Yellow fever is a disease transmitted by mosquitoes infected with the virus, with Aedes aegypti – the same mosquito that spreads the Zika virus — being the most common species.
Symptoms of yellow fever — which can take between three to six days to develop — include fever, chills, headache, backache, muscle aches and pain, nausea, vomiting, and fatigue. Approximately 15 percent of people who contract yellow fever develop serious illness which can lead to bleeding, shock, organ failure — and sometimes death.
A small percentage of infected people experience a second — yet more severe — phase of illness which includes high fever, jaundice and internal bleeding. At least half of severely affected patients who do not receive treatment die within ten to 14 days.
What You Should Do to Protect Yourself
The government of Angola requires all travelers older than nine months of age to show proof of yellow fever vaccination upon arrival. In addition, the Centers for Disease Control and Prevention recommends that all travelers to Angola aged nine months or older be vaccinated against yellow fever.
You are strongly advised not travel to Angola if you have never been vaccinated against yellow fever. You may need to contact a yellow fever vaccine provider well in advance of travel. The Centers for Disease Control and Prevention no longer recommends booster doses of yellow fever vaccine for most travelers. However, travel to Angola is currently at a higher risk due to the outbreak, so you might consider getting a booster dose if your last yellow fever vaccine was greater than ten years ago.
With the spread of the outbreak to other provinces in Angola — as well as increasing numbers of imported cases reported by other countries in Africa — the World Health Organization requests prioritizing vaccination of people who are at highest risk; and the organization is in discussion with manufacturers and partners to divert shipments of vaccines for national routine immunization programs until the emergency stockpile is replenished.
In the meantime, you can protect yourself from yellow fever by getting the yellow fever vaccine and preventing mosquito bites. The following advice — complete with links — is from the Centers for Disease Control and Prevention.
Get the Yellow Fever Vaccine
Visit a yellow fever vaccination (travel) clinic and ask for a yellow fever vaccine.
- You should receive this vaccine at least ten days before your trip.
- After receiving the vaccine, you will receive a signed and stamped International Certificate of Vaccination or Prophylaxis (ICVP, sometimes called the “yellow card”), which you must bring with you on your trip.
- For most travelers, one dose of the vaccine lasts for a lifetime. Consult a travel medicine provider to see if additional doses of vaccine may be recommended for you based on specific risk factors.
- In rare cases, the yellow fever vaccine can have serious and sometimes fatal side effects. People older than 60 years and people with weakened immune systems might be at higher risk of developing these side effects. Also, there are special concerns for pregnant and nursing women. Talk to your doctor about whether you should get the vaccine.
Prevent Mosquito Bites
- Cover exposed skin by wearing long-sleeved shirts and pants.
- Use an EPA-registered insect repellent containing DEET, picaridin, oil of lemon eucalyptus (OLE), or IR3535. Always use as directed.
- If you are also using sunscreen, apply sunscreen first and insect repellent second.
- Pregnant and breastfeeding women can use all EPA-registered insect repellents, including DEET, according to the product label.
- Most repellents — including DEET — can be used on children aged older than two months.
- Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.
- Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:
- Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last.
- If treating items yourself, follow the product instructions carefully.
- Do not use permethrin directly on skin.
- Stay and sleep in screened or air conditioned rooms.
- Use a bed net if the area where you are sleeping is exposed to the outdoors.
- Yellow Fever in CDC Health Information for International Travel — “Yellow Book”
- Clinical and Laboratory Guidance
- Diagnostic Testing
- Testing for Vaccine Adverse Events
- Yellow Fever Vaccine Booster Doses
- Frequently Asked Questions about Yellow Fever
- Avoid Bug Bites — Information for travelers
- Insect Repellent Use and Safety
- Yellow Fever Vaccine Information Statement (VIS)
- Authorized Yellow Fever Vaccine Centers in the United States
While the situation is not dire enough to warrant avoiding nonessential travel to Angola altogether, significant caution needs to be exercised — especially as cases of yellow fever have been exported by travelers during the current outbreak to countries which include China, Democratic Republic of Congo and Kenya; and Namibia and Zambia are on high alert for imported cases.
If you plan on traveling to Africa, you should consider getting your yellow fever vaccine as a precautionary measure. The total cost of a yellow fever vaccine can typically range from $150.00 to $350.00 depending on where you go; so shop around for the best price — and the signed and stamped International Certificate of Vaccination or Prophylaxis is valid for ten years.
Photograph ©2016 by Brian Cohen.