Gelbfieber in Sudan - Virus breitet sich aus

[Birgitt]

Da der aktuelle Gelbfieberausbruch in Darfur/Sudan lt. Paul Reiter vom Institut Pasteur, Paris, mittlerweile die Hauptstadt Khartoum erreicht hat, möchte ich in diesem Thread gesondert darauf hinweisen:

The news from Darfur must surely be treated as an international emergency; 3.5 million refugees are housed in camps in the province and water is an increasing problem. The virus has now reached Khartoum (pop. more than 5 million); a major epidemic could spawn the global catastrophe that entomologists and other public health specialists have been predicting for decades [...]

In summary, it is hard to overestimate the seriousness of this situation. As mentioned, the virus has already reached Khartoum (population of the city and adjoining cities over 5 million); water storage is widespread, especially in residential areas.

If transmission becomes epidemic in Khartoum then the world is open to catastrophe; the number of vaccines available is limited and the global dispersion of the virus could affect any place where dengue and chikungunya are transmitted, whether by _Ae. aegypti_, _Ae. albopictus_ or other species.

In other words, more than 2.5 billion people throughout the tropics and subtropics would be at risk.

Alles weitere dazu siehe:

Aktuelle Epidemien in Afrika

Gruß
Birgitt

[Birgitt]

YELLOW FEVER - AFRICA (14): SUDAN (DARFUR, KHARTOUM)
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In this update:
[1] newswire
[2] WHO release



******

[1] Newswire

Date: 11 Nov 2012
Source: Examiner [edited]
http://www.examiner.com/article/darfur- ... s-khartoum


Yellow fever is caused by a virus carried by mosquitoes, and it is a common disease in South America and in sub-Saharan Africa.

Cases from the yellow fever outbreak in the Darfur region of western Sudan continue to rise, as the World Health Organization (WHO) Sudan reports 266 suspected cases in 20 localities, according to the WHO news release of 9 Nov 2012. Of the 266 cases, 85 fatalities have been reported, which equates to a case fatality rate of 32 per cent.

According to surveillance data, Central Darfur is still the hardest hit area, accounting for 73 per cent of all cases. This is followed by West Darfur (12 per cent), South Darfur (11 per cent), with North and East Darfur accounting for the remainder.

Member of Parliament Ibrahim Abbaker said last week that the outbreak in Darfur has reached "epidemic levels" that require immediate intervention from the central government.

The Ministry of Health in the capital city of Khartoum has even reported the emergence of the 1st case of the mosquitoborne viral disease in the Sudanese capital, according to a Radio Dabanga report on Saturday [10 Nov 2012].

The yellow fever vaccination plan, which will cover 3 587 772 persons in the age group 9 months and above, has been finalized. However, this depends on the reconfirmation of the diagnosis by the reference laboratory, the Institute Pasteur, in Dakar, Senegal, according to a WHO Situation Report on Friday [9 Nov 2012].

To date, more than 100 medical doctors and medical assistants have been trained in South Darfur on disease surveillance, case management, outbreak investigation, and infection prevention and control.

WHO says the 266 suspected cases have presented to health facilities with common symptoms, including fever, bleeding, and vomiting in 99, 64 and 58 per cent of the cases, respectively.

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******
[2] WHO release
Date: 9 Nov 2012
Source: WHO/EMRO press release [edited]
http://www.emro.who.int/sdn/sudan-news/ ... ember.html


The yellow fever outbreak has now affected 20 localities in Central, South, West, and North Darfur. As of [8 Nov 2012], 266 suspected cases have been reported, including 85 deaths (case fatality rate of 31.8 per cent).

Reports have been received since the last week of September 2012 from the districts of Zalengei, Nertity, Wadisalih, Azoom, Mukjer, Bendisi, Nyala, Kass, Kubum, Sharq Agabal, Yassin, Mershingm, Rehaid Albirdy, Genaina, Kernik, Baidha, Habila, Forbranga, Saraf Omra, and Alseraif.

Surveillance shows that 72.9 per cent of the reported cases are from Central Darfur; 10.9 per cent are from South Darfur; 12 per cent are from West Darfur; 4.1 per cent are from North Darfur, and 0.1 per cent are from East Darfur.

WHO has been assisting the technical support teams deployed by the Federal Ministry of Health in Central, South and West Darfur for initial support and to conduct outbreak investigations, initiate responses, entomological surveys, active case searches, and to hold meetings with community leaders in affected areas to raise awareness, as well as to provision blood bank supplies and personal protective equipment to affected states.

To date, health cadres in affected areas have been vaccinated against yellow fever. Moreover, WHO and the Ministry of Health have started training programmes for more than 225 health staff in the affected localities on yellow fever surveillance, case management, outbreak investigation, and infection prevention and control. On [6 Nov 2012], training programmes for medical doctors on yellow fever surveillance, case definition, and management started in Nyala and Kass localities in South Darfur.

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[The number of cases in Darfur continues to rise. One wonders about the delay in getting lab results; perhaps there was a delay in the specimens reaching Dakar. - Mod.JW

In the 1st report on this outbreak covered by ProMED-EAFR (see Yellow fever - Sudan: (Darfur) 20121103.28571503), there were a total of 84 suspected cases, including 32 deaths, reported in the districts of Azoom, Kass, Mershing, Nertiti, Nyala, Wadi Salih and Zalingei during the period 1-31 Oct 2012. The above reports increase the number of suspected cases to 266 with 85 fatalities reported from 20 localities in Sudan and mention the start of reports in the last week of September 2012.

Information on the epidemiologic investigations would be greatly appreciated, including dates of onset of cases along with epidemic curves.

For a map of Sudan, see the March 2012 map of Sudan available on Relief Web at http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf. For the HealthMap/ProMED map of Sudan, see http://healthmap.org/promed/index.php?n ... 30.05,5,96. - Mod.MPP]

[Birgitt]

YELLOW FEVER - AFRICA (15): SUDAN (DARFUR), WHO
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[1] Date: Tue 13 Nov 2012
Source: Reuters [edited]
http://www.reuters.com/article/2012/11/ ... PA20121113


A yellow fever outbreak has killed nearly 100 people over the last 7 weeks in Sudan's Darfur, the World Health Organization said, a region where fighting has undermined access to healthcare.

The mosquito-borne disease has spread throughout the remote western territory, but the reported cases have been concentrated in central Darfur, the WHO and Sudan's health ministry said in a joint statement. The statement said 329 suspected [now confirmed -- see [2] below] yellow fever cases and 97 deaths had been reported since the last week of September [2012]. The outbreak had hit the regional capitals of El Geneina and Nyala.

There is no effective treatment for the hemorrhagic fever, but there is a vaccine. Some 3.6 million people would be vaccinated in the affected areas, the statement said. It did not say how long the program would take. Nearly half the yellow fever cases were in people between the ages of 15 and 30, it said, and about a quarter were children aged 5 to 15.

Darfur has been plagued by conflict since rebels took up arms in 2003, complaining that the government had neglected the region and locked its non-Arab minorities out of power. Healthcare is provided almost entirely by aid agencies in some parts of Darfur. Hundreds of thousands of people may have died in Darfur's conflict, the United Nations and human rights groups have estimated. The government has put the death toll at 10 000.

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[2] Date: 13 Nov 2012
Source: WHO Global Alert & Response [edited]
http://www.who.int/csr/don/2012_11_13/en/index.html


Yellow fever in Sudan
---------------------
The Federal Ministry of Health (FMOH) in Sudan has notified WHO of a yellow fever outbreak affecting 23 localities in Greater Darfur. As of 11 November 2012, a total of 329 suspected cases including 97 deaths were reported from this outbreak. Central and South Darfur have reported most of the suspected cases.

Laboratory confirmation was conducted by the WHO regional reference laboratory for yellow fever, the Institut Pasteur in Dakar, Senegal, on 2 samples, which tested positive for yellow fever by IgM ELISA test and RT-PCR. Differential diagnosis for other flaviviruses was negative.

WHO is supporting the FMOH and other partners in the epidemiological investigation and response to the outbreak. Ongoing activities include strengthening of epidemiological surveillance, conducting entomological assessment and standardizing clinical case management. Community leaders are also being mobilized to support with raising awareness on yellow fever in the affected localities.

The government of Sudan has requested the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG) to provide support for a reactive mass vaccination campaign. The YF-ICG has approved 2.4 million doses of vaccine, which are expected to arrive in the country shortly. Sudan, with support from WHO is expected to start the emergency mass vaccination campaign in the affected areas in order to protect the at risk populations and stop the spread of the disease.

The YF-ICG consists of representatives from the United Nations Children's Fund (UNICEF), Medecins sans Frontieres (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC) and WHO, which also serves as its Secretariat.

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[There is now official laboratory confirmation of the diagnosis. It is to be hoped that mass vaccination will be able to begin before the end of the month. There is no news about any more cases in Khartoum. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1A1E.]

[Birgitt]

YELLOW FEVER - AFRICA (16): SUDAN (DARFUR, KHARTOUM)
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Date: Wed 14 Nov 2012
Source: Alertnet [excerpts, edited]
http://www.trust.org/alertnet/news/expe ... l-hits-107


The death toll from a yellow fever outbreak in west Sudan hit 107 on Tuesday [13 Nov 2012], and a medical expert, noting that mass vaccination is not scheduled to begin until next month, warned of a "pending catastrophe" if the disease spreads beyond Darfur.

"This is a terribly serious situation," Paul Reiter, professor of medical entomology at the Pasteur Institute in Paris, told AlertNet. "If [the epidemic] really were to start moving rapidly, we really would not be able to do very much. It all balloons very quickly. ... We have very little means at our disposal for combating an epidemic in the case of yellow fever."

Yellow fever is a viral infection that is transmitted by mosquitoes in tropical regions. The majority of patients in Darfur have experienced fever, bleeding, and vomiting, according to WHO.

War has ravaged Darfur since rebels took up arms in 2003, saying the central government had neglected the region. Conflict has continued despite the presence of the world's largest peacekeeping operation, the United Nations-African Union Mission in Darfur (UNAMID), and humanitarian workers have often been attacked.

There is no specific treatment for yellow fever, only supportive care to treat dehydration and fever, and blood transfusion if needed. Vaccination is the main preventative measure.

WHO is waiting for vaccines to be imported from the International Coordinating Group on Yellow Fever Vaccine Provision, which manages the global pool of the vaccine, before it can start a mass vaccination campaign in Darfur.

"Logically speaking, we will be talking about 3 weeks to a month," Anshu Banerjee, the WHO representative in Sudan, told AlertNet, "one week for the vaccine to arrive, one week for the vaccine to get to Darfur, then the training."

Sudan requested 3.6 million doses of the vaccine but is being given only 2.4 million. There are regular shortages in the global supply of the yellow fever vaccine due to unpredictable demand and its relatively short shelf life. "If more vaccine had been available, I am sure they would have released more vaccine," said Banerjee. "There is a pipeline problem in the sense that the vaccine that is available at the moment cannot be easily replenished with new vaccine."

The news that a man in the Sudanese capital Khartoum is being treated for yellow fever has raised fears in the media. The government announced that there would be a mass vaccination campaign in Khartoum. "The problem, however, is that there is no vaccine yet available for Khartoum," Banerjee said. He said there was no need to begin vaccinating people in Khartoum because there had been no transmission of the disease within the city. The man who is being treated for yellow fever in Khartoum caught the disease while in Darfur.

Reiter is less confident. "If the person has been in Khartoum for any length of time and if he has been in contact with mosquitoes, then, whether he's been treated or not, there still is the possibility that transmission will occur," he said.

People who have yellow fever can infect mosquitoes which bite them in the early stages of the disease because they have high levels of the virus in their blood, he said. This is how viruses travel from one country to another. "There's so much mobility of pathogens nowadays," Reiter said. "It's one of the really big emerging problems."

For example, millions of people fell sick with the chikungunya virus when it spread from Kenya to Mauritius, India and Italy between 2004 and 2007, carried by infected travellers, he said. "If transmission becomes epidemic in Khartoum, then the world is open to catastrophe. ... More than 2.5 billion people throughout the tropics and subtropics would be at risk," Reiter said in a [ProMED-mail] post on 11 Nov 2012.

WHO said it is actively searching for new cases and has trained more than 200 medical staff in controlling and responding to the disease; 7 isolation centres have been set up in Darfur, and blood bank units are being strengthened.

"For the moment, I think we are dealing with the situation," Banerjee said.

[byline: Katy Migiro]

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[To view a photo of an isolation ward in the south of western Sudan's Darfur region, see: http://www.trust.org/contentAsset/resiz ... 1211141345.

A map showing Darfur province and Nyala city can be found at http://www.theglobaldispatch.com/wp-con ... 80x300.png.

The case in Khartoum is confirmed above and should not be ignored until 2 incubation periods [2x6 = 12 days] have passed without transmission in the city. His case was 1st reported in a press statement on Thu 8 Nov 2012; see ref. (12) below. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1A1E.]

[Birgitt]

YELLOW FEVER - AFRICA (17): SUDAN (DARFUR)
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[1]

Date: Fri 16 Nov 2012
Source: Radio Dabanga [summarized, edited]
http://www.radiodabanga.org/node/38491


Issa Mohamed Musa Yusuf, the minister of health from Central Darfur, told Radio Dabanga that 72 people had died of yellow fever [YF] in the state by Friday [16 Nov 2012]. He also said that 296 people have been infected so far [but see [2[ below].

The minister also told Radio Dabanga that one person died on Thursday [15 Nov 2012] afternoon at a Zalingei hospital as a result of the disease. In addition, he continued, one person from Bindissi locality and another 3 from Um Dukhun locality were recently infected with yellow fever. Cases have also been reported in Jebel Ahmer, Zalingei locality, he said.

Yusuf said yellow fever infections are mostly found in the countryside of Central Darfur, adding that this is the disease's worst epidemic in Darfur.

According to a citizen from Bishara El-Tayeb, Central Darfur, 35 people have died in the village since the yellow fever outbreak one month ago. Besides, a total of 6 people were diagnosed with the disease on Friday [16 Nov 2012], he said, explaining the spread of yellow fever cannot be contained.

Ahmed Ishaq Yaqoup, health minister of West Darfur, announced that 40 people died, and another 113 were infected as a result of the spread of yellow fever in the state. He asserted that rural areas are mostly affected, citing specifically zones around El-Geneina, Mornei and Habila. The minister also confirmed the incidence of the disease in other localities in West Darfur.

Empty syringes arrived at the El-Geneina airport in West Darfur on Friday [16 Nov 2012] according to Minister Yusuf. He told Radio Dabanga he expects the vaccine doses to arrive in the region by the end of the last week of November 2012.

During a news conference on Friday [16 Nov 2012] in Khartoum, the undersecretary of the federal Ministry of Health announced that he expects vaccinations against yellow fever to arrive in Sudan on Saturday or Sunday [17-18 Nov 2012]. He said that once in Sudan, the vaccines will be sent to Darfur. Hopefully, he concluded, the vaccination process will begin by the end of the next week [the end of the week of 25 Nov 2012].

The minister appealed to citizens from Central Darfur to immediately [report] yellow fever cases to the nearest medical center and to follow the ministry's preventive instructions.

*******
[2]
Date: 15 Nov 2012
Source: Baku-APA [edited]
http://en.apa.az/news_who_says_death_to ... 82625.html


WHO says death toll from yellow fever in Sudan's Darfur rises to 110
--------------------------------------------------------------------
The World Health Organization ( WHO) on Thursday [15 Nov 2012] announced that the death toll from yellow fever jumped to 110 in Sudan's Darfur region, APA reports quoting Xinhua. "The total number of cases has reached 374, including 110 deaths, with a case fatality rate of 29.4 percent," said WHO in a statement, a copy of which was obtained by Xinhua. It further said that the outbreak affected 23 localities in Darfur's 5 states, noting that it was working to [deliver] 2.4 million doses of yellow fever vaccine as an emergency vaccination campaign.

The WHO earlier said 7 quarantine centers have been established in Nyala, Kass, Nertity, Zalengei, Garcilla, Morni and Geneina in response to the outbreak. [Quarantine is not normally applicable in a YF epidemic; perhaps isolation wards are meant. - Mod.JW].

The organization noted that there was a need for a minimum of 4. 8 million U.S. dollars to conduct the campaign and provide treatment for the patients, requesting all its partners to support its efforts by pooling manpower and financial resources.

--
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[The YF outbreak continues to smolder in West Darfur, with cases occurring in a variety of villages. A 13 Nov 2012 report indicated that there have been 107 YF deaths in Darfur (see ProMED-mail archive no. 20121114.1409831), and a report from the Sudan Ministry of Health on that same date reported 97 deaths (see ProMED-mail archive no. 20121113.1407906), but the above report stated that there have been 72 YF deaths.

The arrival of syringes is good news. The arrival of the vaccine will be even better news. One hopes that when it does arrive in Darfur, vaccination teams will be ready to immediately fan out across the region to apply it. Since 11 days are required for the vaccine to be effective after application, one can expect cases to continue into mid-December 2012. The above report does not specifically indicate that cases are occurring in the large refugee camps located in Darfur. Should that occur, a massive number of cases could result in a short period of time. One hopes that the vaccine campaign will prevent that from happening as well as halting additional cases in the villages of Western Darfur.

Maps showing the locations of North, West and South Darfur can be accessed at http://www.lib.utexas.edu/maps/africa/t ... l_2007.jpg, and a HealthMap/ProMED-mail map of Darfur can be accessed at: http://healthmap.org/r/1A1E. - Mod.TY]

[According to a report on All Africa dated 15 Nov 2012 at: http://allafrica.com/stories/201211160034.html the 1st cases reportedly came from Jebel Ahmar (Jebel Marra(?) on Google Maps), which is at Nertiti on the road to the Chad border, less than 100km away as the monkey travels through the mountain forest. Checking the historical photos on Google Earth, there has been an extraordinary amount of reforestation of the region since 2004 -- they must have had a lot of rainfall since then.

But there must be a YF cases over the border in Chad. I suppose there are NGOs in the refugee camps close to the Sudan border there -- why haven't they reported anything? - Mod.JW]

[Birgitt]

YELLOW FEVER - AFRICA (18): SUDAN (DARFUR)
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[1]
Date: Sun 18 Nov 2012
Source: ShangaiDaily, Xinhua News Agency report [edited]
http://www.shanghaidaily.com/article/ar ... ?id=108258


Death toll from yellow fever in Sudan's Darfur region jumps to 150
------------------------------------------------------------------
The death toll from yellow fever jumped to 150 in Sudan's Darfur region and the number of infection cases to 400, Khartoum's Al-Ray Al Am daily reported Sunday [18 Nov 2012].

"The death cases from yellow fever in Darfur region reached 150 in addition to the infection of 400 people," the report said.

The paper further disclosed that great quantities of yellow fever vaccines have arrived in the country and have been received by Sudanese Ministry of Health, while the remaining quantity is expected to arrive in the coming days to reach 4.2 million doses at a cost of more than 7 million US dollars.

The vaccines would be transported to the region to commence a vaccination campaign by the end of this week [week ending 25 Nov 2012].

According to the paper, the disease outbreak has sparked panic among the citizens of the region.

The World Health Organization (WHO) last week announced that the total
number of cases had reached 374, including 110 deaths, with case fatality rate of 29.4 percent.

It said 7 quarantine centers have been established in Nyala, Kass, Nertity, Zalengei, Garcilla, Morni, and Geneina in response to the disease outbreak in the region.

Yellow fever is mainly spread by mosquitoes, and its most frequent symptoms are fever, bleeding, and vomiting. There is no effective treatment for the disease, other than alleviate dehydration and fever and blood transfusion.

--
Communicated by:
ProMED-EAFR from HealthMap Alerts
<promed-eafr@promedmail.org>

[Yellow fever deaths in Darfur have increased by 40 since the most recent ProMED-EAFR update of 16 Nov 2012 (archive no. 20121117.287980). Good enough, yellow fever vaccines are already in the country to allow reactive yellow fever vaccination to protect at-risk populations and hence prevent new cases/deaths.

For a map of Sudan, see the March 2012 map of Sudan available on ReliefWeb at http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf. For the HealthMap/ProMED-mail interactive map of Sudan, see http://healthmap.org/r/3EpA. - Mod.JFW]

[ProMED-mail Correspondent SB found a snippet in the Khartoum newspaper Alnilin [in Arabic] which said that Professor Mamoun had revealed the emergence of yellow fever [YF] cases in Khartoum and that the Khartoum Minister for Health had revealed the 'emergence' of 2 cases. The URL for this snippet is not longer available on the internet. The arrival of YF vaccine is good news indeed. However the delay until the end of the week to begin the vaccination campaign in Darfur, and the 11 days post-vaccination period for reliable immunity to occur, indicate that additional YF cases and deaths can be expected. The occurrence of 2 YF cases in Khartoum is a serious concern. It was not stated if these cases were imported from Darfur or were locally acquirted. In either case, is these individuals were viremia while in Khatrom, there is a risk of ongoing transmission there. This would complicate the YF situation in Sudan considerably. ProMED would appreciate receiving addition information as it becomes available. - Mod.TY]

******
[2]
Date: Mon 19 Nov 2012
Source: Sudan Vision [edited]
http://news.sudanvisiondaily.com/detail ... pid=216244

Sudan's Minister of Health Bahar Idriss Abu Garda announced the arrival of anti-yellow fever vaccines to Darfur States where the disease had struck. Anti-yellow fever vaccination campaign will kick off on Tuesday [20 Nov 2012], said Abu Garda who stopped over El Fasher en route to west Darfur, the hard-hit area.

West Darfur Minister of Health Ahmed Ishaq Yagoub told Sudan Vision yesterday that fatalities as a result of the disease reached 43 and122 cases contracted the disease.

By the kickoff of the vaccination campaign, the Health Ministry has made great strikes in its endeavour to combat the disease in the region, he said. Abu Garda added that the Health Ministry made great efforts to control the spread of the disease and the international community has positively responded to the campaign against yellow fever. He praised efforts made by the North Darfur State to prevent the outbreak of the disease. Comparatively, the health situation in North Darfur is better, he said.

Abu Al Abbas Abdullah, Minister of Health of North Darfur State said 5 cases suspected to be yellow fever were reported in the State and that samples were taken for lab test. He underlined the precautionary measures taken by the State to that end, affirming the readiness of the ministry to continue awareness and vaccination campaigns.

Health authorities in Darfur States have affirmed the stability of the health situation after the campaigns of spraying to control spread of yellow fever.

Central Darfur State Health Minister Eissa Mohamed Musa said causes of the disease are declining after measures were taken to control the outbreak. He said cases of the disease shot up to 303 among them 73 fatalities over the past days. He added that vaccines are being transported to the region, adding that many patients have recovered from the disease in their quarantines. He said a campaign will start today in all Darfur States to control the disease.

Abu Baker Hussein, governor of East Darfur State confirmed the stability of the security situation in the state, adding that there were no fatalities as a result of the disease in his state.

The minister added that many health staff has been trained and several health clinics opened as part of efforts to control the disease.

Hamad Ismail Hamad, governor of South Darfur, said health situation in the area is stable and the cases are now decreasing and the disease is under control. He said vaccines have reached the area to control the disease. He said campaign for vaccination against yellow fever and polio will start on Tuesday.

Dr. Ahmed Ishaq, Minister of Health of West Darfur State said cases of yellow fever reached 122 until yesterday among them 43 fatalities. He said 35 mobile spraying pumps were delivered to the State to combat mosquitoes that transmit the disease. He said the federal ministry of health received quantities of vaccines to control spread of yellow fever.

[Byline: Najat Ahmed]

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[The figures given in this report are significantly lower than the numbers of fatalities and total cases cited in the 1st report [1] above. Given the sharp increase in the number of reported cases in the past 2-3 days, it is difficult to understand that the outbreak is under control and decreasing as the health officials indicated. Spraying is, at best, a temporary measure to reduce vector mosquito populations. Although adult mosquitoes may be killed, if the breeding sites remain, a new crop of adults will emerge quickly and YF virus transmission will continue. If the vaccination campaign can start on Tuesday, rather than at the end of the week as indicated in [1] above, that will be very helpful in reducing the number of cases. - Mod.TY]

[Birgitt]

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Date: Mon 19 Nov 2012
Source: AllAfrica, Radio Dabanga [edited]
http://allafrica.com/stories/201211190102.html


The Federal Health Minister, Bahr Abu Garda, announced the start of the vaccination campaign against the yellow fever epidemic in Darfur on Tue 20 Nov 2012, targeting 2.4 million people in Central, West, and South Darfur, Radio Dabanga has learned.

Bahr Abu Garda, who arrived in El-Geneina on Saturday [17 Nov 2012] to visit the affected areas, announced to Radio Dabanga in an interview that the vaccination campaign will begin on Tuesday [20 Nov 2012] after arrival of the vaccines to Darfur.

The minister appeals to citizens in the states of Central and West Darfur, where the campaign will be started, to go to the vaccination centers and follow the necessary health instructions, he added to Radio Dabanga from El-Geneina.

On the other hand, he disclosed that the number of deaths as a result of the yellow fever epidemic has reached 110 on Saturday [17 Nov 2012], adding that the total number of cases in West and South Darfur is now 358.

Abu Garda stated that all preparations were done in cooperation with the World Health Organization, including the preparation and equipment of blood banks in Nyala, El-Fasher, Zalingei, and El-Geneina.

The minister noted that the disease seemed to be declining and appealed to citizens to go to the nearest health center as soon as any symptom of the disease emerges, he added to Radio Dabanga.

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[It is good learn that the yellow fever (YF) vaccination campaign will start tomorrow (20 Nov 2012). One presumes that the densely populated refugee camps will be reached quickly, reducing that considerable risk. Reaching more remote villages for public health education and vaccination will be a logistical challenge, since the vaccine requires maintenance of a cold chain. It remains to be seen if the outbreak is declining or not, since distribution of the vaccine will take time and over a week is required to achieve solid immunity following administration of the vaccine. But the presence of the vaccine in Darfur is very good news indeed, and the results of the campaign are awaited with interest.

A recent AlertNet report (http://www.trust.org/alertnet/multimedi ... 36ab065ca0) indicated that as of 14 Nov 2012 the Sudan Red Crescent has conducted workshops on health care and prevention of yellow fever at a community center in Al Riad camp for Internally Displaced Persons, West Darfur. It is encouraging to see the Red Crescent taking proactive measures to deal with the YF outbreak.

Fortunately, there are no reports of additional YF cases in Khartoum.

Maps showing the locations of North, West, and South Darfur can be accessed at http://www.lib.utexas.edu/maps/africa/t ... l_2007.jpg, and a HealthMap/ProMED-mail map can be accessed at http://healthmap.org/r/3EpA. - Mod.TY]

[Birgitt]

YELLOW FEVER - AFRICA (20): SUDAN (DARFUR)
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Date: Wed 21 Nov 2012
Source: Radio Dabanga [edited]
http://www.radiodabanga.org/node/38663


News reports received on Tuesday, 20 Nov [2012] read that the total number of cases of the yellow fever epidemic has reached 518, while the death toll has reached a number of 134 cases across Darfur, Radio Dabanga learned. The numbers published on Tuesday [20 Nov 2012] are based on statistics from the state health ministries of Central, South, and West Darfur.

On Monday [19 Nov 2012], the United Nations Country Team (UNCT) and UNAMID [UN African Union Mission in Darfur] conducted a meeting at UN Development Programme's headquarters in Khartoum. Both parties raised their concerns about the outbreak of yellow fever in Darfur and reviewed the steps being taken to assist the Government of Sudan in mitigating the epidemic.

West Darfur: 45 dead
--------------------
Ahmed Ishaq, West Darfur's health minister announced the start of the yellow fever vaccination campaign in 4 of the state's localities on Wednesday [21 Nov 2012]. The minister disclosed to Radio Dabanga that the number of deaths caused by the epidemic rose to 45 on Tuesday [20 Nov 2012], while the total number of cases reached 137.

Ishaq said that the campaign will start in the localities of Kereinek, Baida, El-Geneina, and Habila, describing the residents' responses as 'significant'.

Additionally, West Darfur's health minister said that approximately 950 000 vaccines have arrived to West Darfur. He stated that the preparation work for the campaign has been completed.

Central Darfur: 73 dead
-----------------------
At the same time, Central Darfur's Health Minister Abdullah Mousa announced an increase in the number of deaths to 73 and a total number of 309 have been infected.

Mousa disclosed to Radio Dabanga that all preparatory work for the campaign, which will start on Wednesday [21 Nov 2012], has been completed. The minister added that the campaign was due to start on Tuesday, according to the Federal Health Minister's statement.

Central Darfur's health minister said that the start of the campaign was delayed with one day due to the conditions in the state as well as the unavailability of the airport, which reportedly caused a delay in the arrival of the vaccines to Zalingei.

He announced that the campaign will start in the state's 4 localities of Zalingei, Nertity, Wadi Saleh, and Azum, adding that the remaining (4) localities will be included in the next phase of the campaign.

South Darfur: 16 dead
---------------------
Simultaneously, South Darfur's Health Minister Ahmed al-Tayyeb Ibrahim proclaimed that the death toll in the state has reached 16, while the total number of cases has reached 72.

The minister revealed to Radio Dabanga that the vaccines against yellow fever arrived on Tuesday [20 Nov 2012], stressing that they will be distributed to the localities with the highest incidence rates at first, to start the campaign as soon as possible.

When asked about the number of localities targeted by the campaign, the minister refused to comment. He explained that he was not able to disclose the exact localities due to safety reasons, but affirmed that all affected areas will be included.

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[It is good to learn that the vaccination campaign is beginning today (21 Nov 2012) in all 3 affected Darfur states. Clearly, the earlier statements by some of the health authorities that the situation was under control was not correct. One hopes that will change in a couple of weeks as the vaccination campaign progresses. The logistical challenges in Darfur will be a major concern for the vaccination teams as they move around this geographically large area.

Maps showing the locations of North, West, and South Darfur can be accessed at http://www.lib.utexas.edu/maps/africa/t ... l_2007.jpg, and a HealthMap/ProMED-mail map can be accessed at http://healthmap.org/r/3EpA. - Mod.TY]

[Birgitt]

YELLOW FEVER - AFRICA (21): SUDAN (DARFUR)
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Date: Wed 21 Nov 2012
Source: Radio Dabanga [edited]
http://www.radiodabanga.org/node/38662


Activists and residents from Kabkabiya locality, North Darfur, have informed Radio Dabanga on Tuesday 20 Nov [2012], about the alleged arrival of 4 new cases of a disease resembling yellow fever from Jebel 'Aamer and Sref Beni Hussein localities.

The patients were taken to the hospital in Kabkabiya for treatment, but remain in critical condition, sources told Radio Dabanga. A local resident said one of the patients was referred to the hospital in El-Fasher but died during the trip.

The resident explained that another patient passed away on Monday [19 Nov 2012], as a result of the disease. At the same time, one of the remaining patients was taken to El-Fasher hospital on Tuesday morning [20 Nov 2012], after his condition became more critical.

He stressed that residents are living in fear, as the disease can cause a sudden death, adding that doctors withhold information on the patients' conditions from their relatives, which causes even more fear and panic, he added to Radio Dabanga from Kabkabiya.

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[Yesterday's previous yellow fever (YF) report (see ProMED-mail archive no 20121121.1418557) gave numbers of cases and fatalities in West, Central, and South Darfur. The report above mentions suspected YF cases from North Darfur, underscoring the widespread geographic distribution of the outbreak, and the challenge in getting adequate vaccination coverage sufficient to halt transmission over this very extensive area.

A map showing the locations of North, West, Central, and South Darfur can be accessed at http://www.lib.utexas.edu/maps/africa/t ... l_2007.jpg, and a HealthMap/ProMED-mail map can be accessed at http://healthmap.org/r/3EpA. - Mod.TY]

[Birgitt]

Yellow fever in Sudan - update
22.11.2012 - WHO

The Federal Ministry of Health (FMOH) in Sudan began a 10-day mass vaccination campaign against yellow fever in Darfur on 20 November 2012, in response to the outbreak.

As of 17 November 2012, the outbreak is reported to have affected 26 localities, with a total of 459 suspected cases including 116 deaths. Two cases were confirmed by IgM ELISA test and RT-PCR by the WHO regional reference laboratory for yellow fever, the Institut Pasteur in Dakar, Senegal. An outbreak investigation team led by the Ministry of Health, with support from WHO are in the field to assess the extent of the outbreak and prioritize areas for the mass vaccination campaign.

With support from the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG), the Central Emergency Response Fund (CERF), and international non-governmental organizations (INGOs), the vaccination campaign will be carried out in the most affected 12 localities in Darfur region, targeting approximately 2.2 million people.

The YF-ICG is a partnership which manages stockpile of yellow fever vaccines for emergency response. It is represented by United Nations Children's Fund (UNICEF), Médecins Sans Frontières (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC) and WHO, which also serves as the Secretariat.

Seven INGOs, including the International Committee of the Red Cross, MSF-Belgium, MSF-Spain, MSF-Swiss, Merlin, Save the Children-Swiss, and International Medical Corps are currently working in the 12 localities prioritized for the vaccination campaign. They will actively support the FMOH in this emergency response.

WHO is supporting the State Ministries of Health in conducting field investigations to better assess the epidemiological situation and the risk of disease spread, as well as on-the-job trainings for health staff to strengthen their disease surveillance systems and to improve collection of samples and laboratory diagnosis..

WHO has activated the Global Outbreak Alert and Response Network (GOARN) and additional support will soon be provided to the ongoing response efforts in the country.

Gruß
Birgitt

[Birgitt]

YELLOW FEVER - AFRICA (22): SUDAN (DARFUR)
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[1]
Date: Thu 22 Nov 2012
Source: Akhirlahza [in Arabic, trans. Corr.SB, edited]
http://www.akhirlahza.sd/akhir/index.ph ... e&id=22816


[This report is from one of the main Arabic language newspapers in Sudan. The initial part of the report gives incidence figures that are somewhat lower than those from reports over the past 3 days (see ProMED-mail archives below), so will not be given here. New information follows. - Mod.TY]

Ahmed Ishaq Yaqoub, Minister of Health in West Darfur, pointed to the arrival of 35 mounted spray pump machines mounted [presumably on vehicles? Corr.SB] and a federal health and blood bank equipment worth over one million [Sudanese pounds; USD 225 000]. The Minister of Health in South Darfur, Ahmed Al-Tayeb, said that the disease is spreading to new areas of the state and new cases must be expected. He pointed out that intensive efforts are under way to combat and trap mosquitoes which transmit the disease. The good news is that a conference [was held?] in Nyala on Monday (Nyala had recorded 2 cases in southern and northern areas of the State) and a programme of education and Health is being undertaken to inform the public about the dangers of the disease.

Newspaper sources state that about 10 000 workers in the gold mines fled to Nyala after the spread of yellow fever in the mining areas of Jebel Amer. This has created concern and tension among the citizens in Nyala with the possibility of transferring the infection to the cities with the event of carriers of this disease. The sources added that the mining area had more than 60 cases. A prospector, with family, said some miners had come from the neighboring countries of Chad and the Central African Republic. 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, especially to [be provided to] the Nyala Teaching Hospital where many of the patients in critically ill condition are being treated. The referral hospital for the states of Central and Southern Darfur is in a deplorable state from the accumulation of hundreds of patients, some sleeping on the ground outside, lack of medical staff, and acute shortage of medical equipment.

Observers fear of the spread of the disease to the south side of South Darfur state with the nomadic movement that started from the north (of Darfur). It is important to provide vaccines that protect all the citizens of the state from this incurable disease.

[Byline: Mahad Mohamed Khair]

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[Re "...vaccinate all citizens of the state, especially to [be provided to] the Nyala Teaching Hospital where many of the patients in critically ill condition are being treated...": the medical and nursing staff at that hospital were reportedly vaccinated on Tue 20 Nov 2012, so will be protected by the end of the month. Vaccination cannot help inpatients.

Re "...some miners had come from the neighboring countries of Chad and the Central African Republic..." If there is already YF in the mining camps, miners fleeing back to those countries rather than to Nyala will pose a threat to those countries.

Map of Sudan showing Jebel Marra in the west central part of the country:
http://dianabuja.files.wordpress.com/20 ... .jpg?w=584
Map of Jebel Marra showing Nertiti and Zalingei on road west to Chad:
http://blogfordarfur.org/archives/wp-co ... a-Map1.bmp. - Mod.JW]

******
[2]
Date: Thu 22 Nov 2012
Source: Radio Dabanga [edited]
http://www.radiodabanga.org/node/38701


West Darfur
-----------
The death toll as a result of the yellow fever epidemic in West Darfur has risen to 47, while the total number of infections reached a number of 157, Radio Dabanga learned on Wednesday 21 Nov [2012].

Ahmed Ishaq Yaqoub, West Darfur's Health Minister, told Radio Dabanga that 2 people passed away on Wednesday [21 Nov 2012] as a result of the fever, thus bringing the death toll to 47. He added that the state of West Darfur did not experience any issues with the vaccines so far; however, he claimed that some of the centers remain empty due to the remote location.

The minister explained that the campaign will continue for 11 more days, which he considers to be sufficient for vaccinating all citizens in West Darfur's 4 localities. Yaqoub announced that all schools in the state have been visited and all pupils have been vaccinated in the meantime.

West Darfur's health minister added that he visited the localities of Foro Baranga and Habila on Wednesday [21 Nov 2012] to check the conditions of the hospitals and to ensure that all patients are received and vaccinated. [Vaccinating individuals who are ill with yellow fever virus infections is not effective treatment because the vaccination comes too late. If the statement means that well individuals are being vaccinated at the hospital, that is a preventive measure. - Mod.TY]

He appealed to the citizens in the affected localities to go to the vaccination centers.

North Darfur
------------
At the same time, Abu al-Abbas Abdullah al-Tayyeb, North Darfur's Health Minister, told Radio Dabanga that 250 000 doses of the vaccine have arrived in the state. He claims this is not sufficient to cover all the affected areas, adding in a press statement that the vaccines will be distributed to the localities adjacent to the regions where the disease is still spreading.

The minister announced that the vaccination campaign will start on Wednesday [21 Nov 2012] and will continue for 12 days in the localities of Sreif and Saraf Omra, he added to Radio Dabanga.

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[The stated lack of sufficient YF vaccine, and the relatively brief time allocated for application (11-12 days), considering the large geographic area and scattered cases within it, are a cause for serious concern. Adequate surveillance to promptly detect new cases in new locations is also a significant challenge in the Darfur states. The reports above indicate that spraying is an additional measure to halt transmission. As noted in previous comments, this will provide only temporary mosquito vector control if not accompanied by elimination of breeding sites. - Mod.TY

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3EpA.]

[Birgitt]

YELLOW FEVER - AFRICA (24): SUDAN (DARFUR)
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Date: Thu 22 Nov 2012
Source: AllAfrica, Radio Dabanga report [edited]
http://allafrica.com/stories/201211230053.html


A total of 18 new cases of yellow fever [YF] have been registered in East and West Darfur by Thursday night, 22 Nov [2012], different sources informed Radio Dabanga. One of the victims has reportedly passed away.

East Darfur
-----------
The Governor of East Darfur, Abu Baker Hussein, announced the emergence of 4 new cases of yellow fever in the state on Thursday [22 Nov 2012]. Hussein said that according to the ministry of health, one of the infected victims recently died.

He explained that although the population has access to vaccines against the disease, there are not enough doses for everyone.

West Darfur
---------
On the same day, sources told Radio Dabanga that 14 people were infected with the disease in Mornei, West Darfur. They revealed that the hospital allocated extra wings to receive the 'large influx' of yellow fever patients.

A source from Mornei camp feared the disease might spread even further among residents, explaining that 260 people have been infected so far.

He revealed that the hospital in Mornei only has one doctor to treat all the cases of yellow fever and demanded that the displaced be transferred to El-Geneina for treatment, the state's capital.

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[There are 2 statements in the report above that raise significant concerns: first, that there is not an adequate supply of the vaccine, and second, that cases are occurring in the Mornei refugee camp where the density of susceptible individuals is high, facilitating YF virus transmission. One hopes that the national and international groups that have just begun to carry out the vaccination campaign can deal quickly with these situations.

A map showing the locations of North, West, Central, and South Darfur can be accessed at http://www.lib.utexas.edu/maps/africa/t ... l_2007.jpg, and a HealthMap/ProMED-mail map can be accessed at http://healthmap.org/r/3EpA. - Mod.TY]

[Birgitt]

YELLOW FEVER - AFRICA (25): SUDAN (DARFUR)
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Date: Thu 22 Nov 2012
Source: Sudan Federal Ministry of Health/WHO Situation Report No. 9 [summ. & edited]
http://reliefweb.int/sites/reliefweb.in ... t_1172.pdf


Highlights
- After the 2nd day of a 12 day vaccination campaign, 13 per cent of the targeted population in Geneina, Kerinik, Habila and Beidha in West Darfur localities were vaccinated against yellow fever.

- As of 21 Nov [2012], the total number of reported cases has reached 537, including 127 deaths (case fatality rate of 23.6 per cent). The outbreak has now affected 30 localities in Central, South, West, North, and East Darfur.

- The US Naval Medical Research Unit No. 3 (NAMRU-3) based in Cairo, Egypt, has deployed a team to Sudan to support laboratory analysis of collected samples as well as conduct on-job training sessions at the National Public Health Laboratory starting on Sat 24 Nov 2012.

Epidemiology
- As of 21 Nov [2012], a total of 537 suspected cases, including 127 deaths (CFR 23.6 per cent), have been reported from the localities of Zalengei, Nertity, Wadisalih, Azoom, Mukjer, Bendisi, Rokoro, Um Dukhun, Nyala, Kass, Kubum, Sharq Agabal, Mershing, Rehaid Albirdy, Ed Alfirsan, Shatayia, Yassin, Elddaen, Assalaya, Genaina, Kernik, Baidha, Habila, Forbranga, Jabal Moun, Sirba, Saraf Omra, El Fashir and Alseraif. Reports of cases were received from 2 Sep 2012.

- 30 localities, out of 57, in Darfur are now affected by the yellow fever outbreak.

- About 62.7 per cent of the reported cases are from Central Darfur, 8.5 per cent are from South Darfur, 19.3 per cent are from West Darfur and 8.8 per cent are from North Darfur.

- 1.5 per cent of the reported cases are in the age group 0-1.9, 2 per cent are in the age group 2-4.9, 22.8 per cent are in the age group 5-14.9, 48.1 per cent are in the age 15-29.9 and 16.3 per cent are 30-44.9 years and 6.3 per cent are in the age group of 45 years and above.

Actions taken

- After the 1st day of a 12 day vaccination campaign, 13 per cent of the target population in Geneina, Kerinik, Habila and Beidha in West Darfur localities were vaccinated against yellow fever.

- In Zalengei, vaccination campaign started on 22 Nov [2012] while in North Darfur the campaign will start on 24 Nov 2012 in North Darfur.

- The US Naval Medical Research Unit No. 3 (NAMRU-3) based in Cairo, Egypt, has deployed a team to Sudan to support laboratory analysis of collected samples as well as conduct on-job training sessions at the National Public Health Laboratory starting on Sat 24 Nov 2012.

- Technical support teams from FMoH remain on ground in Central, South and West Darfur to continually conduct active search for new cases, as well as entomological surveys in affected areas. Blood banks in affected areas and localities where most cases are referred to have been prepositioned with required blood units and laboratory supplies necessary for blood transfusion.

Recommendations
- As active search for cases is on-going, collection of more blood samples for laboratory testing of patients from newly affected localities should be strengthened.

- Parallel containment activities/measures should be sustained at least for 10 days, after the vaccination campaign starts.

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[The end of this report states, "Parallel containment activities/measures should be sustained at least for 10 days, after the vaccination campaign starts." This is highly questionable. At the rate they are going they are not going to achieve 80 per cent coverage in 10 days, and it should go on for 2-3 weeks after it ends to allow for extrinsic incubation in the vector mosquito and the incubation period in humans. - Mod.JW

According to the report above, the yellow fever (YF) outbreak in Darfur was 1st notified on 2 Sep 2012 -- nearly 3 months ago. Unfortunately, there was no vaccination campaign implemented at that time, resulting in the subsequent spread throughout Darfur, illustrating the need for prompt response early on, as was done in Paraguay in 2008. The above report indicates that there is an entomologist (or more?) on the field team. It would be of interest to know what the status of the mosquito vector, _Aedes aegypti_ is in various locations in Darfur. One hopes that the Sudan and international health teams will remain in place until after the last cases is reported.

A map showing the locations of North, West, Central, and South Darfur can be accessed at:
http://www.lib.utexas.edu/maps/africa/t ... l_2007.jpg, and a HealthMap/ProMED-mail map can be accessed at http://healthmap.org/r/3EpA. - Mod.TY]

[Birgitt]

YELLOW FEVER - AFRICA (26): SUDAN (DARFUR)
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Date: Sun 25 Nov 2012
Source: Radio Dabango [edited]
http://www.radiodabanga.org/node/38882


West Darfur
---
West Darfur's Minister of Health, Ishaq Ahmed Yaqoub, disclosed that a number of yellow fever patients disappeared from the hospital before completing their treatment in Foro Baranga and Habila localities, sources told Radio Dabanga on Sunday 25 Nov [2012].

The minister warned that leaving the hospital before completing treatment is dangerous and could endanger the patient's life.

He appealed to all yellow fever patients, through Radio Dabanga, not to leave the hospital or clinic before completing their treatment. Lastly, the minister appealed to the people to visit the vaccination centers before the campaign ends.

Additionally, the minister disclosed that the incidence of yellow fever has stabilized in the state.

Central Darfur
---
On the other hand, Central Darfur's Minister of Health, Issa Mohamed Moussa Ahmed, disclosed that approximately 700 000 doses of the vaccine have arrived to the state.

He explained that this quantity will only cover the 4 localities affected by the epidemic. These 4 localities are Zalingei, Azum, Wadi Saleh and Nertity. The minister added that the deficit in vaccinations is around 527.

Ahmed confirmed that the incidence of yellow fever has stabilized in Central Darfur, he added to Radio Dabanga.

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[It is good to see the yellow fever (YF) vaccination campaign progressing. The shortage of vaccines in Central Darfur is of concern, however. Continued success of the campaign will depend heavily on effective surveillance to detect new cases and rapid response to vaccinate people in those areas. One presumes that the indication of "incidence is stabilized" means that the incidence rate has not increased.

Maps showing the locations of North, West, and South Darfur can be accessed at http://www.lib.utexas.edu/maps/africa/t ... l_2007.jpg, and a HealthMap/ProMED-mail map can be accessed at http://healthmap.org/r/3EpA. - Mod.TY]

[Birgitt]

Sudan - Gelbfieber
26.11.2012

In der Region Darfur gibt es seit Anfang Oktober einen Ausbruch von Gelbfieber, mehr als 500 Personen sind erkrankt. In einigen Regionen wurden bereits Impfkampagnen gestartet, weitere sind geplant. Größere Ausbrüche von Gelbfieber wurden 2003 und 2005 verzeichnet. Impfschutz empfohlen, kosequenten Mückenschutz beachten. / Quelle: crm

Gruß
Birgitt