Vanuatu: Dengue Fever Outbreak - Emergency Plan of Action n° MDRVU003 Operation update n° 1

Summary of major revisions made to emergency plan of action:

This update details progress of the operation from start, 26 January 2017 to 4 April 2017, and extends the operation by approximately 6 weeks (from 26 April 2017 until 31 May 2017) to allow monitoring and evaluation (M&E) and lessons learnt activities to be finalized without haste, also considering that the Cat 2 Tropical Cyclone Cook passed over Vanuatu on 9 April, even if impacts are considered minor. As expected however, the Vanuatu Red Cross Society (VRCS) staff and volunteers have been involved in assessments and an elevated risk of increased incidence of vector borne disease due to the amount of rainfall and flooding exists in some areas. The Health RDRT is about to finish his mission in Vanuatu on 15 April and the regional health manager of the IFRC Pacific country cluster support team will continue to provide technical support to the VRCS for the rest of the operation, namely the M&E and learning activities, and therefore, a one week support mission in the end of April will be covered by the operation for quality assurance and operational sustainability.

Changes to the original EPoA activities were initially made on 8 February when the VRCS entered into a contract with telecommunications company, Digicel, to provide a communication campaign utilizing SMS messages. These messages are focused geographically in the two provincial locations where community mobilization and other activities are provided as part of this operation. The decision to incorporate the Digicel SMS campaign into this operation was twofold. Firstly, the Digicel campaign expedited the dissemination of targeted communication to the dengue ‘hotspot’ locations which the Ministry of Health (MoH) had requested assistance with.

Secondly, several activities included in the EPoA were superfluous because they duplicated MoH activities. By eliminating, reducing and rationalizing some activities, significant savings were achieved that were able to be applied elsewhere. In this case, savings were directed to finance the cost of the Digicel campaign (VUV 648,000 approximately equivalent to CHF 5,950). This course of action, as detailed in the below table, has been achieved without impact on anticipated outcomes although reach of communications activities to an anticipated 20,000 indirect beneficiaries has been revised down to 10,000. The breakdown below provides specific detail.

A. Situation analysis

Description of the disaster

On November 2016, the Ministry of Health (MoH) has observed an increased reported number of dengue fever cases in the country. Like other Pacific Island countries and territories, Vanuatu is prone to dengue outbreaks and epidemics. The country has experienced five major outbreaks since 1970 – the worst occurred in 1989 with over 3,000 admissions and 12 deaths. Since the 1989 outbreak, the government has upgraded its surveillance and control system and developed dengue preparedness plans. With the rainy season in full effect from November to April, it is feared that this dengue outbreak could expand considerably without appropriate and timely intervention.

As of 9 December, the MoH announced that they would no longer send all cases for testing. Only cases from new sites, severe dengue cases and about two cases per day will be tested to detect potential introduction of new dengue virus serotypes and/or Zika virus and/or Chikungunya virus. The number of confirmed cases may therefore not accurately reflect the true extent of the outbreak. With this current situation, the National Dengue Task Force (NDTF) has issued a press statement to focus on education and awareness as the key preventive measure to control this epidemic. On 30 December 2016, the MoH through the NDTF, established a stratified Orange Alert due to the growing number of cases of dengue fever in the country. Orange Alert for Port-Vila 4 municipal Ward, Yellow Alert for Efate rural areas, Lenakel-Tanna, Luganville-Santo, and Sola-Banks, and Green alert in the remaining areas of country where dengue cases were not reported. Alert levels may continue to vary according to the level of propagation and detection of cases.

As of 19 March 2017, up to 2,043 suspected cases of dengue fever have been reported nationwide to the MoH during the outbreak period. The current dengue epidemic of serotype 2 affects all age groups and therefore is a national threat that warrants national responsibility, public, private and communal response. Two imported cases of Dengue-1 with travel history to Vanuatu were reported by New Caledonia Department of Health and Social Affairs for the period: 01/01/2017 to 03/02/2017. Of the 2,043 suspected cases, 351 have been confirmed positive Forty-four per cent (44%) of positive cases are found among children aged between five and 14, 29.1 per cent are found among those between the ages of 15 and 24, and 17.4 per cent are among those between 25 and 34. Ninetyone per cent (91%) of cases have been found in the population above four (4) years of age.

As at 3 April, total number of cases notified for the two provinces where the EPoA is focused are Shefa 1,271 and Malampa 166. In terms of the two Island locations that the EPoA community mobilization and awareness activities are focused: Emae has had three cases confirmed and 11 cases suspected (source: Emae health center). Malekula has had 166 notified cases (source: MoH website).

According to the data provided by the MoH, dengue cases have showed a downward trend since peaking at the end of January 2017. Data provided by the MoH may have limitations due to issues associated with reporting. Data presented does not take into account unreported cases of dengue. With this current situation, number of cases suspected 2,358 with 446 confirmed, the National Dengue Task Force (NDTF) has issued a press statement to focus on education and awareness as the key preventive measure to control this epidemic.