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Angola: Epidemic (Yellow Fever) Emergency Plan of Action Preliminary Final Report (MDRAO006)

Situation Report
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A. Situation analysis
Description of the disaster

At the launch of the Emergency appeal, Angola was experiencing the largest outbreak of yellow fever in 30 years. The strain of the yellow fever virus was closely related to a strain identified outbreak in Angola in 1971. The outbreak was detected in Luanda in late December 2015, with the first cases (hemorrhagic fever suspected as being yellow fever) were reported in Eritrean visitors beginning on 5 December 2015 and confirmed by the Pasteur WHO reference laboratory in Dakar, Senegal, on 19 Jan 2016. On 20 January 2016, the health minister of Angola reported 23 cases of yellow fever with 7 deaths among Eritrean and Congolese citizens living in Angola in Viana Vila, a suburb of the capital of Luanda.

As of the 15th of July 2016, according to WHO`s situational report, Angola reported 3,116 suspected cases of yellow fever with 361 deaths with a Case Fatality Rate (CFR) of 10%. Among those cases, 877 were laboratory confirmed.

WHO implemented Incident Management (IM) system and coordinated multi-agency teams to respond to the epidemic. Since the beginning of the outbreak all 18 provinces of Angola reported suspected cases, placing all provinces at risk, indicating limited surveillance. The capital of Angola, Luanda, reported the majority of cases, with 489 laboratory confirmed cases (58%) of local transmission. The outbreak was classified as an urban cycle of yellow fever transmission, which can spread rapidlyAn immediate response was launched by the Angolan Ministry of Health and its partners. Despite initial efforts, the outbreak rapidly increased in size and scale, spread across the country and resulted in exportation of cases to at least four other countries. This exportation 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 was complicated by both the limited vaccine supply and the outbreaks in DRC, and a concurrent but separate outbreak that occurred in Uganda. 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 other countries increased the complexity and urgency of the response to the outbreak in Angola and the surrounding countries.

The Angolan Ministry of Health began a campaign of preventive measures including vector control and vaccination in Viana in the first week of February 2016, in partnership with the World Health Organization (WHO).The Ministry reported that the government had enough vaccine for routine vaccination, but not to contain an outbreak. WHO supported the government in the immunization campaign and by the 19th of September 2016 people were vaccinated in 73 municipalities of 18 provinces in Angola with a cumulative number of 17,917,134 (70% of total Angolan population).

A second phase of the vaccination campaign in Angola was announced in the WHO situation report of 23 September, planned to be implemented in 16 new municipalities in 2017, contingent upon the availability of vaccination doses, to cover 100% of the target population with the Yellow Fever vaccine.
An initial DREF allocation was approved on the 23rd of February 2016 to support Angola Red Cross to assist emergency vaccination efforts through social mobilization activities. A second allocation was approved on the 6th June 2016 to extend the timeframe of the operation and to provide additional technical resource through the deployment of a Regional Disaster Response Team (RDRT) member.

However, given the size and scale of the outbreak and the response required to support the national planned response, 3 FACT team members were deployed on the 13th of June 2016 to ensure quality of implementation. An emergency plan of action was developed by the FACT team and CVA describing a detailed a comprehensive response. This plan was launched as an Emergency Appeal on the 1st of July to the tune of CHF 1,443,961 to support social mobilization activities carried out by the RC volunteers linked to vaccination campaigns, in addition to emergency health, water, sanitation and hygiene promotion activities and to support National Society capacity building.

To date in Angola, a new phase of the vaccination campaign, targeting more than two million people in 12 districts of 10 provinces, was launched early in June 2017. It is very important to conduct a good quality and continued vaccination campaigns to at least 90% of the population in order to have effective preventative controls despite the reality that no confirmed cases have been reported since 23 June 2016 and the Government officially declared the end of the disease spread in December 2016. However, Angola remains vigilant for more cases.