A. Situation analysis
Description of the disaster
Angola is experiencing its first confirmed yellow fever outbreak in 30 years. The first cases were identified in the district of Viana (Luanda province) on 5 December 2015. According to data collected by Cruz Vermelha de Angola (CVA), there have been 277 suspected cases of yellow fever (cumulative) and 65 deaths (CFR 23.5%). The majority of cases have been reported in Luanda. Other affected provinces include Cabinda, Cuanza Sul, Huambo, Huila and Uige. Two previous yellow fever outbreaks in Angola were recorded in 1971 and 1986. Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. There are an estimated 130,000 cases of yellow fever reported yearly, causing 44,000 deaths worldwide each year, with 90 percent occurring in Africa. Vaccination is the most important preventive measure against yellow fever. Yellow fever vaccine coverage in Angola in 2014 was at 77 percent according to WHO and United Nations Children’s Fund (UNICEF), but this was based only on government estimates.
This vaccination coverage is likely to have prevented the disease from spreading more rapidly, however, the country has also previously experienced breaks in the stocks of the vaccine (last in 2013), which have limited the vaccine coverage.
There is a high density of the Aedes aegypti mosquito, the primary vector of yellow fever in affected areas. Surveys conducted by the National Malaria Control Program during 2010–2012 show that Aedes aegypti is present in all 18 provinces in the country except Mexico Province. Thus, the risk of the disease spreading is high. The risk is further exacerbated by the high proportion of susceptible individuals.
The Angolan Minister of Health has recently expressed his concern regarding efforts to control the disease in statements that indicate there is an insufficient quantity of vaccine in the country. He has called on the authorities and organizations to prioritize children and those not previously vaccinated, while acknowledging that in the current epidemic ideally everyone should be vaccinated. In recent weeks, the Government with support from WHO has rapidly scaled up its response and launched a vaccination campaign over the last two weeks in Viana municipality, the hardest hit province. In this campaign, the Government aimed to vaccinate 1.6 million people with vaccines provided by WHO and the Government itself, to a value of 11.9 million euros. CVA has also contributed staff and materials to this intensive vaccination campaign.
The lack of sanitation is believed to be the main cause of the mosquito’s (Aedes aegypti) spread. Previous studies of mosquito populations in Luanda demonstrate that there are high mosquito populations breeding in uncovered water storage. The sanitation situation has worsened due to an economic and financial crisis in Angola, resulting in budgets for rubbish collection being significantly reduced and waste piling up in the poorer areas where the disease was first reported. In general, in most peri-urban, suburban and rural areas, there are currently no waste collection services, resulting in large piles of waste, in some instances blocking the roads.