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SASTM Newsflash - Yellow Fever: Africa (Cameroon - Littoral)


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The Ministry of Health of Cameroon carried out a yellow fever mass vaccination campaign with a reported 94 per cent coverage of the targeted population of 663 900 in 13 health districts considered to be at high risk of yellow fever.


The vaccination campaign was carried out between 27 Aug-1 Sep 2013 in the Littoral Region, following laboratory-confirmation of 2 cases with yellow fever in the area in April 2013. The index case was a 43-year-old woman from Ndom Health district who became ill on 15 Mar 2013.


The patients were laboratory confirmed at the Institute Pasteur of Cameroon by IgM ELISA (antibody) test, which was followed by the seroneutralizing test (PRNT) [plaque reduction neutralization test] for yellow fever by the Institute Pasteur in Dakar, Senegal, a WHO regional reference laboratory for yellow fever.


In 2012, suspected cases were reported from the South-West area which includes North-West, South-West and West regions. These cases were identified as part of the surveillance system which identifies patients with fever and jaundice within the 14 days of onset.


WHO country office has been working with the health authorities in the field investigation and response to the outbreak. There is ongoing surveillance for yellow fever in the country.


GAVI Alliance and the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG*) supported the reactive mass vaccination campaign which covered over 663 900 people in 13 health districts considered to be at high risk for yellow fever, namely Dibombari, Edea, Loum, Manjo, Manoka, Mbanga, Melong, Ndom, Ngambe, Nkondjock, Nkongsamba, Pouma, and Yabassi.


* The YF-ICG is a partnership that manages the stockpile of yellow fever vaccines for emergency response on the basis of a rotating fund.

It is represented by 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 the Secretariat. The stockpile was created by GAVI Alliance.


Communicated by:ProMED-mail


[WHO does not mention if the world stockpile of YF vaccine is being maintained at 6 million doses, or whether it has been restocked to 6 million after the mass vaccinations of millions of people in Darfur, Sudan, Ghana, and the Northern Province of Cameroon after the large epidemics there at the end of 2011 and 2012.


There has been a worldwide shortage of the vaccine in recent months which may have accounted for the serious delay in implementing mass vaccination in the province since March 2013, but I understand the shortage was only of single dose vials. Presumably the world stockpile consists of multi-dose vials. Further details of the stockpile would be appreciated.


There were months of delay before either Cameroon or Ghana reported their 2011 epidemics. Since the Revised International Health Regulations (IHR) came into effect, it seems that country IHR focal points believe that it is no longer necessary to report YF outbreaks to WHO. This is incorrect, and should not be blamed on WHO.


Of concern, this WHO Outbreak News report above, dated 8 Oct 2013, is the 1st YF report from Cameroon WHO since 8 Oct 2010! Yet in the interval, ProMED has reported

31 Aug 2013 Yellow fever - Africa (23): Cameroon 20130831.1914605

25 Apr 2013 Yellow fever - Africa (14): Cameroon, Niger


01 Mar 2012 Yellow fever - Africa (03): Cameroon (NO)


03 Feb 2012 Yellow fever - Africa: Cameroon, Ghana WHO 2011 20120203.1032090


So YF has not been notified by Cameroon to WHO since February last year (2012), and the current outbreak was reported to WHO 7 months late. This is NOT the fault of WHO -- but I wonder what Cameroon believes its IHR focal point's duty is in the case of YF outbreaks?


A location map of Ndom, not far from Cameroon's largest city, Douala (capital is Yaounde), can be seen at <http://www.weather-forecast.com/locations/Ndom>.


Perhaps the index case above had been infected during the outbreak in the Northern Province and travelled to Littoral, where she fell ill.


Cameroon has borders with Nigeria, Chad, Central African Republic, Congo Republic, Gabon, and Equatorial Guinea -- see map at


from all of which countries travellers have probably visited Douala and other places in Littoral province during the intervening months, and returned home. Their home countries would probably have been very interested to receive advance notice of this outbreak.






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