Despite an existing yellow fever vaccine, the disease is widespread in 34 countries in sub-Saharan Africa, with serious outbreaks occurring in recent years. Currently, there is a resurgence of the yellow fever outbreaks in three states in Nigeria – Delta, Enugu and Bauchi.
Experts say the resurgence of disease linked to factors including climate crisis, lack of awareness, citizens thinking that yellow card served only tourists and travellers, and low immunization rate in the country
Viral infection Yellow fever is causing 78,000 deaths per year in Africa. The virus can be transmitted by several mosquito species, or vectors, but the main vector in serious urban outbreaks is the mosquito species Aedes aegypti. Spread through the bite of an infected mosquito, symptoms of the disease include yellowness of the eyes, sudden fever, headache and body pain.
According to the situation report by the Nigeria Centre for Disease Control (NCDC) as at November 11th, 2020 says between the 1st and 11th of November 2020, a total of 222 suspected cases, 19 confirmed cases and 76 deaths have been reported from Delta, Enugu and Bauchi states, noting that most of the cases are males, with age ranging from 1-55 years.
The agency disclosed that Seventy-four suspected cases with 35 deaths were reported from Delta State; 70 suspected cases with 33 deaths from Enugu State and 78 suspected cases with 8 deaths from Bauchi state respectively.
Greg Odogwu, an environmentalist, said that the Nigerian health authorities have become lukewarm about public sensitisation, stating that people are no longer aware that yellow fever is a health challenge; and we now carry on as if it no longer exists. The only time we hear about yellow fever is when we want to travel to certain countries and are required to present the popular “yellow card”.
“The yellow card is the personal certificate of vaccination given to someone who has taken the yellow fever vaccination. The way yellow cards served only tourists and travellers made most Nigerians assume that the epidemic was dead in our country,” he said.
According to Odogwu, the second reason for the yellow fever outbreak is climate change. There is scientific evidence that the burden of yellow fever in Africa is likely to increase even under the most optimistic climate change scenario.
“Just a few months ago, the World Health Organisation released a finding which projects that changing temperature and rainfall across Africa could increase yellow fever deaths by up to 25 percent by 2050. This is according to a new modelling of the burden of yellow fever by scientists at the Imperial College London and the WHO,” he added.
Similarly, Doyin Odubanjo, Public health expert, said that outbreaks events are expected and should have taken more precaution, stating that the country should have had a full scale vaccination programme a few years ago.
We would have prevented this outbreak and this is because we know that it comes in circles almost every ten years; so, we should have done a bit more to be prepared to prevent such an outbreak.
“Ill- preparedness or inadequate preparedness for whatever reason we were not as prepared as it should have been. Sometimes, it also has to do with some key policy makers who may not even approve some certain things which they are supposed to approve because we feel it’s not a threat to us and we do not pay attention to it.
“Nigeria’s poor services and a lack of knowledge about the importance of vaccines have been identified as the biggest challenges. We cannot keep reacting to issues; we have to be proactive to deal with outbreaks in this country. However, lifestyle generally exposes us to infections, partly because the habitants. So, we experience more of human transmission. It is a bit a natural demarcation between human and rodents and of these vectors,” he said.
The yellow fever vaccination was introduced in Nigeria in 2004 as one of the routine vaccines expected to be given to children during routine immunisation. In spite of this, the country is still witnessing outbreaks of the disease.
According to the World Health Organisation (WHO), only about 35 million people have been vaccinated in Nigeria, Meanwhile, the global campaign to eliminate yellow fever epidemics by 2026. In a national 10-year plan, some 75 million people are expected to be vaccinated by 2021.
The increasingly regular occurrence of yellow fever outbreaks is largely because many people are unvaccinated, according to the NCDC.
Chikwe Ihekweazu, director general of NCDC, said Yellow fever is a vaccine-preventable disease. A single vaccination provides immunity for life.
“The yellow fever vaccine is available for free in primary health care centres in Nigeria as part of the national childhood routine immunisation schedule,
“The State Epidemiology Team in the affected states is leading the response with support from NCDC, the National Primary Health Care Development Agency (NPHCDA) and World Health Organisation (WHO),” he said.
Nigeria has been battling successive yellow fever outbreaks since September 2017. The NPHCDA, with assistance from WHO has been applying and obtaining donated vaccines through the International Coordinating Group (ICG) on Vaccine Provision, established in 1997, to manage the provision of emergency vaccine supplies to countries during major outbreaks to conduct reactive vaccination campaigns in response to outbreaks.
However, Nigeria is one of the countries implementing Eliminate Yellow Fever Epidemics (EYE) strategy. This strategy is being steered by WHO, Gavi the Vaccine Alliance and United Nations Children’s Fund (UNICEF), to protect at-risk populations, prevent international spread and contain outbreaks rapidly.
As part of EYE strategy, Nigeria has developed a 10-year strategic plan for the elimination of yellow fever epidemics. Through this strategy, the country plans to vaccinate at least 80percent of the target population in all states by 2026.
Odogwu said by protecting at-risk populations, immunization is considered to be the most important and effective measure against yellow fever. Outbreaks are unusual events that require additional resources and partner support.
“Planning is essential for a successful response in conjunction with close coordination of partners. Rapid containment of an outbreak is essential to prevent amplification into devastating epidemics. It is dependent on early detection and confirmation; emergency vaccine stockpiles and rapid response. All these, the WHO, working with the NCDC, has now deployed in Nigeria,” he said.
