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Published in: 11/01/2019

Partners join forces in Brazil to eliminate yellow fever epidemics in the world

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Rafaela de Oliveira

Experts, member countries, vaccine manufacturers and other partners from around the world met in Brasilia, Brazil, to help ensure that more than 1 billion people are protected from yellow fever by 2026. The event was organized by the Pan American Organization of Health (PAHO) in conjunction with the Secretariat to Eliminate Yellow Fever Epidemics (EYE) of the World Health Organization (WHO), UNICEF and GAVI - the Vaccine Alliance.

The Annual Partners Meeting of the EYE 2019 strategy, which began on October 28 and ended on October 30, addressed the achievements, challenges and the way forward. WHO Deputy Director General for Emergency Response, Ibrahima Socé Fall, insisted that the risk of outbreaks and the spread of yellow fever persists. "There is a lot of work to do. Fortunately we have a plan. The implementation of mass vaccination campaigns must be accelerated. Our partners and all countries at risk must be fully committed to ensure that we eliminate yellow fever epidemics worldwide by 2026 ".

Yellow fever cannot be eradicated by having a jungle reservoir of the virus, but epidemics can be eliminated if the population's immunity levels effectively increase through mass vaccination and are maintained through routine childhood immunization. Large-scale access to yellow fever vaccines is essential to establish and maintain high levels of immunity.

Socorro Gross, representative of PAHO and WHO in Brazil, mentioned that yellow fever is an important challenge and that all people living or traveling to endemic countries should be vaccinated. He also said that the lessons learned in Brazil are important to share around the world. "Holding this meeting here in Brazil has a very special meaning, because the country has successfully faced outbreaks in the last four years. Either because of its strategies to reach the most vulnerable populations. Whether due to laboratory and surveillance actions. either because of their immunization strategies, including the use of fractional doses. "

This result, added the coordinator of Arbovirus Surveillance in the Brazilian Ministry of Health, Rodrigo Said, was due to the joint work of the federal, state and municipal levels. "If it were not for this collective effort, I am sure that our scenario would have been much worse. Today, we have a better laboratory response, better organized services, better medical care for patients, surveillance models capable of predicting and identifying epizootics ( outbreaks in primates), as well as a greater capacity to intensify actions in the areas where the virus circulates. "

Robin Nandy, UNICEF Immunization Chief, stressed the importance of working in a more integrated way to achieve effective results. "The global trend is to move away from a purely vertical disease approach towards a more horizontal system approach. We don't want to be in a situation where we approach yellow fever in a geographic area today and have measles outbreaks in the same areas for a year. or two later, all due to the same gaps in our ability to provide immunization services. " He added that, instead, it is key to ensure that vertical programs, which serve to address specific disease risks, can also make valuable contributions to strengthen health systems and, therefore, mitigate the risk of all disease outbreaks. preventable by long-term vaccination.

Laurence Cibrelus, head of the EYE Secretariat, said the next steps should now include a stronger link between global and regional mechanisms; Enhanced platforms and tools for continuous participation of partners and personalized contributions, contingency planning and stronger participation of countries / partners to achieve maximum impact at the national level. "We have the mechanisms and the means to advance the strategy and achieve remarkable results, but there are still challenges. We need to make joint efforts to respond to the urgency of preventing yellow fever outbreaks."

Over the next decade, vaccine manufacturers are expected to meet the global demand for more than one billion doses needed to eliminate the risk of yellow fever epidemics.

Africa and the Americas

Yellow fever has resurfaced as a threat to public health in Africa and the Americas. In 34 countries in Africa and in 13 in Central and South America, the disease is endemic throughout the country or in some regions. Africa concentrates the vast majority of cases in the world: every year there are up to 170,000 serious cases of yellow fever, and 60,000 deaths.

During 2018, five countries and territories of the Americas region notified confirmed cases of yellow fever. Brazil was the one with the highest number of cases and deaths. Thus, in the period from July 2017 to June 2018, it reported 1,376 confirmed human cases including 483 deaths, while in the same period for 2018-2019, 91 confirmed cases were reported in the country.

Mamoudou Djingarey, area director of the WHO infectious risk management program in Africa, said there are still many issues in the implementation of the multispace strategy at scale, including "recognition of the increased risk of epidemic yellow fever as a threat to health security and ensure a sufficient supply of vaccines to meet global needs. "

Meanwhile, Sylvain Aldighieri, deputy director of Health Emergencies at PAHO, described the scenario of the Americas and pointed out some of the lessons learned. "Immunization is the key; surveillance of epizootic allows anticipating cases in humans approximately one month in advance; and it is essential to ensure updated knowledge for better clinical management in primary health care," he said. Aldighieri also noted that no yellow fever virus has been detected in Aedes aegypti mosquitoes, something that could possibly indicate a higher risk of transmission of urban yellow fever in the region.

In Latin America, all endemic countries have introduced the vaccine into their routine immunization programs for children nationwide, and have carried out vaccination campaigns for populations residing in risk areas. They also maintain the vaccination of internal and international travelers to risk areas.

EYE strategy

The EYE strategy was developed following the unprecedented yellow fever outbreak that hit Angola in 2016 and later spread to the neighboring Democratic Republic of the Congo (DRC). It was the first time that cases were reported in Asia (11 Chinese workers infected in Angola returned to China). The strategy was designed in collaboration with more than 50 partners to be directed to the countries and regions most vulnerable to yellow fever outbreaks and face the greatest risk of urban epidemics due to the changing epidemiology caused by factors such as environmental degradation and climate change.

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