YELLOW FEVER:YELLOW FEVER:DRAFT CHECKLIST FOR

NATIONAL & REGIONALCONTINGENCY

PLANJack Woodall, PhD

Institute of Medical BiochemistryFederal University of

Rio de Janeiro, Brazil (retd.)(Formerly WHO Geneva)

ASIA

DETECTION CONTROL

FIVE KEY AREAS:1.1.Public informationPublic information2.2.Diagnosis & SurveillanceDiagnosis & Surveillance3.3.Mosquito vector controlMosquito vector control4.4.VaccinationVaccination5.5.Hospitalisation/Health CareHospitalisation/Health Care

WHY PREPARE NOW?

• SHORTENS reaction time when YF emergency arises

• Allows IMMEDIATE implementation of prevention & control measures

• SAVES LIVESSAVES LIVES

PUBLIC INFORMATIONREMEMBER:• Rumours dangerous, cause fear & confusion– NEVER try to cover up a YF outbreak– Provide information to mass media from start

• NEVER try to play situation down by saying– “This is only an outbreak, not an epidemic”– “It is already under control”

• INSTEAD say– “We are taking all necessary steps to protect

you. Here is what you can do to help: 1)... 2)... 3)...”

Actions to take NOW re info (1)Draft press release in all key languages, e.g.:• Q. What is YF? A. Like dengue but worse• Q. How is it transmitted? A. By

mosquitos• Q. How to prevent it? A. By mosquito

control;– community MUST help

• Q. Is there a vaccine? A. Yes– will be provided FREE, first to priority sectors

• Q. What are priority sectors? A. These:1. Health & essential services personnel & families 2. Etc.

Prepare draft press release (in all key languages), e.g.:• Q. What is YF? A. Fever like haemorrhagic dengue • Q. How is it transmitted? A. By mosquitos• Q. How to prevent it? A. By mosquito control;– community MUST help around their houses

• Q. Is there a vaccine? A. Yes -- will be provided first to priority sectors

• Q. Which are priority sectors? A. These:1. Health & essential services personnel (to prevent

them fleeing)2. their families3. etc.

Actions to take NOW re Info (2)

• Design eye-catching LEAFLET giving above info– printer-ready

• Get a WEBSITE ready (hidden until needed)– with same Q&A -- plus• DAILY UPDATE: No. cases, locations, press info• Locations, dates & times of – Vaccination of priority groups– anti-mosquito spraying

• Plan emergency TELEPHONE lines (public info)

DIAGNOSIS & SURVEILLANCEREMEMBER:• Nobody is expecting to see a YF case– cases will be misdiagnosed as dengue, hepatitis or

something else

• No lab test will be requested– in any case, probably not locally available

• YF may not be a reportable diseaseTherefore

YF will NOT be suspected or reportedYF will NOT be suspected or reported

Monkey Surveillance

• S. AMERICA: Monkey die-off VHF cases = YF• AFRICA: Monkeys don’t die human

outbreak that looks like smallpox= Monkeypox

• INDIA (Karnataka): Monkey die-off VHF cases = KFD (Kyasanur Forest Disease)

• (Surat): Ratfall human outbreak = Plague

• ASIA: Monkey die-off VHF cases = YF?

Actions to take NOW re Diagnosis& Surveillance

• Make YF a reportable disease (IHR regs.)• Prepare Case Definitions:

• Obtain travel hx from all VHF suspected cases– Africa or South America travel in last 2 weeks?

• Install rapid YF lab test in key locations– region-wide & nationwide– begin random testing of all haemorrhagic fever cases

• Begin active surveillance for dead monkeys

SuspectedSuspected, , ProbableProbable, , Confirmed Confirmed

MOSQUITO CONTROL

REMEMBER:• YF mosquito is same as dengue mosquito

Therefore • Good dengue control = Good YF control• No evidence that Asian mosquitoes are less

able to transmit YF• Even poorly transmitting mosquitos can

cause large urban epidemics– e.g. Nigeria 1987

Actions to take NOW re Mosquitos• Switch to DDT – temporarily until House Index <1.0

• Identify dengue hot-spots for spray & larvicide• Spray all health facilities & remove rubbish• Spray all cemeteries and vacant lots• Stockpile larvicide & adulticide• Prepare paperwork for priority importation of spray

equipment, insecticide & supplies• Plan for loud-speaker vans to tell neighbourhoods,

ahead of spraying, to leave windows open• Improve rubbish collection

EMERGENCY Action for Mosquitos• Media– use all means to motivate community action

• Spraying, larviciding– mobilise police to help spray teams enter vacant

premises

• Rubbish removal transport– Co-opt community organisations (Lions, Rotary)

– Mobilise military

VACCINATION (1)REMEMBER:• Dengue, West Nile, JE immunity do NOT

protect against YF• YF vaccine – is one of the SAFEST– lasts at least 10 years (probably for life)

BUT– needs 10 days to take effect– needs cold chain

World YF vaccine stock = only 6 million doses

VACCINATION (2)

• Ring VACCINATION is NO USE – because YF is transported by infected

people much further than by mosquitos (Harrington LC et al. 2005 Am J Trop Med

Hyg. 72(2):209-20.• [Ring SPRAYING is useful to protect

neighbours of a case]

• Add YF vaccine to routine EPI programme (but will take years to protect whole population)

Actions to take NOW re Vaccine (1)

• Identify risk groups• Vaccinate priority groups

1. Health, public safety & essential services personnel (to prevent panic flight)

2. Their families3. ...

• Designate priority admin. & economic centres• Designate public vaccination centres (schools, etc.) in

advance• Verify cold chain, prepare for crash expansion

Actions to take NOW re Vaccine (2)• Sources: identify for YF vaccine procurement• Paperwork: prepare for vaccine procurement• Adverse effects– establish case definition– establish reporting system– prepare explanations to allay public concern

IN EMERGENCY, CONVERT ALL EPI VACCINATION CENTRES INTO YF VACCINATION CENTRES

REBUILD REGIONAL YF VACCINE PRODUCTION

HOSPITALS/HEALTH CENTRES WITH BEDS

REMEMBER:• YF NOT transmitted by contact–exception: blood transfusion

• No need for barrier nursing–use routine blood precautions

• ESSENTIAL –mosquito mesh in doors/windows –OR insecticide-treated bednets

Actions to take NOW re Hospitals/ Health Centres

• Mosquito screen isolation ward(s) OR• Stock supply of insecticide-treated bednets• Intensify mosquito control around all health facilities

– including rubbish removal• Update contact info for all health facilities• Arrange for military hospitals to take possible

overflow from civil hospitals

• PLEASE DO NOT PUT THIS IN A FILE & LEAVE FOR A LESS BUSY TIME

• ANY DELAY IN IMPLEMENTATING YOUR NATIONAL PLAN COULD BE

• FATAL – including for YOU – & your family

• LITERALLYLITERALLY

Thank You!