WHO | Yellow fever – Ethiopia

On March 3, 2020, the Ethiopian Institute of Public Health (EPHI) reported three cases of suspected yellow fever in Enor Ener Woreda, Gurage Zone, SNNPR. The three reported cases were members of the same household (father, mother and son) housed in a village kebab. Two of the three specimens tested positive nationally by reverse transcriptase-polymerase chain reaction (RT-PCR) and subsequently confirmed by a positive plaque reduction neutralization test (PRNT) at the Regional Reference Laboratory, Uganda Institute for Viral Research (UVRI) on March 28 2020th

In response to positive RT-PCR results, EPHI and the Ministry of Health conducted an in-depth investigation and response, supported by partners including WHO.

As of 6 April 2020, 85 suspected cases have been reported with 6 kebels at Enor Ener Woreda, of which 54 have been reported from Wedesh kebels. Among the total suspected cases, 6 samples tested positive at the EPHI National Laboratory and were referred to UVRI for confirmation.

Public health response

• Epidemiological and entomological studies have been carried out at Enor Ener Woreda since 8 March 2020.
• Rapid activation of the vaccination response was determined. The country quickly launched a reactive campaign from March 26 to March 31, 2020 targeting about 32,000 people on affected and surrounding kebabs (12 kebabs in total).
• A request from the International Coordination Group (ICG) for a large-scale reaction campaign is ongoing.

WHO risk assessment

The risk at national level is assessed as high. Currently outbreak in the Gurage zone, the SNNP is showing a rapid increase in the yellow fever epidemic in rural areas. In the context of virtually no population immunity, the high number of suspected cases reported in a short period of time is of great concern. Of concern is the recent confirmation of an outbreak in cases with no travel history. This is an indication of the existence of suitable factors for the increased incidence of yellow fever transmission and the spread of disease beyond the focus area.

Recent entomological studies, in addition to previous entomological studies conducted in 2018, have shown the presence of competent vectors, including Aedes species, and the potential for spread to surrounding areas. The onset of the rainy season could increase mosquito density, further exacerbating the risk of spreading.

Travelers returning to Ethiopia and who may be infected with a possible high level of virus in the blood may be at risk for establishing local yellow fever transmission cycles in areas where a competent vector is present.

The latest yellow fever epidemic occurred in the SNNP region in August 2018, from a total of 35 cases (30 suspects and 5 confirmed cases) were reported from the Wolayita zone in the SNNP region, Ethiopia. While immunization has taken place in selected aspects of the Wolayit zone, communities in the Gurage zone remain susceptible to yellow fever infection.

There is currently a low risk at regional level due to the limited movement of the population, both nationally and internationally, due to the border controls (air / country) associated with COVID-19.

WHO estimates that the overall risk globally is low.

Tip of WHO

Ethiopia is a high priority country for a strategy to eliminate the yellow fever epidemic (EYE). The introduction of yellow fever vaccination into routine immunization is planned for 2020. Vaccination is an essential means of preventing and controlling yellow fever. In urban centers, targeted vector control measures are also helpful in interrupting transmission. WHO and partners will continue to support local authorities in implementing these interventions to control the current epidemic.

WHO recommends vaccination against yellow fever for all international travelers 9 months of age or older going to Ethiopia. Ethiopia also requires a yellow fever vaccination certificate for travelers 9 months of age or older who come from countries at risk of yellow fever transmission and for travelers who have traveled more than 12 hours through the airport of a country at risk of yellow fever. WHO generally does not recommend vaccination to travelers whose itineraries are restricted to the Afar and Somalia provinces.

Yellow fever vaccination is safe, highly effective and provides lifelong protection. According to the third edition of International Health Regulations (2005), the validity of an international vaccination certificate against yellow fever also applies to the life of the vaccinated person. An increased dose of yellow fever vaccine cannot be required from international travelers as a condition of entry.

The WHO encourages its Member States to take all necessary steps to ensure that passengers are well informed about the risks and preventative measures, including vaccination. Travelers should also be aware of the symptoms and signs of yellow fever and instruct them to seek medical attention quickly if signs and symptoms of yellow fever infection occur.

The WHO has published the guiding principles for immunization activities during the COVID-19 pandemic and is currently developing specific operational guidelines for conducting mass vaccination campaigns in the context of COVID-19. When conditions permit, the EYE Strategy will support the rapid renewal of preventive YF activities in accordance with WHO Guidelines.

WHO does not recommend any restrictions on travel and trade in Ethiopia based on the information available on this epidemic.

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