In Angola, keeping yellow fever cases at zero

As the rainy season brings the mosquito that transmits the virus, vaccination and prevention continue to be vital

By Marcos Gonzalez, Heitor Lourenço and Manuel Francisco
Children and women being vaccinated against yellow fever
31 October 2016

After living through the worst outbreak of yellow fever in decades, Angola is celebrating the absence of any confirmed cases since late June. But the battle is far from over. UNICEF and partners continue to support vaccination and prevention initiatives.

LUANDA / CACUSO / CUANHAMA, Angola, 31 October 2016 – At the Lombe health centre in the town of Cacuso, Isabel, 10, sits slightly removed from a group of people who are waiting to be vaccinated for yellow fever. Shy and alone, she looks at the team of vaccinators not knowing what to do.

When one of the staff approaches her, Isabel explains that she had come to get her vaccine, but had not been accepted because she was unaccompanied. “My dad is working and my mom went to the square to sell food,” she says. “She told me to come here because my five brothers already have the vaccine.”

A short time later, a social mobilization team travels to Isabel’s house where they meet her family, who confirm her story. Isabel’s mother authorizes her vaccination, and also promises to go to the health centre herself the next day. Neither she nor Isabel’s father have had the vaccine.

While many children cry when they receive the vaccine, Isabel grins from ear to ear. She returns home happy, with the yellow card that certifies she is vaccinated, as well as some informational brochures to share in her neighbourhood.

UNICEF Angola/2016/Francisco

Isabel with Sónia, a volunteer and social mobilizer, proudly showing the yellow card that proves she has been vaccinated against yellow fever.

The worst outbreak in decades

Isabel is one of the millions of people who have lived through Angola’s worst yellow fever outbreak in decades. From 5 December 2015 – when the first cases appeared – until 13 October 2016, at least 376 people have died as a result of suspected cases of yellow fever.

This year, a combination of rising levels of standing water in the rainy season, the El Niño climate phenomenon, and the concentration of waste from lack of street cleaning has increased the presence of Aedes aegypti mosquitoes. This type of mosquito not only transmits yellow fever, but also dengue, Zika and chikungunya. As a result, yellow fever quickly spread from Luanda to almost the entire country.

International alarms went off when the outbreak spread beyond Angolan borders and other countries began reporting cases. The disease was especially prevalent in the neighbouring Democratic Republic of Congo (DRC), with 77 confirmed cases and 16 deaths.

Health authorities in both countries immediately launched mass vaccination campaigns. The International Coordinating Group on Vaccine Provision for Yellow Fever Control – with representatives from WHO, UNICEF, Médecins Sans Frontières and the International Federation of Red Cross and Red Crescent (IFRC) – approved sending 20 million vaccine doses to Angola and 9.4 million to DRC.

By the end of September, 16 million people over the age of six months had been vaccinated in Angola, which has a total population of 25 million. UNICEF assisted with the procurement and distribution of vaccines, and provided support to the cold chain, including cold boxes, vaccine carriers and ice packs donations.

Girls in the Caculuvale community prepare to receive their yellow fever vaccinations.
Girls in the Caculuvale community prepare to receive their yellow fever vaccinations. UNICEF is working with the Government to prevent further outbreaks during the rainy season.
Zero cases since June

There have been no confirmed cases of yellow fever in Angola since the end of June. This milestone was achieved through the hard work of epidemiological surveillance, laboratory testing, eradication of mosquito breeding sites and social mobilization at the national and provincial levels.

Despite this considerable progress, the outbreak remains a public health issue that warrants continued action and international support. The threat of new cases is especially great now that the rainy season has started, which can increase the presence of the Aedes aegypti mosquito. Vaccine funding therefore remains critical.

WHO, UNICEF and partners continue to provide support to the Angolan Government, and about 2 million people living in densely populated urban or remote border areas are expected to be vaccinated in October.

Another key to prevention is communication and social mobilization among the population. IFRC and UNICEF Angola recruited and trained nearly 3,000 mobilizers to reach thousands of people with messaging on yellow fever prevention and health education at houses, schools or local markets. This direct contact brings reliable information to the population, and helps resolve any doubts or questions about the vaccine.

“At the start of campaigns in Luanda, a large number of men were not being vaccinated. They believed the vaccine could cause infertility, or they could have serious problems to get the vaccine and drink alcohol,” says Camilla Sá Freire, UNICEF communication for development in emergencies consultant. With the help of mass media campaigns and traditional leaders’ support in rural areas, these false beliefs were eventually changed.

Now, in anticipation of the effects of La Niña phenomenon, mobilizers are spreading messages in communities about sanitation, vector control, breastfeeding and handwashing to further prevent yellow fever.

UNICEF Angola/2016/Lourenço

Marta Lobías and her son – the first in the queue to be vaccinated against yellow fever at the community jango. She will continue to spread the word about the benefts of getting vaccinated.

Social mobilization in action

In the province of Cunene in the south of the country, a familiar scene unfolds. Dozens of people wait to be vaccinated at the jango in the Caculuvale neighbourhood, in the municipality of Cuanhama. The jango is a space traditionally used as a forum for debate and discussion in the community. Today it hosts the teams working on the yellow fever vaccination campaign.

In the front of one of the queues, Marta Lobias, 27, is looking forward to receiving the vaccine along with her three-year-old child. She heard about this campaign at her church and did not hesitate to come. She sells chickens in the market, but today she left her business to come to the post. “This is to prevent disease, it is more important,” she says with satisfaction.

After 30 minutes of waiting, Marta and her son receive their immunization, along with 1,000 other people who came to the post today. Now, she returns home with a mission to tell her colleagues in the market and neighbours about the importance of getting vaccinated.