Highlights

As of 19 December 2012, 26% of Nyala’s targeted population as well as 88% of the targeted population of

Forbranga locality in West Darfur were vaccinated against yellow fever during Phase II of the vaccination

campaign. The campaign commenced on 9 December in West Darfur, 17 December in South Darfur, and on

18 December in Central Darfur.

The outbreak has now affected 34 localities in Central, South, West, North, and East Darfur. As of 19 December,

the total number of suspected cases has reached 836, including 168 deaths (case fatality rate of 20.1%).

As part of the emergency response plan, WHO recommended the third phase of vaccination campaign for

approximately 2 million people residing in Kabkabyaia, Edd Elfursan (including Kabum locality), Elwihda,

Shaeriya (including Yassin locality), Eldaen, Rokiro and Um Dukhun.

United Kingdom’s Department for International Development (DFID) is supporting Phase-III of the yellow fever vaccination campaign with USD2.9 million and the United States Agency for International Development (USAID) with USD 500,000. Phases I and II have been supported by CERF, ECHO and the Government of Sweden.

To further asses the epidemic risks in other areas of the country, the national yellow fever risk assessment commenced on 12 December. The final report is expected to be released in February 2013.

Epidemiology Out of 64 localities in Darfur, 34 localities are affected by the yellow fever outbreak. Between 2 September and 19 December, the total number of suspected yellow fever cases has reached 836,

including 168 deaths (CFR 20.1%). About 52.2% of the reported cases are from Central Darfur, 9.5% are from South Darfur, 17.4% are from West

Darfur and 20.3% are from North Darfur. 1.1% of the reported cases are in the age group 0-1.9, 2% is in the age group 2-4.9, 18.3% are in the age group

5-14.9, 54.5% are in the age 15-29.9 and 17.1% are 30-44.9 years and 7% are in the age group of 45 years and above.

In the presence of Sudan’s Health Minister Bahr Idriss Abu-Garda, a memorandum of understanding between DFID and WHO regarding UK’s support for Phase III of the vaccination campaign amounting to £1.8 million (USD2.9 million) was signed by DFID’s Head in Sudan Ben Mellor and WHO Representative in Sudan Dr Anshu Banerjee. Photos courtesy of DFID

Yellow Fever Outbreak in Darfur, Sudan

Situation Report No 14, 20 December 2012 Federal Ministry of Health | World Health Organization

0

5

10

15

20

25

30

35

40

2-S

ep

14

-Se

p

27

-Se

p

3-O

ct

9-O

ct

12

-Oct

15

-Oct

18

-Oct

21

-Oct

24

-Oct

27

-Oct

30

-Oct

2-N

ov

5-N

ov

8-N

ov

11

-No

v

14

-No

v

17

-No

v

20

-No

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23

-No

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26

-No

v

29

-No

v

2-D

edc

5-D

ec

8-D

ec

11

-De

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14

-De

c

17

-De

c

Suspected cases of yellow fever by date of onset in Central , South, West, East and North Darfur between 2 September to 19 December, 2012 (Source FMoH)

0

50

100

150

200

250

W 36 W 37 W 38 W 39 W 40 W 41 W 42 W 43 W 44 W 45 W 46 W 47 W 48

no

of

case

s

Epid Week (W 32--)

Suspected cases of Yellow fever and reported deaths in Central and South Darfur in the period W 36 to W 48 (Source FMoH)

DEATHS

CASES

Table below shows the number of sentinel sites reporting daily and percentage represented against the total number of surveillance sites in Greater Darfur (19 December 2012):

State No. of sentinel sites % of daily surveillance report

Central Darfur 45 84.4%

South Darfur 120 96.7%

West Darfur 88 81.8% North Darfur 68 57.4%

East Darfur 25 100% Total 346 83.8%

Table below shows attack rate (AR), case fatality rate (CFR) and status of laboratory samples per locality in affected localities in Greater Darfur between 2 September and 19 December 2012.

State Locality

No of cases

Attack rate/10000 population

Deaths CFR Laboratory samples Total(+ve YF)(-ve YF) Pd

South Darfur

S.Algabal 9 6.0 7 77.8% 2 0 0 2 Kass 25 11.8 13 52% 11 5 4 2 Mershing 3 1.5 1 33.3% 2 1 0 1 Kubum 8 2.6 1 12.5% 11 0 8 3 Nyala 11 2 1 9.1% 18 2 3 13 Ed Elfirsan 12 4.4 1 8.3% 7 1 2 4 R. Albirdy 5 1.7 1 20% 2 0 1 1 Shataia 1 2.4 0 0% 0 0 0 0 Alsalam 4 4.1 1 25% 4 1 2 1 Tulus 1 0.8 0 0% 1 0 1 0 Belail 1 0.5 0 0% 0 0 0 0 Sub Total 80 2.4 26 32.5% 58 10 21 27

Central Darfur

Zalingei 153 50.1 29 19% 9 4 5 0 Wadisalih 57 32.8 14 24.6% 5 5 0 0 Azoom 73 161.5 24 32.9% 6 4 2 0 Nertity 101 73.1 24 23.8% 19 4 6 9 Mukjer 18 18.5 0 0% 1 1 0 0 Bendisi 13 24.9 1 7.7% 1 1 0 0 Um Dukhun 16 11.9 3 18.8 % 0 0 0 0 Rokoro 6 5.0 0 0% 0 0 0 0 Sub Total 437 40.9 95 21.7% 41 19 13 9

West Darfur

Genaina 27 9 6 22.2% 8 3 5 0 Beidha 34 9.8 10 29.4% 2 2 0 0 Habila 17 35.2 12 70.6% 2 1 1 0 Kernik 51 68.1 7 13.7% 7 4 2 1 Forbranga 9 13 0 0% 5 3 2 0 Jebel Moon 3 6.8 0 0% 2 0 1 1 Sirba 5 7.5 1 20% 3 0 3 0 Sub Total 146 14.7 36 24.7% 29 13 14 2

North Darfur

Saraf Omra 8 6.2 1 12.6% 5 3 2 0 Alseraif 157 223.5 8 5.1% 40 7 22 11 Kebkabyia 2 0.9 0 0% 28 2 22 4 Waha 1 2.9 0 0% 0 0 0 0 Elfashir 2 0.3 0 0% 1 0 1 0 Sub Total 170 5.3 9 7.3% 74 12 47 15

East Darfur

Assalaya 1 1.1 1 100% 1 0 1 0 Elddaen 1 3.4 1 100% 1 1 0 0 Yassin 1 3.4 0 0% 1 1 0 0 Sub Total 3 3.4 2 66.7% 3 2 1 0

Grand Total 836 9.9 168 20.1% 205 56 96 53

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

fever bleeding vomiting headache joint pain Jaundice

Patients presented to health facilities with common symptoms. The most frequent symptoms are fever which is present in 95.3 % of the cases, bleeding in 45.3%, and jaundice in 45.5%. Figure (below) shows details of frequently reported symptoms.

Actions taken As of 19 December 2012, 19% of South Darfur targeted population (Nyala, Elsalam, Belail), 88% of the targeted

population of West Darfur (Forbranga), Bendisi 4% and Mukjer 5% of Central Darfur were vaccinated against

yellow fever during Phase II of the vaccination campaign. The campaign commenced on 17 December in South

Darfur, on 9 December in West Darfur and on 18December in Central Darfur.

Non-government organizations (ADRA, ARC, ICRC, IMC, Merlin, MSF-B, MSF-CH, MSF-E, SC-S, WVI) supported

Phase 1 and are supporting Phase 2’s operational costs for yellow fever vaccination campaigns. Till date they have contributed around USD 450,000.

Technical support teams from FMoH remain on ground in Central, South and West Darfur to continually conduct active search for new cases, as well as entomological surveys in affected areas. Blood banks in affected areas and localities where most cases are referred to have been prepositioned with required blood units, as well as laboratory supplies necessary for blood transfusion.

State Phase-I Phase-II

Locality coverage % Locality coverage %

West Darfur

Habila 94% Forbranga 88% Krenik

Geneina Beidha

North Darfur

Saraf Omra 97% - Alseref

Central Darfur

Azum 96% Mukjer 5% Wadi Salah Bendisi 4% Zalengei Nertiti

South Darfur

Kass 98% Nyala 26% Elsalam 14%

Jebel Marra Belail 8%

The national yellow fever risk assessment to explore the epidemic risk in other areas of the country started on 12 December and field work will continue until 29 December. Laboratory analysis will be done at the Central Public Health Laboratory with support from WHO Collaborating Centre Pasteur Institute in Dakar. The final report is expected to be released in February 2013.

The table below shows donors' support till date for the yellow fever vaccination campaign and case management.

Donor Amount

Central Emergency Response Fund (CERF) 2.6 million USD ECHO (European Commission’s Humanitarian Aid) 775,000 Euros Government of Sweden 1.5 million USD United Kingdom’s Department for International Development (DFID)

2.9 million USD

United States Agency for International Development (USAID)

500,000 USD

Recommendations There is a need to increase the sampling rate of suspected cases from all localities in order to better

characterize the outbreak, its spread and inform on vaccine need. WHO recommends that a detailed analysis and synthesis of all accumulated data be done as soon as possible

to determine the extent of YF virus circulation and guide further interventions.

Chad

Central African Republic

North Darfur

South DarfurEast Darfur

Central Darfur

West Darfur

Kutum Mellit

El Radoom

Sunta

Sheiria

Klaimendo

Bahr El Arab

El Kuma

Um Dafug

Katayla

El Taweisha

Gerida

Tawilla

KornoiKulbus

Buram

Niteaga

Um Buru

Alwehda

El Ferdous

Dar El Salam

Umm Keddada

El FasherCases: 2,

Lab_Sample: 1,+Ve_YF: 0

Wadi SalihCases: 57,

Lab_Sample: 5,+Ve_YF: 5

MukjarCases: 18,

Lab_Sample: 1,+Ve_YF: 1

ZalingeiCases: 152,

Lab_Sample: 9,+Ve_YF: 4

Ailliet

KereinikCases: 49,

Lab_Sample: 5,+Ve_YF: 4

El SireafCases: 157,

Lab_Sample: 22,+Ve_YF: 7

Dimsu

Rahad El BerdiCases: 5,

Lab_Sample: 2,+Ve_YF: 0

Ed DaeinCases: 1,

Lab_Sample: 1,+Ve_YF: 1

El SalamCases: 4,

Lab_Sample: 3,+Ve_YF: 1

Umm DukhunCases: 16,

Lab_Sample: 0,+Ve_YF: 0

KebkabiyaCases: 2,

Lab_Sample: 2,+Ve_YF: 2

YassinCases: 1,

Lab_Sample: 1,+Ve_YF: 1

KassCases: 25,

Lab_Sample: 8,+Ve_YF: 5

El Malha

Ed El FursanCases: 11,

Lab_Sample: 15,+Ve_YF: 1

Jebel MoonCases: 3,

Lab_Sample: 1,+Ve_YF: 0

BielelCases: 1,

Lab_Sample: 1,+Ve_YF: 0

AzumCases: 72,

Lab_Sample: 6,+Ve_YF: 4

KubumCases: 8,

Lab_Sample: 9,+Ve_YF: 0

El Tina

Sharq Jabel MarraCases: 9,

Lab_Sample: 0,+Ve_YF: 0

NertitiCases: 101,

Lab_Sample: 10,+Ve_YF: 4

SirbaCases: 5,

Lab_Sample: 4,+Ve_YF: 0

Abu Karinka

Abu Jabra

El GeneinaCases: 27,

Lab_Sample: 8,+Ve_YF: 3

BindisiCases: 13,

Lab_Sample: 1,+Ve_YF: 1

HabilaCases: 17,

Lab_Sample: 2,+Ve_YF: 1

BeidaCases: 34,

Lab_Sample: 3,+Ve_YF: 2

MarshangCases: 3,

Lab_Sample: 2,+Ve_YF: 1

RokoroCases: 6,

Lab_Sample: 0,+Ve_YF: 0

Saraf OmraCases: 8,

Lab_Sample: 3,+Ve_YF: 3

ShattaiCases: 1,

Lab_Sample: 0,+Ve_YF: 0

AssalayaCases: 1,

Lab_Sample: 1,+Ve_YF: 0Tullus

Cases: 1,Lab_Sample: 0,

+Ve_YF: 0

Foro BarangaCases: 9,

Lab_Sample: 5,+Ve_YF: 3

Nyala NorthNyala

Cases: 9,Lab_Sample: 8,

+Ve_YF: 2

Yellow Fever outbreak in Darfuras of 18 December 2012

Disclaimer: The presentation of material on the map contained herein does not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or areas or its authorities of its frontiers of boundaries.IMPORTANT:This map is used for planning purposes ONLY, state boundaries between West and Central, South and East Darfur States ARE NOT FIELD VERIFIED, and have been demarcated based on the locality boundaries stated by the Government of Sudan website (www.sudan.gov.sd). Localities boundaries ARE NOT FIELDVERIFIED and continuously being updated.

HISU-SUDANMap Ref.:2012-0053

North Darfur

South DarfurEast Darfur

West Darfur

Red Sea

SudanChad

Ethiopia

LibyaEgypt

Eritrea

Saudi Arabia

Central African Republic

NorthernNile

Red Sea

Northern KordofanGedaref

Kassala

Southern Kordofan

Sennar

Blue Nile

White NileEl Gezira

Khartoum

South Sudan

LegendYF-Cases

1 Dot = 1Cases

States Boundary-UnverifiedInternational BoundaryOther Darfur Locality

VaccinationVaccinated LocalityVaccination Target Phase 2Vaccination Target Phase 3

0 10 20 30 405 Kilometers

Data Source: Epidemiology and Zoonotic Diseases Directorate -Sudan Federal Ministry of Health &WHO- CDC Dec 2012.Printing Date: Dec 19,2012For further information or comments please contact us at:HISU@sud.emro.who.int. F