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YELLOW FEVER: DRAFT CHECKLIST FOR NATIONAL & REGIONAL CONTINGENCY PLAN

ASIA. YELLOW FEVER: DRAFT CHECKLIST FOR NATIONAL & REGIONAL CONTINGENCY PLAN. Jack Woodall , PhD Institute of Medical Biochemistry Federal University of Rio de Janeiro, Brazil ( retd .) ( Formerly WHO Geneva ). DETECTION  CONTROL. FIVE KEY AREAS: Public information

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YELLOW FEVER: DRAFT CHECKLIST FOR NATIONAL & REGIONAL CONTINGENCY PLAN

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  1. ASIA YELLOW FEVER:DRAFT CHECKLIST FORNATIONAL & REGIONALCONTINGENCY PLAN Jack Woodall, PhD Instituteof Medical Biochemistry Federal Universityof Rio de Janeiro, Brazil (retd.) (Formerly WHO Geneva)

  2. DETECTION  CONTROL FIVE KEY AREAS: • Publicinformation • Diagnosis & Surveillance • Mosquito vectorcontrol • Vaccination • Hospitalisation/HealthCare

  3. WHY PREPARE NOW? • SHORTENS reaction time when YF emergencyarises • Allows IMMEDIATE implementationofprevention & controlmeasures • SAVES LIVES

  4. PUBLIC INFORMATION REMEMBER: • Rumoursdangerous, cause fear & confusion • NEVER try to coverup a YF outbreak • Provideinformation to mass media from start • NEVERtry to play situationdownbysaying • “This is onlyanoutbreak, notanepidemic” • “It is alreadyundercontrol” • INSTEADsay • “We are takingallnecessarysteps to protectyou. Here is whatyoucan do to help: 1)... 2)... 3)...”

  5. Actions to take NOW re info (1) Prepare draftpress release (in allkeylanguages), e.g.: • Q. What is YF? A. Feverlikehaemorrhagic dengue • Q. How is it transmitted? A. By mosquitos • Q. How to prevent it? A. By mosquito control; • community MUST help aroundtheirhouses • Q. Is there a vaccine? A. Yes -- willbeprovidedfirst to prioritysectors • Q. Which are prioritysectors? A. These: • Health & essentialservicespersonnel (to preventthemfleeing) • theirfamilies • etc. Draft press release in allkeylanguages, e.g.: • Q. What is YF? A. Like dengue butworse • 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 • willbeprovided FREE, first to prioritysectors • Q. What are prioritysectors? A. These: • Health & essentialservicespersonnel & families • Etc.

  6. 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)

  7. DIAGNOSIS & SURVEILLANCE REMEMBER: • Nobody is expecting to see a YF case • cases willbemisdiagnosed as dengue, hepatitisorsomethingelse • No labtestwillberequested • in any case, probablynotlocallyavailable • YF maynotbe a reportabledisease Therefore • YF will NOT besuspectedorreported

  8. Monkey Surveillance • S. AMERICA: Monkeydie-offVHF cases = YF • AFRICA: Monkeysdon’tdie humanoutbreakthatlookslikesmallpox = Monkeypox • INDIA (Karnataka): Monkeydie-off VHF cases = KFD (Kyasanur Forest Disease) • (Surat): Ratfall  humanoutbreak= Plague • ASIA: Monkeydie-off VHF cases = YF?

  9. Actions to take NOW re Diagnosis& Surveillance • Make YF a reportabledisease (IHR regs.) • Prepare Case Definitions: • Obtaintravelhxfromall VHF suspected cases • AfricaorSouth America travel in last 2 weeks? • Installrapid YF labtest in keylocations • region-wide & nationwide • beginrandomtestingofallhaemorrhagicfever cases • Begin activesurveillance for deadmonkeys • Suspected, Probable, Confirmed

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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)

  15. Actions to take NOW re Vaccine (1) • Identifyriskgroups • Vaccinateprioritygroups • Health, publicsafety & essentialservicespersonnel (to preventpanicflight) • Theirfamilies • ... • Designatepriorityadmin. & economic centres • Designatepublicvaccination centres (schools, etc.) in advance • Verifycoldchain, prepare for crash expansion

  16. Actions to take NOW re Vaccine (2) • Sources: identify for YF vaccineprocurement • Paperwork: prepare for vaccineprocurement • Adverseeffects • establish case definition • establishreporting system • prepare explanations to allaypublicconcern IN EMERGENCY, CONVERT ALL EPI VACCINATION CENTRES INTO YF VACCINATION CENTRES • REBUILD REGIONAL YF VACCINE PRODUCTION

  17. 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

  18. 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

  19. 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 – & yourfamily • LITERALLY

  20. Thank You!

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