By Charly Agwam – Bauchi
The scourge of Yellow Fever has become a reccuring event in Bauchi state. As recent as November 2020, an outbreak of the disease claimed eight lives in Ganjuwa local government area. According to the Bauchi State Primary Healthcare Development Agency (BSPHCDA), 23 people died from yellow fever attack, the previous year.
In its 2019 report on Yellow Fever in Nigeria, the World Health Organization (WHO) noted that Nigeria is responding to successive yellow fever outbreaks, with nearly a three-fold increase in number of confirmed cases in 2019 compared to 2018, suggesting intensification of yellow fever virus transmission.
WHO said, of the total 3,547 samples taken, 207 tested positive for yellow fever by Immunoglobulin M (IgM) in Nigerian network laboratories. In addition, 197 samples from 19 states were confirmed positive using reverse transcriptase polymerase chain reaction (RT-PCR). The case fatality rate for all cases (including suspected, probable and confirmed) is 5.1%, and 12.2% for confirmed cases.
“Sixty-eight per cent (134 cases) of the total (197 cases) confirmed cases were reported from four states, including Bauchi, Katsina, Edo and Ebonyi. Cases in Edo state have declined after a reactive vaccination campaign in late 2018. From 1 January through 10 December 2019, a total of 115 confirmed cases and 23 deaths were reported from Bauchi (62 cases), Katsina (38 cases) and Benue (15 cases),” WHO stated. “These cases tested positive by RT-PCR at national laboratories and/or RT-PCR and serologic tests at a regional reference laboratory, Institute Pasteur Dakar (IPD). Further epidemiological investigations are underway.”
Like in other yellow fever prone states, the government of Bauchi state has, at various times, launched vaccination exercise to control the spread of the disease in the state, however, much of the responses have been reactive and restricted to only the affected population.
“A targeted response has been implemented in Alkaleri Local Government area (LGA) in Bauchi state. However, reports of ongoing transmission indicate that more vaccination and a wider geographical scope is needed,” the WHO report added.
In response to the outbreak of yellow fever that caused the death of eight people in Ganjuwa local government area last month, Chairman of the Bauchi State Primary Healthcare Development Agency, Dr. Rilwanu Mohammed promised yet another round of vaccination – only for the affected population.
“Our polio team were in communities in Ganjuwa for routine exercise and they found out that eight people died of unknown disease, so they reported back. Eight samples were brought for lassa fever and yellow fever tests. However, all the samples tested positive for yellow fever. Last year, by this time, we had cases of yellow fever in six LGA of Bauchi, Alkaleri, Warji, Ningi, Kirfi and Darazo. We will begin a vaccination exercise in earnest against the deadly disease in Ganjuwa LGA,” he said.
Meanwhile, medical experts are urging the Bauchi and other affected states to expand the yellow fever vaccination to a wider geographical scope in order to prevent future outbreak of the disease in the state, and build laboratories with optimum testing capacity to test samples of suspected cases and minimize deaths.
Dr. Daniel Anaeze, a consultant epidemiologist urged the government of Bauchi state to carryout a rapid yellow fever vaccination coverage assessment to ascertain the vaccination needs of the population and build laboratories across the state, capable of handling and testing suspected yellow fever samples.
“The reoccurrence of yellow fever in Bauchi and few other states is a thing of concern. The yellow fever vaccine has been around for some years. Immunization is now the most effective method of prevention of yellow fever, supplemented with prevention of mosquito bites. The Bauchi state government needs to, as soon as possible, carryout a yellow fever vaccination coverage assessment to know the vaccination needs of the population.
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“There is also a need to expand the vaccination to include as many people as possible. This can only be done by building more laboratories to increase its testing capacity. However, there needs to be thorough sensitization of the public, because up till now, some people still see vaccination through the lens of ignorance and baseless myths,” he said.
Dr. Anatu Ibrahim, a medical doctor who is into private practice noted that even though vaccination against yellow fever is important, not everyone can take the vaccine.
“Yellow fever is a viral hemorrhagic fever that is transmitted by mosquitoes. If these mosquitos, mainly the Aedes and Haemogogus species bite a monkey that has the fever, they can pass it to humans which can lead to outbreaks. And people who live in jungles, are most affected, like the situation in Bauchi where most of the affected areas are close to forests.
“It is a condition that can lead to a high fever, bleeding into the skin, and cell death in the liver and kidneys. It damages the liver cells, leading to jaundice, a condition in which the skin becomes yellowish in color. It is an acute, systemic disease that starts suddenly and affects the whole body. Symptoms of the disease include; high temperature, slow pulse, albuminuria, jaundice, congestion of the face, and hemorrhage, or bleeding.
“However, as much as vaccination is the surest way out, since there’s no cure yet, not everyone can take the yellow fever vaccine. It can cause adverse effect in some people. Those who have compromised immune system like HIV, or those with cancer, specific allergies, older people (65 years and above) and children younger than 9 months old can not take the vaccine. Of course, the government needs to conduct a yellow fever vaccination coverage assessment before the vaccination exercise in the state,” she noted.
In Africa, out of 54 nations, only five countries; Eritrea, São Tomé, Somalia, Tanzania and Zambia have low potential for exposure to yellow fever virus (YFV)1, WHO said in its 2017 report on Africa. These countries are not holoendemic (only a portion of the country has risk of yellow fever transmission).
Although the yellow fever vaccine is free for children from 9 months old and is available as part of the routine childhood immunisation schedule in government-owned/public health facilities across the country, it costs about 2,000 NGN ($4) for adults not covered in the mass vaccination campaigns to access the vaccine.
The NCDC says only registered Yellow Fever Vaccination Centers like Passport Health can give the yellow fever vaccine and provide the International Certificate of Vaccination (“yellow card”) to travelers and other individuals. However, for a nation with half of its population living below one dollar per day, it’s a long shot for poor people to access yellow fever vaccine, except if government intervenes.
Notably, a national rapid response team has been deployed to Bauchi and other affected states to support the outbreak response activities including surveillance, case management support and risk communications. However, Bauchi state and other yellow fever disease-prone states have to move from reactive to a more proactive approach in responding to yellow fever attacks in order to prevent future outbreaks and deaths.