![\"nora_hellman\"](\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/08\/nora_hellman-150x150.jpg\")
Responding to an outbreak of yellow fever is not as exotic as you may imagine.<\/p>\nResponding to an outbreak of yellow fever is not as exotic as you may imagine.<\/p>\n
What kind of exciting and interesting things do you do as an emergency response nurse with Save the Children’s emergency health unit in the Democratic Republic of Congo (DRC) the day before one of the largest ever vaccination campaigns in Africa starts? Label things. 204 vaccine carriers, to be exact, carefully labelled in permanent marker. In a response of this scale the details are important\u2014a label could make the difference between life and death.<\/p>\n
The yellow fever outbreak has required an immense amount of planning as the virus has the potential to spread rapidly in DRC, and beyond, for a number of reasons:<\/p>\n
Urban transmission<\/span>. Kinshasa is a city with an estimated population of 10 million people, although the last census was completed in the 1980s and some estimate it is millions more. Kinshasa is densely populated and a breeding ground for the Aedes aegypti<\/em> mosquito, a day biting species and the vector for Yellow Fever.<\/p>\n Limited immunity among the adult population<\/span>. Yellow Fever immunization was only integrated into the national Expanded Program on Immunization in 2003. At least seven million people in Kinshasa have never received the vaccine, leaving an incredibly large number of people susceptible to the disease.<\/p>\n Population movement<\/span>. The movement of adults to find work and support their families is common, and the border with Angola\u2014where the outbreak began and where 80% of the current cases in DRC originated\u2014is relatively porous, further increasing potential for the spread of the disease.<\/p>\n And so with a potential public health emergency looming, a target population of over 340,000 people, and an agreement to support the Ministry of Health\u00a0to run 102 vaccination sites\u2014we planned. And we labelled things. And now it has begun. And the response has been overwhelmingly positive so far.<\/p>\n At vaccination sites there are crowds of people, eager to get the vaccine. Even children, not typically excited to get stuck with a needle, are lined up patiently waiting their turn.<\/p>\n Results from a household cluster survey to assess coverage show that by day five\u00a0of a ten\u00a0day campaign we are rapidly approaching 80% of coverage.<\/p>\n Responding to a disease outbreak might not be as exotic as you imagine, but it is crucial that the necessary resources and support are provided to local health staff and the MoH. Technical supervision, cold chain and waste disposal management, and real time data collection are all essential to improve quality and assure adequate vaccination coverage.<\/p>\n I am proud to be part of Save the Children\u2019s Emergency Health Unit\u2014a team of doctors, nurses, water, and sanitation engineers, logistics specialists, and other experts in the field of public health and emergency response\u2014supporting the Yellow Fever vaccination campaign in Binza Ozone, Kinshasa. And if I am honest, I actually love labelling things.<\/p>\n![\"vaccine_carriers\"](\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/08\/vaccine_carriers-300x200.jpg\")
Vaccine, or lack of it<\/span>. Despite the fact that there is a highly effective vaccine\u2014immunity is conferred in one week for 95% of people after one dose\u2014there are only four manufacturers in the world and vials take over a year to produce. The global stockpile will not meet the needs of this outbreak, so an innovative strategy of fractioned dosing is being implemented. There is evidence this will protect people for at least a year\u2014buying some time to produce more vaccine.<\/p>\n