A sudden outbreak of Yellow Fever in Nigeria’s Southern Delta State claimed 22 lives last week while additional cases are being currently managed at the government hospital in Asaba, the State’s Commissioner for Health, Dr. Mordi Ononye said penultimate Friday. According to health authorities, Yellow Fever is a potentially deadly disease with no cure. Dr. Adeyemi Olusola of the Holy Family Catholic Hospital, Festac Town, Lagos, in an interview with CONSTAINCIA URUAKPA said Yellow Fever is a disease that kills within a very short period, “I think about seven to ten days when it becomes very bad, most people die. So, probably, that’s why they had a very high death rate within a short period.” The medical professional said vaccination is the most important means of preventing the fever and that most people who are not vaccinated living mainly in the tropical regions are at risk of being infected. He speaks further on the symptoms, diagnosis, prevention and treatment. Excerpts.
Despite the relatively low incidence in Yellow Fever in recent decades, following the effective vaccination campaign, the fever was recently identified as source of over 30 deaths within two weeks in three communities in Delta State. What you think triggered this outbreak? How come it took 30 persons to die before the Delta State Government health authorities realised it was yellow fever?
Well, concerning the government getting to know a bit late, the thing about most of these diseases is that they mimic a lot of common illnesses we have in our environment, like the normal Malaria fever, all those things you have. So, they mimic them a lot. So, most of the symptoms are very similar, except when it gets to the complicated case when you see some involvement of some organ and some other symptoms, which might be suspicious of it. The other fact about it, is the test; the WHO confirmatory lab is not in Nigeria; it’s in Dakar, in Senegal. So, for them to transport the samples to Dakar and get the result back, it takes time. So, that might be a factor with it.
Then, for you to have an outbreak recently, it’s possible because the truth is that it’s common within this tropical environment which is within the African Tropical Region. That’s why we are having it more within our axis; due to the geographical distribution, West Africa has more of the tropical region. And that’s why it’s common within the tropical region of Africa. So, the State government getting to be notified of the disease, people telling others of their illness takes time because most of the time, people are not enlightened about Yellow fever to an extent.
So, that might be the factor with having that kind of issue occurring. Most times, a lot of factors come into play in situations of this nature. I think probably awareness from people, trying to notify the local government, the state government about the disease, and the time it takes before one is been tested; all these could be factors that contributed to that delay.
And Yellow fever is a disease that kills within a very short period; I think about seven to ten days when it becomes very bad, most people die. So, probably, that’s why they had a very high death rate, and that within a short period. The disease has a very short incubation period, that’s about three to seven days. Initially, sometimes, people would think it’s ordinary Malaria that they have, before they get to the hospital from where they are referred to the tertiary institution where most of these tests are being carried out, and treatments are being done, their health situation would have worsened. We have a lab here in Nigeria where they do the test, but they will still have to do a WHO confirmation before they start pronouncing that it’s a public notification disease within the region. So, I think that might be a factor with what happened.
Has there been any study relating Yellow Fever with ethnicity?
Well, the study attached to Yellow fever is just the tropical region that is attached to the Western African Region. There’s nothing about ethnicity in the disease because it can affect any part of the country especially the tropical region. In Nigeria, we have about 16 States that were reported within the North, the South-South; Kwara State was a bit involved. There was a spread within those regions. The disease is not particular to any ethnic group; it’s just that it’s perculiar to some tropical regions. That’s why you have more in the western region part of Africa.
The tropical region is known to be a habitat of most mosquitoes, which is the main carrier of the disease. There are specific mosquitoes; the Aedes species, they are the ones involved in the spread of the disease. So, it’s does not have anything to do with ethnicity or a group of people, but a tropical region issue. What enhances the breeding of this particular mosquito? Like I said, the disease is common in the tropical region. The tropical region has more forests, that encourage the breeding of Aedes mosquitoes, and that’s why also Africa is known for more Malaria because of the mosquitoes that it breeds in our environment.
Although you said the symptoms are similar to that of other illnesses like Malaria fever, but it’s very important for us to look at the symptoms. What are the symptoms?
Yes, the symptom starts from mild to severe cases. At the initial stage one can have normal headache, loss of appetite, fever, muscle pain, nausea, vomiting. Yellow fever is a hemorrhagic disease. What I mean by hemorrhagic disease is a bleeding disorder disease. So, you could start having bleeding from the nose, the eyes, the mouth, and even sometimes, the patient could have dark yellowish urine because of the state of it. So, those are the symptoms you could see. And it could last within a very short period because it has an incubation period of about three to seven days. So, sometimes, people just present the mild symptoms, but later when they come down, they come down with the severe symptoms.
That’s when you start having bleeding from the orifice; the nose, the mouth, and even sometimes when some people with the disease vomit, you see them vomiting blood, they experience abdominal pain, dark yellowish urine. Those are the symptoms you have with them. Then, the yellowness of the eyes and the skin is a very classical thing about Yellow fever. It has the yellowness attached to it, irrespective of whether you have all the other symptoms there. Most times, it mimics some diseases like hepatitis where you have yellowness of the eyes, fever, vomiting and even in Malaria too, you have fever, vomiting, body pains, which are still similar symptoms at the early stage.
Is there a cure for yellow fever?
Yes. The thing is this; when patients come down with the disease, there’s no cure, so, you treat patients symptomatically. When they come with dehydration, you try to hydrate the body, when they have bleeding, then, you try to control the bleeding. Then when they have fever, you try to knock down the fever, stop the vomiting, muscle pain, e.t.c. So, you try to manage the patient symptomatically, and at the end, try to ensure there is no organ damage before it gets to that complicated case. So, try to manage all those symptoms gradually. Rehydrate the person, balance the electrolyte in the body, which the person is losing, stop the bleeding in the way you can. Probably give some treatment and all the things to help to stop the bleeding and all other symptoms.
Are there preventive measures that people can take against Yellow fever?
Yes, there is a lot of prevention for it. The first way of preventing Yellow fever is by vaccination. The other one that I think is important is like I said, it’s a tropical disease, and it’s being spread by mosquito, which is the vector. So, the moment we can control our environment, we control the spread of mosquito too, it helps because if you are being vaccinated, and you are trying to do an environmental control, controlling your environment with the spread of mosquitoes around, it goes a long way to prevent the spread of the Yellow fever disease.
Are there contraindications for Yellow fever vaccine? Who shouldn’t take it?
Yes, there are contraindications to it. One, the vaccine is meant for people nine months and above. A child below nine months can’t take the vaccine. So, children of seven, eight, below nine months can’t take it. From nine months up to old age can take it. Then also, there are some people that might not be able to take it. When a patient is a mono-suppressed, i.e. the immune system is very, very down. So, patients like that might not be able to take it. Probably some might have AIDS already; the immune system is really down, and very symptomatic with AIDS.
So, you can’t give those kind of people the vaccine. And some other mono-suppressed state; maybe some organ, some other form of disorders could make the immune system very low. So, you can’t give those kinds of people the vaccine. Following the outbreak in Delta State, the Federal Government announced that with the support of WHO and Gavi, the Vaccine Alliance it will launch the accelerated series of preventive vaccination campaign to protect Nigerians against yellow fever. The fourth phase will target more than 30 million people in seven States, and complete the pending 2019 phase in Anambra.
Why was the campaign stopped in the first place? Considering the population of these seven States, how far can the target of 30 million people go?
Well, for that one, I might not be able to answer it in detail because am not into their system, but what I think must have happened is that; firstly, there must have been people trying to see if there is an outbreak of disease in the offing because I could remember there was a WHO programme on it in 2016 or 2017 or so. I think they are trying to work, trying to detect the stuff in Africa. So, they are trying to know if there is an outbreak in Africa; i.e. is the Yellow fever coming up gradually within African region because it’s common within the tropical region. So, I think they have been trying to work with other partners to ensure they try and vaccinate a lot of people. So, I think the reason it has been pinned down to seven States is because those States were the States with the highest incidence of the Yellow fever.
So, they are trying to vaccinate as much people within that community because when there is an outbreak, you work on people around that area, to ensure you prevent them from spreading it to another community. The truth is, when someone is having Yellow fever, and is not vaccinated, it becomes easy to get it transmitted with a mosquito bite. So, that is the thing; that’s why they vaccinate people around the seven major States, which have been seen as having the highest incidence of the disease. So, that is why they had to do that to ensure they work on it very well to vaccinate those states as fast as possible, to prevent the spread to other area, and to also contain the outbreak rapidly.