Yellow Fever Outbreak in Liberia, One Confirmed Case Reported from Sacleapea 04/04/08 - FPA Staff Report Monrovia - The Liberian Government has announced the outbreak of Yellow Fever in Liberia. Making the disclosure, Deputy Health Minister and Chief Medical Officer of Liberia, Dr. Bernice Dahn said a suspected case of the disease was reported in Sacleapea, Nimba County on March 6, 2008.    Dr. Eugene Nyarko, Representative, World Health Organization(WHO Country Representative, Liberia)   Dr. Bernice Dahn (Chief Medical Officer) She said specimen from a male infected with the suspected disease was brought to Monrovia and tested with a positive result. To confirm this positive result, the specimen was later sent to Dakar, Senegal which further confirmed the case as positive. Dr. Dahn said due to the deadly nature of the disease, international health regulations require that one confirmed case of yellow fever constitutes an outbreak. She noted that besides that one case, no other case has so far been reported to the Ministry of Health as yet, stressing that the confirmed case in Sacleapea could possibly be an isolated situation.  ABOUT YELLOW FEVER   Yellow fever virus, a flavivirus, is transmitted to humans through the bite of infected mosquitoes. Illness ranges in severity from a self-limited febrile illness to severe hepatitis and hemorrhagic fever. Yellow fever disease is diagnosed based on symptoms, physical findings, laboratory testing, and the possibility of exposure to infected mosquitoes. There is no specific treatment for yellow fever; care is based on symptoms. Steps to prevent yellow fever include use of insect repellent, protective clothing, and vaccination. Yellow fever occurs in tropical regions of Africa and in parts of South America. Yellow fever is a very rare cause of illness in U.S. travelers. The last epidemic of yellow fever in North America occurred in New Orleans in 1905. Source: The Center for Disease Control However, the Ministry is currently investigating whether this case is an index one or whether others have gotten infected before the information reached the Ministry. However, as a result of the confirmation, surveillance teams have been dispatched to Nimba and Grand Gedeh counties trying to trace the origin. Secondly, surveillance officers will be mapping out the communities there which will lay the basis for immunization and public awareness campaigns in those counties shortly. She noted that the Ministry of Health is working in collaboration with the World Health Organization (WHO) to secure drugs for the immunization expected to commence shortly. “We have vaccines for preventive activities, not for response. In this case, we will use the vaccines that we have for preventive activities for this response; meaning that we will need additional vaccines. “Normally, once you diagnose one case, you report to WHO. We have done that and they will in turn report to their headquarters where headquarters in turn will mobilize resources to support the response for us and they have already reported to their regional office and we are awaiting feedback,” Dr. Dahn said. As a preventive measure, she is calling on people to keep their communities clean to avid mosquitoes she termed as the agents responsible for transmitting yellow fever. For his part, WHO Country Representative, Dr. Eugene Nyarko said his organization is working with the Ministry of Health to identify some more resources needed for the response. “The response would entail identifying cases not reported within the communities making sure that there are none, providing vaccination against the disease to these communities as well as embarking on environmental sanitation measures which will include identifying breeding sites for mosquitoes and making sure we destroy them and don’t give them a chance to breed,” Dr. Nyarko said.   Yellow fever is viral disease that occurs mainly in Africa and the Americas. It is passed to humans through the bites of mosquitoes carrying the disease, usually during daylight hours. The symptoms of yellow fever can be severe, and it is possible to die from the disease. Large areas of Africa and the Americas, including parts of the Caribbean are at risk, and travellers to those areas are strongly advised to have a vaccination for yellow fever around ten days before they travel. Once in your system, the virus has no effect for three to six days. This time is called the incubation period. Two phases of the disease can then follow: the acute first stage and the toxic second stage. Symptoms of the acute stage include fever, headache, shivers, muscle pain, nausea and vomiting, and an unusually slow pulse. Three or four days later these symptoms normally disappear. However, within 24 hours of these symptoms passing, around 15% of people who have been infected with this virus then develop the toxic phase. If this happens, the symptoms include fever, yellow skin (jaundice, as a result of damage to the liver), abdominal pain, and vomiting. Bleeding can occur from the mouth, nose, eyes and/or stomach blood can then also be seen in the vomit and faeces. The kidneys can also be affected, sometimes leading to kidney failure. Between twenty and fifty per cent of people who enter this toxic phase of yellow fever die within ten to fourteen days. Those who recover do not generally suffer major organ damage, and are then immune to the disease for life. Yellow fever is caused by a virus called the flavivirus. It is passed on by the bite of a type of mosquito known as Aedes aegypti.  First, the mosquito becomes infected by biting an animal or human with the virus. It can then pass it on to any other animals or humans that it bites. Once it is infected a mosquito remains a source of danger throughout its life. It is thought that the virus is widespread amongst the monkeys that live in the tops of trees in the jungle (the jungle 'canopy') in some parts of Africa and America.  Occasionally, an infected mosquito passes the disease on to a person in the jungle (e.g. a forestry worker) who can then act as a source of infection when they return to their own community There is no specific treatment for yellow fever. However effective medical care can provide comfort, and many of the symptoms can be eased. For example, a fever can be treated with paracetamol. Intensive care may be beneficial for those who become seriously ill. The best way to prevent yellow fever is to have the vaccination at least ten days before travelling to an at risk area, to allow the immunity to develop in your system. It is a safe and very effective vaccination. One dose of the vaccine provides immunity for ten years, and sometimes for life. It is advisable to have a booster dose every ten years if you are still at risk. Severe reactions to the vaccine are rare, however some people do experience mild side effects, such as headache, aches in the muscles (and sometimes at the site of the injection), or a slight fever. These symptoms usually fade after about a week. People who should not have a vaccination for yellow fever include; those with an affected immune system, for example if you are receiving chemotherapy or radiotherapy treatment, women who are pregnant,  children under nine months old, and those with an egg allergy (the vaccine contains small amounts of egg).