The many challenges to fighting yellow fever in Democratic Republic of the Congo

Yellow fever crosses borders

Democratic Republic of the Congo shares its long, southern border with Angola, stretching for more than 2500 kilometres. The 2 countries have been inextricably linked for centuries and a steady flow of people cross daily from both sides to visit family or trade. Many young Congolese travel to Angola to search for work or diamonds. But the highly porous nature of the border is making it easier for the yellow fever outbreak in Angola to spread to Democratic Republic of the Congo.

Vaccination of 3 million people along the border

People infected with yellow fever have carried the disease from Angola into the Democratic Republic of the Congo border province of Kwango. Confirmation of local transmission in the poor, largely rural community has sparked fears of further spread. Vaccination is essential to controlling the outbreak. In addition to vaccinating targeted areas of densely populated Kinshasa, WHO is working with government and partners to organize a mass vaccination campaign of approximately 3 million people along the border between Democratic Republic of the Congo and Angola.

Challenges in access

One of the major challenges facing vaccination campaigns in Democratic Republic of the Congo is access. Getting to the southern parts of the country that border Angola involves travelling hundreds of kilometres across difficult terrain. Roads between the numerous villages scattered across the area are often nothing more than forest tracks through dense vegetation.

Accelerating response efforts

A joint mission from Democratic Republic of the Congo's Ministry of Health, WHO and Médecins Sans Frontières meets with local health authorities in Kenge, the capital of Kwango province, to assess needs for the planned yellow fever vaccination campaign. Later, the response team travelled to the border areas to assess challenges and to evaluate how best to accelerate the response to the outbreak and prepare for mass vaccination.

Testing blood samples to treat patients and prevent further spread

As well as getting the vaccines to the border areas, WHO is also assessing how to get blood samples out, so they can be tested. The faster blood samples are tested the quicker people with yellow fever can be treated and those nearby can be vaccinated if the sample is positive. In Kwango province there are no facilities to test for yellow fever and getting samples to the lab in Kinshasa can take up to a week. These men are transporting blood samples for yellow fever testing in a cool box on the back of a motorbike.

Faster transport for quicker blood results

WHO is working with the Ministry of Health and UN partners to explore options for reliable and regular transport of vaccines, blood samples and personnel in and out of the border zones. Here, a WHO logistician assesses the option of reopening this landing strip near Kahemba in Kwango province to allow small planes from Kinshasa to land 2-3 times a week.

Keeping vaccines cold and usable

Solange Kayindji, storekeeper for the Kahemba branch of the WHO Expanded Programme on Immunization, rearranges the contents of the centre’s only refrigerator to create space for yellow fever vaccines delivered by the joint mission. This vaccination centre serves more than 800 000 people across 28 community health centres. A new, large cold room has been built for the centre, but there are no funds available to purchase the fuel needed to run it. “It means we can only receive vaccines in small batches,” said Solange. Once opened, yellow fever vaccine vials should be stored between 2 and 8 degrees Celsius.

Uncovering the spread of yellow fever

Investigating the recent travel history of yellow fever patients helps the response team understand if cases are imported or are spreading locally. Like many young men from this region, 18-year-old Obed Shakhayi went to Angola to search for diamonds. After falling ill with suspected yellow fever, he returned to Democratic Republic of the Congo for treatment and is now recovering in hospital in Kahemba. There is no specific treatment for yellow fever, but adequate supportive care improves outcomes for seriously ill patients. Associated bacterial infections can be treated with antibiotics.

Vaccination awareness

Ensuring that people know about yellow fever and understand the importance of vaccination is important when preparing for a successful campaign. Churches and schools in towns like Kahemba play an important role in educating the community about the disease. But the joint response team found that resources needed for social mobilization, such as funding for megaphones and batteries, posters, flyers and phone credit, were severely lacking.

Getting the word out

Local radio is one of the most important ways to disseminate public health messages to the people in Democratic Republic of the Congo’s border provinces, the majority of whom live in villages that are widely scattered across a vast area and have no electricity or phone network coverage. Getting the local radio station in Kahemba back up and running is a priority action to prepare for the mass vaccination campaign.

Recognizing yellow fever symptoms at the border

Ensuring that health care workers at the border recognize the symptoms of yellow fever and know what actions to take is key to treating patients, tracking the outbreak and targeting the response. At Shamaziamo, the principal border crossing between Angola and Kwango province, Democratic Republic of the Congo, Nurse Nicole Tshibulenu responds to a WHO epidemiologist’s queries on recent cases of fever.

Protection against mosquitoes

Entomologist, Sylvie Fasine, explains the behaviours of the Aedes mosquito, the species that spreads yellow fever, to Angolan and Congolese border guards. She urges them to protect themselves by covering up during peak biting hours, dawn and dusk, and to clear surroundings of potential mosquito breeding sites. Engaging all sectors in combatting the yellow fever outbreak can help bring the outbreak to an end more quickly.