Notes from the Field : Knowledge, Attitudes, and Practices Regarding Yellow Fever Vaccination Among Men During an Outbreak — Luanda, Angola, 2016

Abstract

In January 2016, the Angola Ministry of Health reported an outbreak of yellow fever, a vaccine-preventable disease caused by a flavivirus transmitted through the bite of Aedes or Haemagogus species mosquitoes. Although endemic in rural areas of Angola, the last outbreak was in 1988 when 37 cases and 14 deaths were reported. Large yellow fever outbreaks occur when the virus is introduced by an infected person to an urban area with a high density of mosquitoes and a large, crowded population with little or no immunity. By 8 May, a total of 2267 suspected cases were reported nationally, of which 696 (31%) were laboratory confirmed; 293 (13%) persons died. Most (n=445, 64%) confirmed cases lived in Luanda Province. As part of the public health response that included strengthened surveillance, vector control, case management, and social mobilization, mass vaccination campaigns were implemented in Luanda during 2 February-16 April. Despite >90% administrative vaccination coverage (the number of vaccine doses administered divided by the most recent census estimates for the target population), the province continued to report cases. Field teams reported low numbers of men being vaccinated, which was a concern because of a preliminary analysis that indicated approximately 70% of confirmed yellow fever cases occurred in males. A rapid assessment to identify and address potential barriers to vaccination among men was designed, using a knowledge, attitudes, and practices survey.