Journal of travel medicine
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Multicenter Study
Ebola virus outbreak in North Kivu and Ituri provinces, Democratic Republic of Congo, and the potential for further transmission through commercial air travel.
The 2018-2019 Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of Congo (DRC), continues to spread. The recent discovery of cases in Uganda and in Goma, a major city in the eastern DRC, raises concern for potential EVD transmission in distant locales via commercial air travel. ⋯ There is little commercial airline connectivity from the current EVD-affected area; however, larger cities in DRC and throughout East Africa should be aware of the low potential for EVD importation through this route. Most countries at greatest risk for EVD importation have limited capacity to manage these cases.
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Rationale for review: The global yellow fever vaccine supply is insufficient to provide full-dose vaccination to millions threatened by outbreaks. Given the excess of live-attenuated 17D yellow fever virus in the current single dose vials, dose sparing would increase available vaccine doses manifold. Fractional-dose yellow fever vaccination is now accepted as an emergency solution, as short-term protection has been confirmed in an outbreak situation in the Democratic Republic of Congo, but broader application of this dose-sparing strategy is still not recommended. ⋯ It also appears that fractional-dose vaccination does not elicit more serious adverse events than standard dose vaccination. Short-term immunogenicity studies are currently underway in specific populations (infants, human immunodeficiency virus (HIV)-infected persons and healthy adults living in Uganda and Kenya), of which the results will become available in 2021-22. Conclusions: Available results on long-lasting immunogenicity of fractional-dose yellow fever vaccination are encouraging, although confirmation is required in larger populations including young children living in yellow fever endemic areas.