Yellow fever re-emergence in West Africa: Lessons from the past, advocacy for a control programme.

In French speaking West Africa, yellow fever vaccine became compulsory in 1 941 for the entire African and European population. From 1941 to 1960, 146 million doses were distributed and the number of yellow fever cases decline d sharply No case was reported from 1954 to 1960. As a result of an interru ption in systematic immunization after 1960 ten major epidemics broke out i n West Africa between 1965 and 1995 (over 200,000 cases and 40, 000 deaths) . In 1967, the WHO programme for eradication of smallpox was initiated and it mobilized WHO's energy and finances. The expanded programme of immunizatio n (EPI) was initiated in 1977 but it did not include the yellow fever vacci ne. In 1978, Primary Health Care advocated an immunization strategy through fixed health facilities. in 1986, to amend this strategy WHO recommended a ccelerating EPI progress and instituting National immunization Days (NIDs). In 1990, a recommendation was made to include the yellow fever vaccine in the EPI. in 1997, the target of global poliomyelitis eradication by the yea r 2000 reinforced the NID programme and led to the use of mobile reams. At a time when a measles eradication programme is going to lake over from t he poliomyelitis programme, we must firmly advocate not omitting the yellow fever vaccine as was the case in 1977. Indeed, in yellow fever endemic are as, WHO recommends a simultaneous association of yellow fever and measles v accines for nine month-old infants. This opportunity must be seized to init iate a yellow fever control programme.