Yellow fever in Ghana: the current situation

According to health authorities in Ghana, more than 450 cases of suspected yellow fever have been reported between June and September with at least 3 cases being recently confirmed in the Upper West Region of the country. The full extent of the outbreak is yet to be determined. The Sissala East Health Directorate confirmed the outbreak.

According to news reports, the government has increased surveillance in the area, and a rapid response team has been deployed.

Cases of yellow fever were recently reported in the border regions of Ghana's neighbour, Ivory Coast. Fourteen cases of confirmed yellow fever were reported with 2 deaths. Five cases were reported in Doropo which is very close to the northeastern border with Burkina Faso and Ghana. Cross border coordination is underway.

Most recent outbreaks of yellow fever in Ghana have occurred in the northern regions.

Yellow fever epidemics in Africa

Yellow fever outbreaks in Africa have greater potential to cause epidemics. This was witnessed in Angola in 2016 when more than 28 million doses of the yellow fever vaccine were required to contain a major outbreak. In response to this outbreak, several global health organisations including WHO, GAVI and UNICEF launched the End Yellow Fever Epidemics (EYE) initiative with an aim to eliminate outbreaks by the current year (2026). Ghana is among 27 countries listed as high risk for yellow fever outbreaks.

Routine immunisation for yellow fever was introduced into Ghana's childhood immunisation program in 1992. This has helped Ghana achieve an estimated population coverage of 88% in 2023.

International travellers are required to have a valid International Yellow Fever Vaccination Certificate for entry into Ghana.

Recent modelling for Ghana would suggest high habitat suitability for yellow fever virus in Upper West, Upper East, Northern East, Northern, Savannah and Bono East regions.

What is yellow fever virus disease?

Yellow fever is a serious viral disease. The virus belongs to the Flavivirus genus (the same group containing Japanese encephalitis, dengue fever, Murray Valley encephalitis, and others). The disease is transmitted to humans via a mosquito bite.

Yellow fever is found in tropical and subtropical areas of Africa and South America. The name, "yellow", comes from jaundice due to the hepatitis observed in severe disease.

Most cases of yellow fever are self-limited but the mortality rate in severe disease can be as high as 50%. There is no specific antiviral therapy. Treatment can only be supportive.

Transmission from person to person is possible during the viraemic phase of the disease. This is the main reason for it being subject to international health regulations. It is possible for an infected person to initiate an outbreak after international travel, but this is only possible if the receptive mosquito is present in the area.

For international travellers, the yellow fever vaccination may be required by law in some circumstances. It is important to have a travel medicine consultation if considering travel to/from endemic areas.

Yellow fever risk to travellers

There are several factors which determine risk of exposure. These include:

• immunisation status of the traveller
• local immunisation levels
• local viral transmission (as is happening in certain locations of South America)
• season of travel
• duration of travel
• activities while travelling
• occupational activities

The absence of case reports in a particular region does not equate to "no risk".

Transmission is considered year-round in areas of risk in Africa. Peaks occur between the end of the wet season and the beginning of the dry (July to October).

The Centers for Disease Control and Prevention (CDC) provides updated yellow fever maps and areas of risk.

For Africa, see: Countries at Risk for Yellow Fever: Africa

For South America, see: Countries at Risk for Yellow Fever: South America

Although yellow fever vaccination is the mainstay for protection, mosquito avoidance measures are still very important. It is important to remember, the mosquito that transmits yellow fever, is also responsible for other diseases like dengue, chikungunyaand Zika.

Yellow fever vaccination

The yellow fever vaccination (Stamaril in Australia) is a live attenuated vaccine which provides highly effective and durable immunity for life with a single dose. The vaccine provides immunity within 10 days of vaccination for 80-100% of people vaccinated, and 99% of people within 30 days.

The lifetime recommendation came into effect in July 2016. This was for new and existing certificates. It was previously considered a 10-year vaccine.

WHO's global strategy to eliminate yellow fever epidemics (EYE 2017-2026) can be sourced at the WHO publications page.

This publication has an excellent overview of how the yellow fever virus is transmitted and the differences between risk in Africa and South America. It is very relevant to travellers.