To describe the epidemiology, ecological determinants and public-health response to a yellow-fever (YF) outbreak in Wa East District (WED), Ghana, and to identify operational gaps to strengthen surveillance and immunisation in high-risk rural settings.

A cross-sectional descriptive outbreak investigation integrating epidemiological, entomological, vaccination-coverage and community knowledge assessments, conducted under Ghana’s Integrated Disease Surveillance and Response framework.

WED, located in the Upper West Region of Ghana, is an agrarian, forest-fringe area bordering the Mole National Park, characterised by limited access to health services and seasonal nomadic movements.

All suspected YF cases (N=57) reported between epidemiological weeks 41–46 of 2021; 50 community respondents interviewed for knowledge and awareness and 52 households inspected for entomological indices.

Demographic and clinical characteristics of cases, spatial–temporal distribution, vaccination coverage, Aedes vector indices, community knowledge and awareness levels and response interventions.

A total of 57 suspected cases (33 males 24 females) were identified, of which 12 (21.1%) were laboratory-confirmed. The case-fatality ratio among confirmed cases was 33.3% (95% CI 9.7% to 65.1%). Most cases occurred in individuals aged 6–30 years and were clustered in the Ducie community. The epidemic curve, based on confirmed cases, showed a single focal wave between epidemiological weeks 41 and 46 of 2021, peaking in week 45 and declining thereafter following intensified outbreak response activities, particularly surveillance and risk communication. Routine YF vaccination coverage was 25% before the outbreak, increasing to 95% after the mass campaign. The district’s composite risk score was 83%, indicating very high transmission risk. Entomological indices (House Index=48.5%, CI=36.1%, Breteau Index=159.6) exceeded WHO thresholds, confirming intense Aedes proliferation. Community awareness was low, with only 22% recognising the viral cause, 16% identifying mosquitoes as vectors and 10% knowing that vaccination prevents YF.

The outbreak reflected the convergence of ecological vulnerability, low baseline immunity and poor community awareness. Sustained high routine immunisation, structured Aedes surveillance and continuous risk communication are essential to prevent recurrence and advance Ghana’s commitment to the WHO Eliminate Yellow Fever Epidemics strategy.

To evaluate the performance of the acute flaccid paralysis (AFP) surveillance system in Ghana’s Upper West Region between 2021 and 2023 against WHO benchmarks in order to identify strengths and weaknesses and sustain Ghana’s progress towards a polio-free future.

Retrospective analysis of routinely collected AFP surveillance data.

The Upper West Region of Ghana, a remote and resource-limited border region with high vulnerability to poliovirus importation and circulation.

All 213 AFP cases reported in the Upper West Region between January 2021 and December 2023.

WHO-recommended AFP surveillance indicators, including non-polio AFP (NP-AFP) rate, stool adequacy rate, timeliness of case notification and investigation, stool specimen transport and condition and non-polio enterovirus (NPENT) isolation rate.

A total of 213 AFP cases were reported in the Upper West region between 2021 and 2023, with an average age of 24 months. The NP-AFP rate was consistently above the WHO target, averaging 26.7 per 100 000 population under 15 years. However, stool adequacy rates varied, averaging 73%, with a notable increase from 51% in 2021 to 97% in 2022 and a decline to 70% in 2023. The proportion of districts meeting both NP-AFP and stool adequacy targets fluctuated, with 64% in 2022 but dropping to 27% in 2023. Timeliness of case reporting remained high (≥94%), while investigations within 48 hours declined to 74% in 2023. Stool specimen transport was weak, with only 6% reaching the laboratory within 3 days of collection in 2023. NPENT isolation exceeded the WHO benchmark of ≥10% throughout the study period, with rates of 12% in 2021, 31% in 2022 and 11% in 2023, confirming specimen integrity and laboratory sensitivity despite transport challenges.

The AFP surveillance system in the region demonstrated high sensitivity, as reflected by the NP-AFP rate, but challenges remain in maintaining stool adequacy and sample transportation standards. Strengthening sample transportation and logistics, as well as addressing district-level disparities in surveillance performance, will be essential to improving the overall quality of AFP surveillance in the region.