Yellow Fever and Malaria among Febrile Patients in and Around the Epicentre of a Yellow Fever Outbreak in Ghana.

Abstract

Background Yellow fever is endemic in Ghana and the country has been faced with outbreaks of the disease in the past years. From October, 2021 to February, 2022, yellow fever cases and deaths were recorded in the Savannah, Upper West, Bono and Oti regions of Ghana. Individuals infected with yellow fever have clinical presentations like fever, headache, body pains and vomiting which are similar to that of malaria. Malaria is endemic in Ghana, and is known to be the commonest microbial etiology of fever in febrile patients in Ghana. Infections with yellow fever virus and malaria parasites among febrile inhabitants in and around the epicenter of the yellow fever outbreak zones are unknown after the outbreak. Thus, there is the need to investigate yellow fever infections and malaria parasites in the febrile patients in order to put in the appropriate prophylactic measures in controlling the etiology of fever. Aim The aim of this study was to determine the carriage of yellow fever virus and malaria parasites among febrile patients in and around the epicenter of a yellow fever outbreak in Ghana. Methodology This was a cross-sectional study that was conducted in four districts in Ghana. Two of these districts (Wenchi and Damongo) experienced a yellow fever outbreak in 2021 and the other districts (Tamale and Kumbungu) are in close proximity to the outbreak foci. A total of 498 blood samples was collected during both dry and rainy seasons in Ghana from febrile patients in the study sites. The blood samples were processed for the detection of yellow fever virus and malaria parasites. One-step RT-PCR was performed on serum samples to determine the carriage of yellow fever virus in the participants while conventional nested PCR and microscopy were performed to determine the carriage of malaria parasites in the participants. Results Out of a total of 498 febrile human participants, none of them had the yellow fever virus as detected by real-time PCR. The non-outbreak zones (Tamale or Kumbungu) had the highest prevalence of malaria irrespective of the season of sample collection or technique in disease diagnosis. During the dry season, Tamale and Kumbungu had malaria prevalence of 35% and 21.6% respectively using microscopy. During the rainy season, Tamale and Kumbungu had recorded prevalence of 23% and 30.1% respectively using microscopy. During the rainy season, Kumbungu recorded prevalence of 47.6% using conventional nested PCR. Tamale recorded the highest proportions of malaria infections (35%) during the dry season with the use of microscopy while Kumbungu recorded the highest proportions of malaria infections (30.1%) during the rainy season with the use of microscopy. Also, Kumbungu recorded the highest proportions of malaria infections (47.6%) during the rainy season with the use of conventional nested PCR The highest proportions of malaria infections (12.2%) were observed among the older group (above 15 years) during the rainy season with the use of microscopy while children less than 5 years recorded the highest proportions of malaria infections (9.1%) during the dry season with the use of microscopy. Also, the older age group (above 15 years) recorded the highest proportions of malaria infections (15%) during the rainy season with the use of conventional nested PCR. Conclusion There was no detectable yellow fever virus in the febrile patients. The overall prevalence of malaria infections in the febrile patients was high in this study. High vaccination coverage against yellow fever should be encouraged in yellow fever endemic countries like Ghana and malaria control interventions should target all age groups to completely tackle reservoir infections.