The incidence and mortality of yellow fever in Africa : a systematic review and meta‑analysis

Nwaiwu, Akuoma U. ; Musekiwa, Alfred ; Tamuzi, Jacques L. ; Sambala, Evanson Z. ; Nyasulu, Peter S. (2019)

CITATION: Nwaiwu, A. U., et al. 2021. The incidence and mortality of yellow fever in Africa : a systematic review and meta‑analysis. BMC Infectious Diseases, 21:1089, doi:10.1186/s12879-021-06728-x.

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Publication of this article was funded by the Stellenbosch University Open Access Fund


Background: Understanding the occurrence of yellow fever epidemics is critical for targeted interventions and control efforts to reduce the burden of disease. We assessed data on the yellow fever incidence and mortality rates in Africa. Methods: We searched the Cochrane Library, SCOPUS, MEDLINE, CINAHL, PubMed, Embase, Africa-wide and Web of science databases from 1 January 1975 to 30th October 2020. Two authors extracted data from included studies independently and conducted a meta-analysis. Results: Of 840 studies identified, 12 studies were deemed eligible for inclusion. The incidence of yellow fever per 100,000 population ranged from < 1 case in Nigeria, < 3 cases in Uganda, 13 cases in Democratic Republic of the Congo, 27 cases in Kenya, 40 cases in Ethiopia, 46 cases in Gambia, 1267 cases in Senegal, and 10,350 cases in Ghana. Case fatality rate associated with yellow fever outbreaks ranged from 10% in Ghana to 86% in Nigeria. The mortality rate ranged from 0.1/100,000 in Nigeria to 2200/100,000 in Ghana. Conclusion: The yellow fever incidence rate is quite constant; in contrast, the fatality rates vary widely across African countries over the study period. Standardized demographic health surveys and surveillance as well as accurate diagnostic measures are essential for early recognition, treatment and control.

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