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Background <p>Yellow fever (YF), a severe viral hemorrhagic disease caused by a member of the <i>Orthoflavivirus</i> genus of the <i>Flaviviridae</i> family, poses a persistent public health threat despite the availability of a safe and effective vaccine. The disease disproportionately affects Africa, accounting for 90% of the global burden, and its reemergence has been attributed to several factors. This review examines the factors driving the resurgence of YF in Africa.</p> Methods <p>A systematic narrative review of studies from January 1, 1974, to February 28, 2025, was conducted, using predefined inclusion and exclusion criteria. Searches were performed across multiple databases, identifying 1086 studies. Data on the epidemiology, transmission dynamics, and risk drivers contributing to YF re-emergence were extracted. After extensive screening and evaluation, 22 studies met the eligibility criteria.</p> Results <p>Overall, most of the studies included originated from West Africa (<i>n</i> = 13), followed by East Africa (<i>n</i> = 5), Central Africa (<i>n</i> = 3), while North Africa contributed the least (<i>n</i> = 1). Key drivers identified include low vaccination coverage, urbanization, increased mosquito habitat susceptibility, vector control gaps, and climate change. Reported Case Fatality Rates (CFR) varied, reaching up to 89% in Senegal and 73% in Burkina Faso. Diagnostic challenges, limited access to healthcare among nomadic communities in hard-to-reach areas, and inadequate surveillance were consistent themes, contributing to delayed responses to outbreaks.</p> Conclusion <p>The resurgence of yellow fever in Africa stems from a combination of ecological, epidemiological, and socioeconomic factors. Addressing these drivers requires a One-Health approach across the human-animal-environment interface, including sustained high-quality surveillance and robust diagnostic capacity, improved vaccination coverage, enhanced vector control, and climate adaptation measures. Therefore, strengthening surveillance and health infrastructure is vital for mitigating future outbreaks. Finally, more in-depth studies are required in endemic countries of Africa to decipher the other drivers of yellow fever disease.</p>

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A systematic narrative review of risk drivers of yellow fever reemergence in Africa from 1974 to 2025

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月6日

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  • Samuel Ayanwale,
  • Adedolapo Suleiman,
  • Gift Idumah,
  • Nwachukwu William,
  • Luis M. Hernandez-Triana,
  • Nick Johnson,
  • Simeon Cadmus

摘要

Background

Yellow fever (YF), a severe viral hemorrhagic disease caused by a member of the Orthoflavivirus genus of the Flaviviridae family, poses a persistent public health threat despite the availability of a safe and effective vaccine. The disease disproportionately affects Africa, accounting for 90% of the global burden, and its reemergence has been attributed to several factors. This review examines the factors driving the resurgence of YF in Africa.

Methods

A systematic narrative review of studies from January 1, 1974, to February 28, 2025, was conducted, using predefined inclusion and exclusion criteria. Searches were performed across multiple databases, identifying 1086 studies. Data on the epidemiology, transmission dynamics, and risk drivers contributing to YF re-emergence were extracted. After extensive screening and evaluation, 22 studies met the eligibility criteria.

Results

Overall, most of the studies included originated from West Africa (n = 13), followed by East Africa (n = 5), Central Africa (n = 3), while North Africa contributed the least (n = 1). Key drivers identified include low vaccination coverage, urbanization, increased mosquito habitat susceptibility, vector control gaps, and climate change. Reported Case Fatality Rates (CFR) varied, reaching up to 89% in Senegal and 73% in Burkina Faso. Diagnostic challenges, limited access to healthcare among nomadic communities in hard-to-reach areas, and inadequate surveillance were consistent themes, contributing to delayed responses to outbreaks.

Conclusion

The resurgence of yellow fever in Africa stems from a combination of ecological, epidemiological, and socioeconomic factors. Addressing these drivers requires a One-Health approach across the human-animal-environment interface, including sustained high-quality surveillance and robust diagnostic capacity, improved vaccination coverage, enhanced vector control, and climate adaptation measures. Therefore, strengthening surveillance and health infrastructure is vital for mitigating future outbreaks. Finally, more in-depth studies are required in endemic countries of Africa to decipher the other drivers of yellow fever disease.