travel disease ghana

GHANA TRAVEL REQUIREMENTS

Individuals traveling to Ghana are required to strictly adhere to the following new directives as stated by Ghana’s President during his 16 th address to the Nation on Measures Taken Against the Spread of the Coronavirus:

• All passengers arriving in Ghana must be in possession of a negative COVID-19 PCR test result from an accredited laboratory in the country of origin and the test must have been done not more than seventy-two (72) hours before the scheduled arrival in the country. All airlines have been instructed to ensure compliance with this directive for all passengers traveling to Ghana;
• All passengers would be required to undergo a mandatory COVID-19 test at the airport terminal upon arrival in Ghana at a fee of one hundred and fifty dollars ($150.00) to be borne by the passenger. The test result will be available within thirty (30) minutes;
• Children under the age of five (5) will not be required to undergo testing at the airport;
• Passengers who test positive for COVID-19 will be handled by the health authorities for further clinical assessment and management; and
• Passengers who test negative will be admitted into the country and will be advised to continue to observe COVID-19 safety precautions during their stay in Ghana.

Ministry of Health / Ghana Health Service Guidelines

INTRODUCTION 

Following the declaration of the novel Coronavirus Disease 2019 (COVID-19) as a global Public Health Emergency of International Concern on 30th January 2020, several countries instituted measures to curb the spread of the disease. In Ghana, similar measures were instituted in addition to the Executive Instrument (EI) 61 requiring some practices to be enforced.

As part of plans to reopen the Kotoka International Airport (KIA) on Tuesday, September 1, 2020, the Ghana Health Service/Ministry of Health has instituted measures to prevent and control the spread of COVID 19 in Ghana related to international travel. The outlined measures below are applicable to flight crew and passengers arriving and/or departing KIA within the period of reopening the airport to international travel until further advised.

The Ghana Health Service in collaboration with other partners will provide Port Health Services to ensure safety of flight crew, passengers and users of the airport. Port Health Services at the airport includes all health-related activities within the terminal including laboratory testing, inspection of relevant health documents, screening and triaging of passengers and the management of ill persons including transfer to appropriate health facilities; environmental inspections, supervision of cleaning and disinfection of aircraft and the entire airport terminal among others.

COVID-19 PROTOCOLS FOR DEPARTING AND ARRIVING PASSENGERS 

All passengers departing or arriving on international flights at KIA including those from the ECOWAS region will be required to meet the health requirements outlined below prior to admission into Ghana by the Ghana Immigration Service.

• Departing Passengers 

All passengers on international flights departing KIA will be required to adhere to COVID-19 testing requirements for the destination countries. All persons must be wearing a face mask appropriately (extending from the middle of the nasal bridge to halfway between the chin and the neck) and adhere to social distancing and hygiene protocols. Departing passengers will under g o COVID-19 screening including the checking of temperature.

• Arriving Passengers 

All arriving passengers must not have any symptoms suggestive of COVID-19 including body temperature >38°C. They must be in possession of a COVID-19 negative PCR test result from an accredited laboratory in the country of origin. The test should have been done not more than 72 hours before the scheduled departure time from the country of origin. For passengers who transit through other countries before arriving in Ghana, the first country of departure will be the reference point. For passengers who depart Ghana and return within one (1) week, the passengers will not be required to present a COVID-19 test result from the country of departure. A negative COVID-19 test from Ghana used on departure will serve as evidence of meeting the COVID-19 test criteria for arriving in Ghana. In addition, all persons must be wearing face masks appropriately upon arrival (extending from the middle of the nasal bridge to halfway between the chin and the neck). All passengers will be subjected to a mandatory COVID-19 test at the airport terminal at the cost to the passenger. All persons testing positive will receive further clinical assessment and treatment. All persons testing negative will be advised to continue to observe COVID-19 safety precautions following arrival in Ghana.

• 5 . Exemptions 

The following categories of passengers and crew are exempt from COVID-19 PCR test Testing:

• Children under-5 years of age will not be required to undergo testing at the airport;
• Persons who arrive under emergency circumstances such as diverted flights will not be required to undergo testing if they do not leave the airport or if they remain in transit such that they do not leave the hotel; and
• Airline crew are exempt from the pre-departure and arrival testing and should follow airline policy for testing.

MANAGEMENT OF CONFIRMED COVID-19 CASES

All persons testing positive will receive further clinical assessment and treatment. Confirmed COVID 19 positive will be handled by the Port Health Unit for the remainder of their arrival processes. Following completion of the arrival procedures, they will be sent to the Ga East Municipal Hospital for further clinical assessment and management. All persons testing negative will be advised to continue to observe COVID-19 safety precautions following arrival in Ghana.

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Traveling to Ghana: What You Need To Know

January 24, 2022

Interest has grown in travel to Ghana, a popular tourist destination in West Africa. That means demand for vaccinations and other health services recommended for travel to the region are also on the rise.

Known for its idyllic climate and scenic beauty, Ghana has built a tourism industry around its heritage as an outpost of the trans-Atlantic slave trade.

“There is a lot of interest in travel to Ghana among African-American residents of our region,” says UH infectious disease specialist  Keith Armitage, MD , medical director of the  UH Roe Green Center for Travel Medicine & Global Health . “We see many people in the travel clinic going to Ghana and West Africa.”

Health Concerns

Dr. Armitage said yellow fever is among a number of diseases tourists need to be vaccinated against. Travelers must show proof of yellow fever vaccination to enter the country, or they must quarantine.

“There has been a yellow fever outbreak in Ghana, and also a polio outbreak,” Dr. Armitage says.

Travelers should also be vaccinated against hepatitis A and typhoid. They need medication to prevent malaria and may need booster shots for measles and polio, he says.

“When we see travelers, we also give advice on how to avoid mosquito bites and food- and water-borne illnesses,” Dr. Armitage says. “We advise on treatment if you do get an intestinal illness, and how to deal with dog or animal bites.”

Ghana also requires travelers from abroad to be vaccinated against COVID-19, and they must also present a negative COVID test.

Anyone traveling abroad should be vaccinated and boosted against the virus, Dr. Armitage says.

To get the latest information on COVID-19-related travel requirements, check the web sites of your destination country and the U.S. State Department.

Related Links

As you think about planning for your healthcare needs for your next big trip, the clinicians at the  UH Roe Green Center for Travel Medicine and Global Health  are ready to help you prepare to be safe and healthy while you build lifelong memories.

Tags: Ghana , Global Health , Food- and Water-Borne Illnesses , Mosquito-Borne Illnesses

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• Passports, travel and living abroad
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Before you travel check that:

• your destination can provide the healthcare you may need
• you have appropriate travel insurance for local treatment or unexpected medical evacuation

This is particularly important if you have a health condition or are pregnant.

Emergency medical number

Call 999 or 112 and ask for an ambulance.

Contact your insurance company quickly if you’re referred to a medical facility for treatment.

Vaccine recommendations and health risks

At least 8 weeks before your trip:

• check the latest vaccine recommendations for Ghana
• see where to get vaccines and whether you have to pay on the NHS travel vaccinations page

See what health risks you’ll face in Ghana , including:

• yellow fever

Marburg virus

In September 2022, Ghana declared an end to the Marburg virus disease outbreak that was first reported in July 2022. See more details about the outbreak and more information on Marburg virus and similar diseases . 

The legal status and regulation of some medicines prescribed or bought in the UK can be different in other countries.

Read best practice when travelling with medicines on TravelHealthPro .

The NHS has information on whether you can take your medicine abroad .

Healthcare in Ghana

Medical facilities are poor outside towns. For serious medical treatment, medical evacuation will be necessary. Make sure you have adequate travel health insurance and accessible funds to cover the cost of any medical treatment abroad and repatriation.

FCDO has a list of medical providers in Ghana . 

There is also guidance on healthcare if you’re living in Ghana .

Travel and mental health

Read FCDO guidance on travel and mental health . There is also mental health guidance on TravelHealthPro .

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Travel Advisory November 20, 2023

Ghana - level 2: exercise increased caution.

Updated to reflect threats against LGBTQI+ travelers.

Exercise increased caution in Ghana due to crime and violence against members of the LGBTQI+ community . Some areas have increased risk. Read the entire Travel Advisory.

Exercise increased caution in:

• Parts of the Bono East, Bono, Savannah, Northern, North East, and Upper East regions due to civil unrest.

Country summary:  Violent crimes, such as carjacking and street mugging, do occur. These crimes often happen at night and in isolated locations. Exercise increased caution specifically due to crime:

• In urban areas and crowded markets
• When traveling by private or public transportation after dark as criminal elements may use blockades to slow down and restrict movement of vehicles
• In areas near the northern border in the Upper East and Upper West regions

The U.S. government has limited ability to provide emergency services to U.S. citizens. Local police may lack the resources to respond effectively to more serious crimes.

LGBTQI+ Travelers: Ghanaian law contains prohibitions on “unlawful carnal knowledge” – generally interpreted as any kind of sexual intimacy – between persons of the same sex. Punishments can include fines and/or incarceration. Anti-LGBTQI+ rhetoric and violence have increased in recent years. Members of the LGBTQI+ community have reported safety incidents that include targeted assault, rape, mob attacks, and harassment due to their identity.

Read the country information page for additional information on travel to Ghana.

If you decide to travel to Ghana:

• See our LGBTQI+ Travel Information page and section 6 of our Human Rights Report for further details.
• Enroll in the Smart Traveler Enrollment Program ( STEP ) to receive alerts and make it easier to locate you in an emergency.
• Follow the Department of State on Facebook and Twitter .
• Review the Country Security Report for Ghana.
• Prepare a contingency plan for emergency situations. Review the Traveler’s Checklist .
• Visit the CDC page for the latest Travel Health Information related to your travel.

Areas Near the Northern Border in the Upper East and Upper West Regions – Level 2: Exercise Increased Caution

U.S. citizens traveling in Ghana should exercise caution while visiting border areas, in particular the northern border, and be sure to read Security Alerts affecting those areas. Due to security concerns over criminal activity in remote areas, travel of U.S. government personnel to the northern and northwestern border is currently limited.

Visit our website for Travel to High-Risk Areas .

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U.s. embassy accra.

No. 24 Fourth Circular Road, Cantonments, Accra Ghana Telephone:  +233-(0)30-274-1000 Emergency After-Hours Telephone:  +233-(0)30-274-1000 Email:   [email protected]

Destination Description

Learn about the U.S. relationship to countries around the world.

Entry, Exit and Visa Requirements

Visit the  Embassy of Ghana  website for the most current visa information.

Proof of Yellow Fever vaccination is required upon arrival in Ghana for anyone over nine months of age.

Foreign nationals who are over six years old and who have been physically present in Ghana for a cumulative period of 90 days or more during a calendar year are required to register with the National Identification Authority (NIA). The NIA will issue registered foreign nationals a non-citizen Ghana card. The non-citizen Ghana card will be necessary for all transactions that require identification, i.e. opening bank accounts, obtaining work permits, acquiring driver’s licenses, etc.

A list of permanent registration centers, fee requirements, and answers to frequently asked questions can be found on the  NIA website .

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Ghana.

Find information on  dual nationality ,  prevention of international child abduction,  and  customs regulations  on our websites.

Safety and Security

West Africa faces an increased threat from transnational terrorist groups. Terrorists have targeted Westerners in Côte d’Ivoire, Burkina Faso, Niger, Benin, and Mali.

For more information, see our  Terrorism  page.

Crime:   Violent crimes, such as armed robbery and kidnapping, occasionally occur. Robberies on highways are of particular concern, especially at night. Armed robbers also sometimes target vehicles coming from Kotoka International Airport. If your car is hit by another car while you are driving, go directly to the nearest police station to report the incident. Reports of residential robberies continue to be on the rise.

Street crime remains a serious problem in Accra and other large cities. Thieves carry out crimes of opportunity, such as “snatch & grabs,” on city streets in isolated areas as well as from vehicles idling in traffic. Pickpockets are also prevalent in crowded areas.

Luggage and travel document theft occurs at Kotoka International Airport in Accra and in hotels across Ghana. Keep your documents secure at all times, and don’t leave your baggage unattended. Be wary of all offers of unsolicited assistance at the airport from anyone other than uniformed porters or officials.

Credit card fraud is common. Exercise caution when using credit and ATM cards in Ghana. It is very common for scammers to tamper with credit card terminals. Skimming is the primary means of credit card fraud, and is undetectable until fraudulent charges appear on statements. If you choose to use a credit card anywhere in Ghana, monitor your credit card activity closely.

There are a number of ongoing chieftaincy disputes in Ghana that generally involve competition over limited resources. Several of these disputes have erupted into violence and unrest during recent years. Exercise caution in rural areas and remain alert to outbreaks of unrest. Please see the Travel & Transportation section for more information.  

Refer to the  Ghana Travel Advisory  and the  U.S. Embassy Accra website  for the most updated safety and security information.  

For further information about crime trends in Ghana, the Ghana Police Service Criminal Investigations Department issues advisories on the  Ghana Police Service site .

Demonstrations  occur frequently. They may take place in response to political or economic issues, on politically significant holidays, and during international events. 

• Even demonstrations intended to be peaceful can turn confrontational and possibly become violent. 
• Avoid areas around protests and demonstrations. 
• Check local media for updates and traffic advisories. 

International Financial Scams:  See the  Department of State  and the  FBI  pages for information.

Internet romance and financial scams are prevalent in Ghana. Scams are often initiated through Internet postings/profiles or by unsolicited emails and letters. Scammers almost always pose as U.S. citizens who have no one else to turn to for help. Common scams include:  

• Romance/online dating 
• Money transfers
• Lucrative sales
• Gold purchase
• Contracts with promises of large commissions
• Grandparent/relative targeting 
• Free trip/luggage 
• Inheritance notices
• Work permits/job offers
• Bank overpayments

Victims of Crime:  U.S. citizen victims of sexual assault are encouraged to contact the U.S. Embassy for assistance. Report crimes to the local police at +233 (0)30-277-3906 and contact the U.S. Embassy at +233-(0)30-274-1000 ext. 1570. Remember that local authorities are responsible for investigating and prosecuting crime.

See our webpage on  help for U.S. victims of crime overseas .

• Help you find appropriate medical care.
• Assist you in reporting a crime to the police.
• Contact relatives or friends with your written consent.
• Explain the local criminal justice process in general terms.
• Provide a list of local attorneys.
• Provide our information on  victim’s compensation programs in the United States.
• Provide an emergency loan for repatriation to the United States and/or limited medical support in cases of destitution.
• Help you find accommodation and arrange flights home.
• Replace a stolen or lost passport.

Domestic Violence : U.S. citizen victims of domestic violence may contact the Embassy for assistance.

Tourism : The tourism industry is unevenly regulated outside of the major cities, and safety inspections for equipment and facilities may not commonly occur. Hazardous areas/activities are not always identified with appropriate signage, and staff may not be trained or certified either by the host government or by recognized authorities in the field. In the event of an injury, appropriate medical treatment is typically available only in/near major cities. First responders are generally unable to easily access areas outside of major cities to provide urgent medical treatment. U.S. citizens are encouraged to purchase medical evacuation insurance. See our webpage for more  information on insurance providers for overseas coverage .

Maritime Security : Piracy and armed robbery in the Gulf of Guinea continue to trend upwards. Pirates/armed groups operating in the region typically carry out attacks on vessels using automatic weapons. Attacks, kidnappings for ransom, and robbery of crew, passengers, and ship’s property continue to be common occurrences.

Local Laws & Special Circumstances

Criminal Penalties : You are subject to local laws. If you violate local laws, even unknowingly, you may be expelled, arrested, or imprisoned. Individuals establishing a business or practicing a profession that requires additional permits or licensing should seek information from the competent local authorities prior to practicing or operating a business. 

Public smoking is illegal in Ghana. The U.S. Embassy is aware of arrests for cigarette smoking in public places, but has not received reports of prosecutions.

Be aware that building construction standards are often lower than those found in the United States. These lower standards have contributed to building collapses, fires, and electrical shock.

In recent years, U.S. citizens have reported substantial financial losses from questionable transactions involving gold and other precious metals. The Government of Ghana maintains strict regulations on these natural resources. All agents must be licensed and all transactions must be certified.

Furthermore, some laws are also prosecutable in the United States, regardless of local law. For examples, see our website on  crimes against minors abroad  and the  Department of Justice  website.

Arrest Notification : If you are arrested or detained, ask police or prison officials to notify the U.S. Embassy immediately. See our  webpage  for further information.

Swimming in coastal waters is dangerous and strongly discouraged, even for excellent swimmers. The ocean currents along the coast are powerful and treacherous, and several people drown each year.

Faith-Based Travelers : See the following webpages for details:

• Faith-Based Travel Information
• International Religious Freedom Report  – see country reports
• Human Rights Report  – see country reports
• Hajj Fact Sheet for Travelers
• Best Practices for Volunteering Abroad

LGBTI Travelers : Ghana’s criminal code outlaws “unnatural carnal knowledge,” which is frequently interpreted by local authorities as consensual same-sex sexual relations. This is criminalized as a misdemeanor in Ghana. The U.S. Embassy is aware of arrests and related extortion attempts for such activities, but has not received reports of prosecutions.

See our  LGBTI Travel Information  page and section 6 of our  Human Rights report  for further details.

Travelers Who Require Accessibility Assistance : You may find accessibility and accommodation very different from what you find in the United States. Ghana’s Persons with Disabilities Act (2006) explicitly prohibits discrimination against persons with physical, sensory, intellectual, and mental disabilities in employment, health care, air travel and other transportation, and other domains. The government does not systematically or overtly discriminate against persons with disabilities, but such persons may experience societal discrimination.

Furthermore, the law provides persons with disabilities access to public buildings “as far as is practical.” However, most buildings, transportation, and educational facilities do not provide for people with special needs. Because many streets are unpaved or not well-maintained, and sidewalks are not prevalent, individuals in wheelchairs or who have difficulty walking face challenges.

Students :  See our  Students Abroad  page and  FBI travel tips .

Women Travelers : Rape is a crime in Ghana punishable by five to 25 years in prison. However, rape is significantly underreported and remains a serious problem. Domestic violence is a crime punishable by up to two years in prison and/or a fine. Police rarely respond to reports of domestic violence.

See our travel tips for  Women Travelers .

Medical facilities in Ghana are limited, particularly outside the capital, Accra. You should carry adequate supplies of any needed prescription medicines, along with copies of your prescriptions, the generic name of the drugs, and a supply of preferred over-the-counter medications.

Mosquito-borne illnesses, such as Malaria, Yellow Fever, and Dengue are a significant problem, and prevention of bites and proper Yellow Fever immunization are important for all areas. 

While in Ghana, you should carry and use insect repellents containing either 20 percent DEET, picaridin, oil of lemon eucalyptus, or IR3535; treat clothing and tents with permethrin; and sleep in screened or air-conditioned rooms under insecticide-impregnated mosquito nets.

Refer to the CDC website for  health information for travelers to Ghana.

For emergency services in Ghana, dial 211.

Ambulance services are:

• Not widely available, and training and availability of emergency responders may be below U.S. standards. 
• Not equipped with state-of-the-art medical equipment.  
• Not staffed with trained paramedics, and often have little or no medical equipment. 
• Injured or seriously ill travelers may prefer to take a taxi or private vehicle to the nearest major hospital rather than wait for an ambulance.  

We do not pay medical bills.  Be aware that U.S. Medicare/Medicaid does not apply overseas. Most hospitals and doctors overseas do not accept U.S. health insurance.

Medical Insurance : Make sure your health insurance plan provides coverage overseas. Most care providers overseas only accept cash payments. See our webpage for more information on insurance providers for overseas coverage. Visit the  U.S. Centers for Disease Control and Prevention  for more information on type of insurance you should consider before you travel overseas.

We strongly recommend supplemental insurance to cover medical evacuation.

Always carry your prescription medication in original packaging, along with your doctor’s prescription. Check with the Ghana Food and Drugs Authority to ensure the medication is legal in Ghana.

Vaccinations:  Be up-to-date on all  vaccinations  recommended by the U.S. Centers for Disease Control and Prevention.

Further health information:

• World Health Organization
• U.S. Centers for Disease Control and Prevention  (CDC)  

Air Quality:  Visit  AirNow Department of State  for information on air quality at U.S. Embassies and Consulates. 

The U.S. Embassy maintains a list of doctors and hospitals.   We do not endorse or recommend any specific medical provider or clinic. 

Health Facilities in General :

• Public medical clinics lack basic resources and supplies.  
• Hospitals and doctors often require payment “up front” prior to service or admission. Credit card payment is not always available. Most hospitals and medical professionals require cash payment. 
• Private hospitals usually require advance payment or proof of adequate insurance before admitting a patient.  
• Generally, in public hospitals only minimal staff is available overnight in non-emergency wards.
• Patients bear all costs for transfer to or between hospitals. 

Medical Tourism and Elective Surgery :

• Medical tourism is a rapidly growing industry. People seeking health care overseas should understand that medical systems operate differently from those in the United States, and are not subject to the same rules and regulations. Anyone interested in traveling for medical purposes should consult with their local physician before traveling.
• Visit the  U.S. Centers for Disease Control and Prevention  website for information on medical tourism, the risks of medical tourism, and what you can do to prepare before traveling to Ghana. 
• We strongly recommend  supplemental insurance  to cover medical evacuation in the event of unforeseen medical complications.  

Pharmaceuticals :

• Exercise caution when purchasing medication overseas. Pharmaceuticals, both over the counter and requiring prescriptions in the United States, are often readily available for purchase with little controls. Counterfeit medication is common, and may prove to be ineffective, the wrong strength, or contain dangerous ingredients. Medication should be purchased in consultation with a medical professional and from reputable establishments.  
• U.S. Customs and Border Protection and the Food and Drug Administration are responsible for rules governing the transport of medication back to the United States. Medication purchased abroad must meet their requirements to be legally brought back into the United States. Medication should be for personal use and must be approved for usage in the United States. Please visit the  U.S. Customs and Border Protection  and the  Food and Drug Administration  websites for more information.   

Assisted Reproductive Technology and Surrogacy :

• If you are considering traveling to Ghana to have a child through use of assisted reproductive technology (ART) or surrogacy, please see our  ART and Surrogacy Abroad page . 

Water Quality :

• In many areas, tap water is not potable. Bottled water and beverages are generally safe, although you should be aware that many restaurants and hotels serve tap water unless bottled water is specifically requested. Be aware that ice for drinks may be made using tap water. 

Adventure Travel :

• Visit the U.S. Centers for Disease Control and Prevention website for more information about  Adventure Travel . 

General Health :

The following diseases are prevalent:

• Dengue Fever
• Diarrheal Illness
• Meningococcal Meningitis
• Tuberculosis
• Schistosomiasis
• Typhoid Fever
• Use the U.S. Centers for Disease Control and Prevention-recommended mosquito repellents and sleep under insecticide-impregnated mosquito nets. Chemoprophylaxis is recommended for all travelers, even for short stays.
• HIV/AIDS: Please visit https://www.ghanaids.gov.gh/ for information about HIV/AIDS in Ghana.  
• Visit the U.S. Centers for Disease Control and Prevention website for more information about  Resources for Travelers  regarding specific issues in Ghana.   

Air Quality :

• Air pollution is a significant problem in several major cities in Ghana. Consider the impact seasonal smog and heavy particulate pollution may have on you, and consult your doctor before traveling if necessary.   
• Infants, children, and teens. 
• People over 65 years of age. 
• People with lung disease, such as asthma and chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. 
• People with heart disease or diabetes. 
• People who work or are active outdoors. 

Travel and Transportation

Road Conditions and Safety : Main roads in major cities are generally paved and well-maintained. Secondary roads and many roads outside of major cities are mostly in poor condition. Many accidents occur on the highway from Accra to Cape Coast. Travel in darkness, particularly outside the major cities, is extremely hazardous due to poor street lighting and the unpredictable behavior of pedestrians, bicyclists, and animals. Aggressive drivers, poorly maintained vehicles, and overloaded vehicles pose serious threats to road safety.

Scammers may intentionally bump into vehicles and pretend to be hit. They then attempt to extort money from the vehicle’s occupants. Scams of this nature most commonly occur in congested urban areas.

There has been an increase in robberies on the highways from Bole-to-Wa and Kintampo-to-Tamale, as well as on other minor roads within parts of the Upper West, Upper East, Northern, Eastern, Bono, Bono East, and Ahafo Regions. Embassy personnel are not permitted to travel at night outside of major cities, and are encouraged to avoid the areas listed in our  Travel Advisory . Remain vigilant, and drive with doors locked and windows up.

Traffic Laws : Travelers are routinely stopped at police checkpoints throughout Ghana, and vehicles and passengers may be searched. Drivers must possess an international driver’s license (available from  AAA  and the  American Automobile Touring Alliance ) or a Ghanaian driver’s license. When foreign drivers apply for their Ghanaian driver’s license, they may be asked to have their international driver’s license or their home country driver’s license confirmed by their embassy. The U.S. Embassy in Ghana is unable to authenticate such state-issued or international drivers’ licenses, and advises U.S. citizens to contact the National Identification Authority in Ghana or have their U.S. driver’s license authenticated in the United States prior to arriving in Ghana. While in Ghana, you should carry documentation of your immigration status, such as a passport and a visa.

Public Transportation : Safety standards for small private buses, often called tro-tros, are substandard.

See our  Road Safety page  for more information. Visit the website of  Ghana’s national tourist office and national authority responsible for road safety.

Aviation Safety Oversight : The U.S. Federal Aviation Administration (FAA) has assessed the government of Ghana’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Ghana’s air carrier operations. Further information may be found on the  FAA’s safety assessment page .

Due to safety concerns, Ghana Civil Aviation Authority prohibits transporting via air carrier any Samsung Galaxy Note 7 phone device.

Maritime Travel : Mariners planning travel to Ghana should also check for  U.S. maritime advisories and alerts . Information may also be posted to the  U.S. Coast Guard homeport website , and the  NGA broadcast warnings .

For additional travel information

• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive security messages and make it easier to locate you in an emergency.
• Call us in Washington, D.C. at 1-888-407-4747 (toll-free in the United States and Canada) or 1-202-501-4444 (from all other countries) from 8:00 a.m. to 8:00 p.m., Eastern Standard Time, Monday through Friday (except U.S. federal holidays).
• See the  State Department’s travel website  for the  Worldwide Caution  and  Travel Advisories .
• Follow us on  Twitter  and  Facebook .
• See  traveling safely abroad  for useful travel tips.

Review information about International Parental Child Abduction in Ghana . For additional IPCA-related information, please see the  International Child Abduction Prevention and Return Act ( ICAPRA )  report.”

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Ghana (Africa)

Advice for all destinations.

Read the information on the COVID-19: Health Considerations for Travel page for advice on travelling during the COVID-19 pandemic.

Vaccinations and malaria risk

Review both the Vaccination and Malaria sections on this page to find out if you may need vaccines and/or a malaria risk assessment before you travel to this country.

If you think you require vaccines and/or malaria risk assessment, you should make an appointment with a travel health professional:

• How to make an appointment with a travel health professional

A travel health risk assessment is also advisable for some people, even when vaccines or malaria tablets are not required.

• Do I need a travel health risk assessment?

Risk prevention advice 

Many of the health risks experienced by travellers cannot be prevented by vaccines and other measures need to be taken.

Always make sure you understand the wider risks at your destination and take precautions, including:

• food and water safety
• accident prevention
• avoiding insect bites
• preventing and treating animal bites
• respiratory hygiene
• hand hygiene

Our advice section gives detailed information on minimising specific health risks abroad:

• Travel Health Advice A-Z

Other health considerations

Make sure you have travel insurance before travel to cover healthcare abroad.

Find out if there are any restrictions you need to consider if you are travelling with medicines .

Know how to access healthcare at your destination: see the GOV.UK English speaking doctors and medical facilities: worldwide list

If you feel unwell on your return home from travelling abroad, always seek advice from a healthcare professional and let them know your travel history.

Vaccinations

• Confirm primary courses and boosters are up to date as recommended for life in Britain - including for example, seasonal flu vaccine (if indicated), MMR , vaccines required for occupational risk of exposure, lifestyle risks and underlying medical conditions.
• Courses or boosters usually advised: Hepatitis A; Poliomyelitis; Tetanus; Yellow Fever.
• Other vaccines to consider: Diphtheria; Hepatitis B; Meningococcal Meningitis; Rabies; Typhoid.
• Selectively advised vaccines - only for those individuals at highest risk: Cholera.

Yellow fever vaccination certificate required for all travellers aged 9 months or over.

Notes on the diseases mentioned above

Risk is higher during floods and after natural disasters, in areas with very poor sanitation and lack of clean drinking water.

• Diphtheria :  spread person to person through respiratory droplets. Risk is higher if mixing with locals in poor, overcrowded living conditions.

Risk is higher where personal hygiene and sanitation is poor.

Risk is higher for long stays, frequent travel and for children (exposed through cuts and scratches), those who may require medical treatment during travel.

• Meningococcal Meningitis :  spread by droplet infection through close person to person contact. Meningococcal disease is found worldwide but epidemics may occur within this country, particularly during the dry season. Risk is higher for those mixing with locals for extended periods.
• Tetanus :  spread through contamination of cuts, burns and wounds with tetanus spores. Spores are found in soil worldwide. A total of 5 doses of tetanus vaccine are recommended for life in the UK. Boosters are usually recommended in a country or situation where the correct treatment of an injury may not be readily available.
• Typhoid :  spread mainly through consumption of contaminated food and drink. Risk is higher where access to adequate sanitation and safe water is limited.
• Yellow Fever :  spread by the bite of an infected, day-biting mosquito. The disease is mainly found in rural areas of affected countries but outbreaks in urban areas do occur. Vaccination is usually recommended for all those who travel into risk areas. (View yellow fever risk areas here), and areas where there is an outbreak ongoing (check the 'news' section for outbreaks). In addition, certain countries may want to see proof of vaccination on an official yellow fever vaccination certificate - check above under Immunisations .

Malaria is a serious and sometimes fatal disease transmitted by mosquitoes.You cannot be vaccinated against malaria.

Malaria precautions

• Malaria risk is high throughout the year in all areas.
• Malaria precautions are essential. Avoid mosquito bites by covering up with clothing such as long sleeves and long trousers especially after sunset, using insect repellents on exposed skin and, when necessary, sleeping under a mosquito net.
• Check with your doctor or nurse about suitable antimalarial tablets.
• See malaria map –  additional information can be found by clicking on the Regional Information icon below the map.
• High risk areas: atovaquone/proguanil OR doxycycline OR mefloquine  is usually advised.
• If you have been travelling in a malarious area and develop a fever seek medical attention promptly. Remember malaria can develop even up to one year after exposure.
• If travelling to an area remote from medical facilities, carrying standby emergency treatment for malaria may be considered.

Other Health Risks

Schistosomiasis.

There is a risk of exposure to coronavirus (COVID-19) in this country.

Please be aware that the risk of COVID-19 in this country may change at short notice and also consider your risk of exposure in any transit countries and from travelling itself. 

• The 'News' section on this page will advise if significant case increases or outbreaks have occurred in this country.

Prior to travel, you should:

• Check the latest government guidance on the FCDO Foreign travel advice and country specific pages for travel to this country and the rules for entering the UK on return.
• Ensure you are up to date with UK recommendations on COVID-19 vaccination.
• You can check this in the FAQ's.
• If you are at increased risk of severe COVID-19 you should carefully  consider your travel plans  and consider seeking medical advice prior to making any decisions.

For further information, see  Coronavirus disease (COVID-19)  and  COVID-19: Health Considerations for Travel  pages.

Zika Virus Infection

This country has been categorised as having a risk of Zika (ZIKV) virus transmission.

ZIKV is mainly spread through mosquito bites. The mosquito responsible most commonly bites during daylight hours and is common in towns and cities. 

The illness is usually mild but infection during pregnancy may lead to babies being born with birth defects. There is no vaccine currently available against ZIKV.

Advice for All Travellers

You should practice strict mosquito bite avoidance at all times. Do not travel without adequate travel insurance . Seek pre-travel health advice from a travel health professional 6 to 8 weeks in advance of travel.

Additional recommendations for pregnant travellers or those planning pregnancy

If you are planning pregnancy in the very near future you should consider whether you should avoid travel to this country.

• contact your GP, obstetrician or midwife for further advice, even if you have not been unwell or had any symptoms of ZIKV infection
• use barrier methods of contraception during and after travel and for the duration of your pregnancy, even in you have not been unwell or had any symptoms of ZIKV infection
• If you develop symptoms of ZIKV infection, it is recommended that you avoid becoming pregnant for a further 2 months following your recovery
• 2 months afterwards if you are female
• 3 months afterwards if you are male or if both partners travelled

These measures reduce the chance of sexual transmission of ZIKV and/or the risk of ZIKV infection in pregnancy.

For further information, see Zika virus infection page.

• 57 additional items in the news archive for this country

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Ghana Travel Health Information

Read below for travel health advice on Ghana from the MDtravelhealth channel on Red Planet Travel.

Page Sections

Medications

Immunizations

• Recent outbreaks of diseases
• Other Infections
• Food and Water
• Insect Tick Protection
• Swimming and Bathing
• General Advice
• Medical Facilities
• Travel with children

Travel and pregnancy

• Safety Information
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Are you a doctor or medical professional with knowledge of the situation in Ghana  Why not apply to contribute to this page? You will get a link and referrals to your clinic from this site.

Summary You can't Edit

Summary of recommendations

Most travelers to Ghana will need vaccinations for hepatitis A , typhoid fever , polio , and yellow fever , as well as medications for malaria prophylaxis and travelers' diarrhea . Meningococcal vaccine is recommended for travel during the dry season (November through June). Other immunizations may be necessary depending upon the circumstances of the trip and the medical history of the traveler, as discussed below. Insect repellents are recommended, in conjunction with other measures to prevent mosquito bites. All travelers should visit either a travel health clinic or their personal physician 4-8 weeks before departure.

Malaria:Prophylaxis with Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline is recommended for all areas.

Vaccinations:

Medications You can't Edit

Travelers' diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions , as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.

Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.

If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.

Malaria in Ghana: prophylaxis is recommended for all travelers. Either mefloquine (Lariam), atovaquone/proguanil (Malarone)(PDF) , or doxycycline may be given. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Those taking mefloquine (Lariam) should read the Lariam Medication Guide (PDF). Atovaquone/proguanil (Malarone) is a combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics.

Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours. See malaria for details. Symptoms of malaria sometimes do not occur for months or even years after exposure.

Insect protection measures are essential.

For further information about malaria in Ghana, including a map showing the risk of malaria in different parts of the country, go to the World Health Organization and Roll Back Malaria .

Immunizations You can't Edit

The following are the recommended vaccinations for Ghana:

Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF) . Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.

Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.

Typhoid vaccine is recommended for all travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.

Yellow fever vaccine is required for all travelers. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center , which will give each vaccinee a fully validated International Certificate of Vaccination. The vaccine should not in general be given to those who are younger than six months of age, immunocompromised, or allergic to eggs (since the vaccine is produced in chick embryos). It should also not be given to those with a malignant neoplasm and those with a history of thymus disease or thymectomy. Caution should be exercised before giving the vaccine to those who are between the ages of 6 and 8 months, age 60 years or older, pregnant, or breastfeeding. Reactions to the vaccine, which are generally mild, include headaches, muscle aches, and low-grade fevers. Serious allergic reactions, such as hives or asthma, are rare and generally occur in those with a history of egg allergy.

Polio immunization is recommended, due to the persistence of polio in sub-Saharan Africa. Any adult who received the recommended childhood immunizations but never had a booster as an adult should be given a single dose of inactivated polio vaccine. All children should be up-to-date in their polio immunizations and any adult who never completed the initial series of immunizations should do so before departure. Side-effects are uncommon and may include pain at the injection site. Since inactivated polio vaccine includes trace amounts of streptomycin, neomycin and polymyxin B, individuals allergic to these antibiotics should not receive the vaccine.

Meningococcal vaccine is recommended for travel during the dry season (November through June), especially if prolonged contact with the populace is likely. Meningococcal vaccine has few side-effects. Mild redness at the injection site may occur. Young children may develop transient fever.

Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF) . A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.

Rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.

Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.

Tetanus - diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.

Measles - mumps - rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.

Cholera vaccine is not generally recommended, even though cholera is reported, because most travelers are at low risk for infection. Two oral vaccines have recently been developed: Orochol (Mutacol), licensed in Canada and Australia, and Dukoral , licensed in Canada, Australia, and the European Union. These vaccines, where available, are recommended only for high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. The only cholera vaccine approved for use in the United States is no longer manufactured or sold, due to low efficacy and frequent side-effects.

Recent outbreaks of diseases You can't Edit

Recent outbreaks

A major cholera outbreak was reported from Ghana in 2014, causing 7800 cases and at least 51 deaths in the Greater Accra Region by the end of August, as well as hundreds of cases in other regions. The main symptoms of cholera are profuse watery diarrhea and vomiting, which in severe cases may lead to dehydration and death. Most outbreaks are related to contaminated drinking water, typically in situations of poverty, overcrowding, and poor sanitation. Most travelers are at extremely low risk for infection. Cholera vaccine, where available, is recommended only for certain high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. All travelers should carefully observe food and water precautions , as below.

Cholera outbreaks occur regularly in Ghana. An outbreak was reported from the Northern and Western regions in August 2011, from the Central region in June 2011, and from the Eastern region in March 2011. A major outbreak was reported from greater Accra in February 2011, causing 4190 cases and 36 deaths by the end of March. In January 2011, cholera outbreak occurred in southern Ghana. In November 2010, a cholera outbreak was reported from the Eastern Region of Ghana. In January 2009, a cholera outbreak occurred in the Greater Accra Region, chiefly involving the Okaikoi, Ablekuma, and Ayawaso constituencies. At around the same time, outbreaks were reported from the Eastern Region and from the Anyako community in the Keta Municipality of the Volta Region, southeastern Ghana. An increase in the number of cholera cases was reported from the Greater Accra Region in September 2008 and before that in June 2006. In March 2006, a cholera outbreak was reported from Komenda and its surrounding villages in the Komenda-Edina-Eguafo-Abrem (KEEA) District of the Central Region (see ProMED-mail ; April 7 and June 23, 2006). In November 2005, a cholera outbreak was reported from communities in Greater Accra, Ashanti, Eastern, and Northern Regions (see International Federation of Red Cross And Red Crescent Societies).

An outbreak of yellow fever was reported in February 2013 from Jirapa district, located in the northwestern corner of the Upper West Region of Ghana. In February 2012, a yellow fever outbreak was reported from three districts: Builsa and Kassena-Nankana-West in the Upper East Region and Kitampo-South in the Brong Ahafo Region located in the mid-western part of the country. Three cases were confirmed, two of them fatal. In the year 2011, three cases of yellow fever were reported from the Upper West Region: one each from Wa Municipality, Jirapa District, and Wa East District. An isolated case was also reported from the Northern Region in 2011. An outbreak of yellow fever occurred in the Upper East Region in 1996. Yellow fever vaccine is required for all travelers to Ghana.

An anthrax outbreak was reported in April 2013 from Bawku West District of the Upper East Region. In April 2012, an anthrax outbreak was reported from the Upper East Region, resulting in four human deaths. A smaller outbreak was reported in June 2009 from Tindongo in the Talensi-Nabdam District of the Upper East Region, causing two deaths. In April 1997, an anthrax outbreak occurred in a village in Bolgatanga District in the Upper East Region, resulting in 26 cases and 14 deaths. Anthrax cases occur regularly in the Northern Region and the southern Volta Region (see ProMED-mail ; July 1, 2003, June 25, 2009, April 29, 2012, and April 16, 2013). Most cases occur in those who have direct contact with infected animals. Most travelers are at low risk.

An outbreak of meningococcal disease was reported in February 2010 from the Upper West Region, resulting in 96 cases and 17 deaths (see ProMED-mail ). A meningococcal outbreak in early 2002 caused more than 1400 cases, including 190 deaths. The districts of Bongo, Kessena, West Gonja, Na, Jirapu-Lambus, Gushiegu-Karaga, Techiman, Krachi, East Maprusi, Builsa and Lawra were chiefly affected. An outbreak between November 1996 and March 1997 killed more than 400 people, chiefly in the Upper West, Upper East, Northern and Brong Ahafo Regions. Meningococcal vaccine is recommended for travel during the dry season (November through June), especially if prolonged contact with the populace is likely.

A rabies outbreak was reported in October 2009 from the Bongo district and communities within the Bolgatanga Municipal area in the Upper East Region (see ProMED-mail ). As above, rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites.

An outbreak of H5N1 avian influenza ("bird flu") was reported in April 2007 from a poultry farm east of the capital city of Accra. A second outbreak was reported from a poultry farm north of Accra in May 2007. No human cases have been reported to date. Most travelers are at extremely low risk for avian influenza, since almost all human cases in other countries have occurred in those who have had direct contact with live, infected poultry, or sustained, intimate contact with family members suffering from the disease. The World Health Organization and the Centers for Disease Control do not advise against travel to countries affected by avian influenza, but recommend that travelers to affected areas should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked. A vaccine for avian influenza was recently approved by the U.S. Food and Drug Administration (FDA), but produces adequate antibody levels in fewer than half of recipients and is not commercially available. The vaccines for human influenza do not protect against avian influenza. Anyone who develops fever and flu-like symptoms after travel to Ghana should seek immediate medical attention, which may include testing for avian influenza. For further information, go to the World Health Organization , Health Canada, the Centers for Disease Control , and ProMED-mail .

Other Infections You can't Edit

Other infections

• Schistosomiasis (acquired by swimming, wading, rafting, or bathing in contaminated fresh water; swimming and bathing precautions are advised, as below).
• African trypanosomiasis (sleeping sickness)
• Anthrax (prevalence greatest in the Northern, Upper East, and Eastern regions; also occcurs in parts of the Volta and Central Regions; outbreak reported from the Upper East region in April 2008; see ProMED-mail , April 15, 2008)
• Lymphatic filariasis
• Onchocerciasis (may be developing resistance to ivermectin, the drug most commonuly used to treat it; see ProMED-mail , July 20, 2007)
• Dengue fever (flu-like illness sometimes complicated by hemorrhage or shock; transmitted by mosquitoes)
• Brucellosis (low incidence)

HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.

Food and Water You can't Edit

Food and water precautions

Do not drink tap water unless it has been boiled, filtered, or chemically disinfected . Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, and sea bass.

All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro) , levofloxacin (Levaquin), rifaximin (Xifaxan) , or azithromycin (Zithromax) . Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.

Insect Tick Protection You can't Edit

Insect and Tick Protection

Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accommodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night. In rural or forested areas, perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.

Insect repellents are ineffective against tsetse flies, which transmit sleeping sickness (African trypanosomiasis). Areas infested with tsetse flies, which are usually known to local inhabitants, should be avoided. Travelers at risk should wear long sleeves and long pants of medium weight fabric in neutral colors that blend with the environment. Also, travelers should avoid riding in the back of open vehicles, since dust may attract tsetse flies, and should take care not to disturb bushes (where tsetse flies rest) during the warmer parts of the day.

Swimming and Bathing You can't Edit

Swimming and bathing precautions

Avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers. Do not use fresh water for bathing or showering unless it has been heated to 150 degrees F for at least five minutes or held in a storage tank for at least three days. Toweling oneself dry after unavoidable or accidental exposure to contaminated water may reduce the likelihood of schistosomiasis, but does not reliably prevent the disease and is no substitute for the precautions above. Chlorinated swimming pools are considered safe.

General Advice You can't Edit

General advice

Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.

Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.

Pack a personal medical kit , customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag , discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.

Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.

Medical Facilities You can't Edit

Medical facilities

For a guide to physicians, hospitals, and pharmacies in Ghana, go to the U.S. Embassy website. Medical facilities are limited in Accra and may be nonexistent elsewhere. Most doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. Serious medical problems will require air evacuation to a country with state-of-the-art medical facilities.

Travel with children You can't Edit

Traveling with children

Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed (see the U.S. Embassy website).

All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics . Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).

Because yellow fever vaccine is not approved for use in children less than nine months of age, children in this age group should not in general be brought to Ghana.

The recommendations for malaria prophylaxis are the same for young children as for adults, except that (1) dosages are lower; and (2) doxycycline should be avoided. DEET-containing insect repellents are not advised for children under age two, so it's especially important to keep children in this age group well-covered to protect them from mosquito bites.

When traveling with young children, be particularly careful about what you allow them to eat and drink (see food and water precautions ), because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever , which are transmitted by contaminated food and water, are not approved for children under age two. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.

Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.

Travel and pregnancy You can't Edit

Because of the risk of malaria and yellow fever , pregnant women should not in general travel to Ghana. Yellow fever vaccine is not approved for use during pregnancy, because it contains live virus. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. Mefloquine (Lariam) is the drug of choice for malaria prophylaxis during pregnancy, but should not be given if possible in the first trimester. If travel to areas with malaria and yellow fever is unavoidable, insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults.

Maps You can't Edit

Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names .

Embassy You can't Edit

Embassy/Consulate Location

(reproduced from the U.S. State Dept. Consular Information Sheet)

Americans living in or visiting Ghana are encouraged to register at the Consular Section of the U.S. Embassy in Ghana and obtain updated information on travel and security within Ghana. Student groups are asked to register with the Consular Section before their arrival, and to contact the Embassy's Public Affairs Section at [email protected] with basic information on their program such as number of students and length and place of stay. At a student group's request, the Public Affairs Section can arrange for group embassy briefings, including security information. The U.S. Embassy is located on Ring Road East, P.O. Box 194, Accra, telephone (233)(21) 775-347 or 48, fax number (233)(21) 701-813. The Embassy maintains a home page on the Internet at http://usembassy.state.gov/accra/

Safety Information You can't Edit

Safety information

For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada , and the Australian Department of Foreign Affairs and Trade .

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Related Pages

Check out our page on Ghana for information on how to get there, accommodation, video and reviews.

Medical Clinics

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• Health Screen Ghana Clinic Full Details Health Screen Ghana Clinic No.1, Information Drive,Education Close,Adabraka OPPOSITE MINISTRY OF INFORMATION,WORKERS COLLEGE COMPOUND, Accra, Ghana Directions +233 26 427 3345
• Binda - Kete-Krachi Rd Full Details Binda - Kete-Krachi Rd, Kpandai, Ghana Directions

Hotels near Ghana

• Okumah Hotel Offering a restaurant, Okumah Hotel is located in Kumasi. Free Wi-Fi access is available. Each room here will provide you with a TV, air conditioning and a hot tub. There is also a refrigerator.
• Wadoma Royale Hotel Offering an outdoor pool and a restaurant, Wadoma Royale Hotel is located in Kumasi. Free WiFi access is available. Each room here will provide you with a TV, air conditioning and a hot tub. There is also a refrigerator.
• Safui Memorial Lodge Offering a restaurant, Safui Memorial Lodge is located in Tamale. Wi-Fi access is available. Rooms here will provide you with a flat-screen TV, air conditioning and satellite channels. There is also a refrigerator.
• Beige Village Golf Resort & Spa Located 100 from Kumasi International Aairport, Beige Village Golf Resort & Spa offers an outdoor swimming pool, spa, golf course, fitness centre, and free airport shuttle service.
• William Guest House William Guest House is located in Dormaa Ahenkro. Each room here will provide you with a TV. There is also a dining table. Featuring a bath, private bathroom also comes with a bath or shower and a bidet.
• Vip Lodge A 20-minute drive from Aburi Botanic Garden, Vip Lodge offers 24-hour reception, a terrace, a garden, a car rental service, and Wi-Fi is available in the hotel room with a supplement.
• Joy Family Lodge Offering a restaurant, Joy Family Lodge is located in Accra. Free WiFi access is available. Each room here will provide you with a TV, air conditioning and a seating area. There is also a refrigerator.
• Meaglent Hotel Featuring an outdoor swimming pool and a fitness centre, Meaglent Hotel in Accra also offers a restaurant and bar. There is free Wi-Fi available in all areas. The air-conditioned rooms come with a TV and en suite bathrooms with a shower.
• Mountain hospitality Located in Accra, Mountain hospitality is self-catering accommodation featuring free WiFi. Accommodation will provide you with a TV. There is a kitchen with a microwave and an oven. Shared bathrooms also come with a shower.
• Accra Royal Castle Apartments Located in Accra, Accra Royal Castle Apartments offers an outdoor pool and a restaurant. This self-catering accommodation features free WiFi. Accommodation will provide you with a TV, air conditioning and a balcony.

More hotels from our Partner Booking.com

Accommodation near Ghana

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Travel Vaccines and Advice for Ghana

Ghana is considered a good and welcoming place, especially for first-time travellers to Africa. Tourism is a growing industry in Ghana.

Ghana presents a lot of opportunities to experience Africa through national parks, nature reserves and villages.

English is the official language of Ghana. But, not always the primary language people speak. Local languages also include Ga, Twi and Ewe.

The largest city, Accra is also the capital city of Ghana. Accra is a growing city with modern amenities of hotels, restaurants and a vast number of museums.

Do I Need Vaccines for Ghana?

Yes, some vaccines are recommended or required for Ghana. The National Travel Health Network and Centre and WHO recommend the following vaccinations for Ghana: hepatitis A , hepatitis B , typhoid , cholera , yellow fever , rabies , meningitis , polio and tetanus .

See the bullets below to learn more about some of these key immunisations:

• Hepatitis A – Food & Water – Recommended for most travellers to the region, especially if unvaccinated.
• Hepatitis B – Blood & Body Fluids – Recommended for travellers to most regions.
• Tetanus – Wounds or Breaks in Skin – Recommended for travellers to most regions, especially if not previously vaccinated.
• Typhoid – Food & Water – Jab lasts 3 years. Oral vaccine lasts 5 years, must be able to swallow pills. Oral doses must be kept in refrigerator.
• Cholera – Food & Water – Recommended for travel to most regions.
• Yellow Fever – Mosquito – Required for all travellers over 9 months of age.
• Rabies – Saliva of Infected Animals – High risk country. Vaccine recommended for long-stay travellers and those who may come in contact with animals.
• Meningitis – Airborne & Direct Contact – Located in the meningitis belt, vaccination is recommended during the dry season (Dec. – June)
• Polio – Food & Water – Recommended for some travellers to this region. Single adult booster recommended.

See the tables below for more information:

Documentation of yellow fever vaccination is required in Ghana. Ensure you are vaccinated before you go or you may be denied entry to the country.

Meningitis spreads in the region during the summer months. A meningitis vaccination is the best form of protection against this potentially deadly disease.

Malaria , dengue and chikungunya are all present in Ghana. Be sure to bring antimalarials, mosquito repellents and netting to stay protected whilst in-country.

Outside of Accra, access to medical facilities is limited. Ensure to bring any prescriptions you will need.

Visit our vaccinations page to learn more. Travel safely with Passport Health and schedule your appointment today by calling or book online now .

Do I Need a Visa or Passport for Ghana?

A visa is required for all travel to Ghana. Passports must have at least six months validity. Proof of yellow fever vaccination is required to enter the country. If you do not have proof of vaccination, you may be vaccinated on site, quarantined or returned to your previous location.

Sources: Embassy of Ghana and GOV.UK

What is the Climate Like in Ghana?

The majority of Ghana is a tropical savanna climate, with a small part of the southwest being a monsoon climate.

North Ghana experiences its rainy season from March-November. South Ghana’s rainy season is from April to mid-November.

Average temperatures range from 21 to 28 degrees.

How Safe is Ghana?

Ghana is facing an increased threat from terrorist groups. Kidnapping that target Westerners have occurred in Cote d’Ivoire, Burkina Faso, Niger, and Mali.

Petty crime and scams are the most common crime that travellers face. Armed robbery and money solicitations at airports are on the rise.

Always remember to travel in groups and avoid travelling at night.

Homosexuality is illegal in Ghana and imprisonment can be from 3-10 years.

Remember that local authorities are responsible for investigating and prosecuting crime.

Coastal Forts in Ghana

The coastal forts of Ghana are a page out of history that helped create progress in Ghana’s modern world.

One of the largest forts in Ghana is the Cape Coast Castle that overlooks the sea. It was one of the world’s largest slave-holding sites and it still reflects the horror of that time.

The castle holds dungeons where slaves were held up to twelve weeks. In contrast, the castle also has a lavish governor’s bedroom to illustrate the inequality of the age.

Other forts to check out in Ghana include Fort Metal Cross, Fort Batenstein and Osu Castle.

What Should I Take To Ghana?

Here are some essential items to consider for your trip to Ghana:

• Prescription Medicine – You can get basic medicine at pharmacies, but formulas may be different.
• Water Filtration – Because of the risk of cholera, typhoid and other water-borne diseases, filtration is a must. Be sure to bring a filter or cleansing tablets.
• Money – Bring travellers cheques or credit card and cash them at an ATM. Don’t use credit cards to buy items as credit card fraud is high.

Embassy of the United Kingdom in Ghana

If you are in Ghana and have an emergency (for example, been attacked, arrested or someone has died) contact the nearest consular services. Contact the embassy before arrival if you have additional questions on entry requirements, safety concerns or are in need of assistance.

British High Commission Accra Julius Nyerere Link, off Gamel Abdul Nasser Avenue PO Box 296 Accra Ghana Telephone: + 233 302 213 250 Emergency Phone: + 233 302 213 250 Fax: + 233 30 2213 274 Contact Form: Click Here

If you have any questions about travelling to Ghana or are wondering which jabs you may need for your trip, schedule an appointment with your local Passport Health travel medicine clinic. Ring us up at or book online now and protect yourself today.

On This Page: Do I Need Vaccines for Ghana? Do I Need a Visa or Passport for Ghana? What is the Climate Like in Ghana? How Safe is Ghana? Coastal Forts in Ghana What Should I Take To Ghana? Embassy of the United Kingdom in Ghana

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Ghana travel advice

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Last updated: March 25, 2024 15:11 ET

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Safety and security, entry and exit requirements, laws and culture, natural disasters and climate, ghana - exercise a high degree of caution.

Exercise a high degree of caution in Ghana due to crime.

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Border areas

Border areas often see higher criminal activity and violence.

There is a heightened risk of terrorist attacks in the northern areas of Ghana bordering Côte d’Ivoire, Togo and Benin, and more specifically, Burkina Faso, where armed groups and militias are active.

The expansion of extremist militants and the limited capacity of the Ghanaian authorities to control borders may increase the risk posed by criminals.

Inter-ethnic violence

Chieftaincy disputes and political tension can sometimes lead to localized violence and unrest.

While possible throughout Ghana, these conflicts most commonly occur in the Upper East, Upper West and Volta regions.

During times of unrest, local authorities may impose curfews.

If you're travelling to an area where unrest is possible or if unrest breaks out where you are:

• monitor local media to stay up to date on the current situation
• follow the instructions of local authorities
• adhere to curfews

Latest curfews imposed – Ministry of the Interior, Republic of Ghana

Crime has steadily increased in the recent years in Ghana, especially in large cities such as Accra, Kumasi, Takoradi and their surroundings.

Several violent incidents have occurred in the following Greater Accra neighbourhoods:

• Agbogbloshie

Avoid going into these neighbourhoods at night.

Violent crime

Violent crime, such as armed robbery, home invasions and kidnapping, occurs. Thieves often target affluent areas where foreigners live. They sometimes carry firearms. In some cases, they have seriously assaulted their victims for failing to comply.

Armed robberies of vehicles at night also occur and armed attacks have been reported along the Accra–Tema and Accra–Kumasi–Tamale highways.

• Ensure that windows and doors in your residence are secured
• If you are the victim of an armed robbery, don’t resist
• Limit intercity travel to daytime hours

Petty crime

Petty crime, such as pickpocketing and purse snatching, is common at crowded markets, beaches, parks and other tourist areas. Attacks by individuals on motorbikes are also frequent.

Theft of luggage and belongings occurs in hotels.

• Ensure that personal belongings, including your passport and other travel documents, are secure at all times
• Be aware of your surroundings and avoid walking alone
• Avoid going to isolated beaches
• Avoid showing signs of affluence, such as flashy jewellery and watches

There is a threat of terrorism. Terrorist attacks could occur at any time. Targets could include:

• government buildings, including schools
• places of worship
• airports and other transportation hubs and networks
• public areas such as tourist attractions, restaurants, bars, coffee shops, shopping centres, markets, hotels and other sites frequented by foreigners

Always be aware of your surroundings when in public places.

2SLGBTQI+ travellers

2SLGBTQI+ persons and their allies have been victims of violence and discrimination.

2SLGBTQI+ travellers could face increased risks to their safety since the “anti-LGBTI” bill was introduced in August 2021.

2SLGBTQI+ travellers should carefully consider the risks of travelling to Ghana.

Travel and your sexual orientation, gender identity, gender expression and sex characteristics

Credit card and ATM fraud is widespread.

Be cautious when using debit or credit cards or when making payments at a payment terminal.  Connectivity issues may prevent the transaction from going through and you may be charged twice.

• Pay with cash whenever possible
• Pay careful attention when your cards are being handled by others
• Use ATMs located in well-lit public areas or inside a bank or business
• Avoid using card readers with an irregular or unusual feature
• Cover the keypad with one hand when entering your PIN
• Check for any unauthorized transactions on your account statements

Overseas fraud

At the airport

At the Kotoka International Airport, thieves sometimes pose as uniformed porters or officials appearing to work at the airport. Official airport employees wear ID cards bearing both their name and photograph.

• Be wary of unsolicited assistance

On the road

On the road, scammers may pose as police officers to stop and demand money from foreigners.

If this occurs:

• Don’t hand over your money or your passport
• Ask for their name tag and Identification number

Tourism industry

Local tour operators or hotels may offer you steep discounts for their services. They could be fake businesses.

• Do your research before booking
• Use reliable internationally known tourism agencies only

If you have lost money to such scams:

•  don’t attempt to confront your scammers
• seek assistance from local authorities or local legal aid

Online scams

Be wary of Internet romance or friendship scams via dating or social media websites. Scammers often use fake profiles to target Westerners and steal from them. Once they succeed in building a virtual relationship, they ask for money for various purposes.

If you are travelling to Ghana to meet someone you met online, keep in mind that you may be the victim of a scam.  Victims of this type of scams have lost thousands of dollars.

Be also wary of unsolicited emails offering enticing business or financial opportunities, often related to the gold industry.

If you intend to make business in Ghana:

• ensure that any business opportunity is legitimate before leaving; if in doubt, contact Canada’s Trade Commissioner Service
• don’t travel to Ghana with the intention to obtain restitution after losing money to a fraud as confrontations have resulted in assaults

Trade Commissioner Service in Ghana - Government du Canada

Demonstrations

Demonstrations occur from time to time in Accra and other major cities. Even peaceful demonstrations can turn violent at any time. They can also lead to disruptions to traffic and public transportation.

• avoid areas where demonstrations and large gatherings are taking place
• monitor local media for information on ongoing demonstrations

Mass gatherings (large-scale events)

Road safety

Road conditions and road safety can vary greatly throughout the country. They are generally good in cities, but poor in rural areas.  Most secondary roads are poorly lit. Pedestrians and roaming livestock pose further hazard, especially at night.

Many Ghanaian cars, especially commercial vehicles, are in poor condition and lack standard safety equipment. Drivers often don’t respect traffic laws. Accidents causing fatalities are common. Most often, victims are pedestrians. Traffic accidents are also common on the road from Accra to Cape Coast and Kumasi.

In town, people may try to get you to stop your vehicle. Pedestrians may bang on your car, making it appear as if they have been hit. Drivers may attempt to cause minor vehicle collisions. Crowds gathering because of these types of incidents can become dangerous.

Police roadblocks are common. You could be subject to inspections. Armed security forces may demand money.

If driving in Ghana:

• avoid driving after dark
• keep your doors locked and windows closed at all times
• proceed immediately to the nearest police station to make a report if you are involved in any traffic incident
• always carry a copy of you ID documents, such as your passport, your International Driving Permit and the vehicle registration

Public transportation

Public transportation is unregulated and unsafe. Many buses and taxis are not well-maintained and have poor safety standards.

Most taxis are in poor mechanical shape in Accra. They often lack seatbelts and most of the time, air conditioning is not functional.

Criminals often target foreigners travelling in taxis at night and violent robberies are frequent.

If you have to use a taxi in Ghana:

• avoid hailing taxis on the street
• use only officially marked taxis
• ensure that there is no other passenger in the car
• limit trips to daytime
• always agree on a fare before departure

If you use a trusted ride-sharing app:

• confirm the driver’s identity before getting in the car
• be aware that the driver might only accept cash payment

Privately owned minibuses, known as tro-tros, have a high accident record.  They are often overcrowded and poorly maintained. Drivers are reckless and drive at excessive speeds.

Private intercity buses are available and they are often better maintained and safer.

Periodic shortages of electricity and running water can occur, particularly during the dry season, from November to March, although the situation is improving, especially in Greater Accra.

Wildlife viewing

Wildlife viewing poses risks, particularly on foot or at close range.

• Always maintain a safe distance when observing wildlife
• Only exit a vehicle when a professional guide or warden says it’s safe to do so
• Only use reputable and professional guides or tour operators
• Closely follow park regulations and wardens’ advice

Coastal waters can be dangerous. Riptides are common. Several drownings occur each year.

Follow the instructions and warnings of local authorities.

Water safety abroad

Women’s safety

Women travelling alone may be subject to some forms of harassment and verbal abuse.

Advice for women travellers

Pirate attacks and armed robbery against ships occur in coastal waters of the Gulf of Guinea. Mariners should take appropriate precautions.

Live piracy report - International Maritime Bureau’s Piracy Reporting Centre

We do not make assessments on the compliance of foreign domestic airlines with international safety standards.

Information about foreign domestic airlines

Every country or territory decides who can enter or exit through its borders. The Government of Canada cannot intervene on your behalf if you do not meet your destination’s entry or exit requirements.

We have obtained the information on this page from Ghana authorities. It can, however, change at any time.

Verify this information with the  Foreign Representatives in Canada .

Entry requirements vary depending on the type of passport you use for travel.

Before you travel, check with your transportation company about passport requirements. Its rules on passport validity may be more stringent than the country’s entry rules.

Regular Canadian passport

Your passport must be valid for at least 6 months beyond the date you expect to leave Ghana.

Passport for official travel

Different entry rules may apply.

Official travel

Passport with “X” gender identifier

While the Government of Canada issues passports with an “X” gender identifier, it cannot guarantee your entry or transit through other countries. You might face entry restrictions in countries that do not recognize the “X” gender identifier. Before you leave, check with the closest foreign representative for your destination.

Other travel documents

Different entry rules may apply when travelling with a temporary passport or an emergency travel document. Before you leave, check with the closest foreign representative for your destination.

Useful links

• Foreign Representatives in Canada
• Canadian passports

Tourist visa: required Business visa: required Student visa: required

Resident registration

If you reside in Ghana, you must register with the National Identification Authority of Ghana to get a non-citizen card. This applies to foreign nationals:

• aged 6 and over
• permanently resident in the country
• resident in the country for at least 90 days in any calendar year

National Identification Authority – Republic of Ghana

Children and travel

Learn more about travelling with children .

Yellow fever

Learn about potential entry requirements related to yellow fever (vaccines section).

Relevant Travel Health Notices

• Global Measles Notice - 13 March, 2024
• COVID-19 and International Travel - 13 March, 2024

This section contains information on possible health risks and restrictions regularly found or ongoing in the destination. Follow this advice to lower your risk of becoming ill while travelling. Not all risks are listed below.

Consult a health care professional or visit a travel health clinic preferably 6 weeks before you travel to get personalized health advice and recommendations.

Routine vaccines

Be sure that your  routine vaccinations , as per your province or territory , are up-to-date before travelling, regardless of your destination.

Some of these vaccinations include measles-mumps-rubella (MMR), diphtheria, tetanus, pertussis, polio, varicella (chickenpox), influenza and others.

Pre-travel vaccines and medications

You may be at risk for preventable diseases while travelling in this destination. Talk to a travel health professional about which medications or vaccines may be right for you, based on your destination and itinerary. 

There is a risk of hepatitis A in this destination. It is a disease of the liver. People can get hepatitis A if they ingest contaminated food or water, eat foods prepared by an infectious person, or if they have close physical contact (such as oral-anal sex) with an infectious person, although casual contact among people does not spread the virus.

Practise  safe food and water precautions and wash your hands often. Vaccination is recommended for all travellers to areas where hepatitis A is present.

Yellow fever   is a disease caused by a flavivirus from the bite of an infected mosquito.

Travellers get vaccinated either because it is required to enter a country or because it is recommended for their protection.

• There is a risk of yellow fever in this country.

Country Entry Requirement*

• Proof of yellow fever vaccination for travellers from all countries.

Recommendation

• Vaccination is recommended.
• Contact a designated  Yellow Fever Vaccination Centre  well in advance of their trip to arrange for vaccination.
• Discuss travel plans, activities, and destinations with a health care professional.
• Protect yourself from mosquito bites .

About Yellow Fever

Yellow Fever Vaccination Centres in Canada * It is important to note that  country entry requirements  may not reflect your risk of yellow fever at your destination. It is recommended that you contact the nearest  diplomatic or consular office  of the destination(s) you will be visiting to verify any additional entry requirements.

Measles is a highly contagious viral disease. It can spread quickly from person to person by direct contact and through droplets in the air.

Anyone who is not protected against measles is at risk of being infected with it when travelling internationally.

Regardless of where you are going, talk to a health care professional before travelling to make sure you are fully protected against measles.

  Hepatitis B is a risk in every destination. It is a viral liver disease that is easily transmitted from one person to another through exposure to blood and body fluids containing the hepatitis B virus.  Travellers who may be exposed to blood or other bodily fluids (e.g., through sexual contact, medical treatment, sharing needles, tattooing, acupuncture or occupational exposure) are at higher risk of getting hepatitis B.

Hepatitis B vaccination is recommended for all travellers. Prevent hepatitis B infection by practicing safe sex, only using new and sterile drug equipment, and only getting tattoos and piercings in settings that follow public health regulations and standards.

 The best way to protect yourself from seasonal influenza (flu) is to get vaccinated every year. Get the flu shot at least 2 weeks before travelling.  

 The flu occurs worldwide. 

•  In the Northern Hemisphere, the flu season usually runs from November to   April.
•  In the Southern Hemisphere, the flu season usually runs between April and   October.
•  In the tropics, there is flu activity year round. 

The flu vaccine available in one hemisphere may only offer partial protection against the flu in the other hemisphere.

The flu virus spreads from person to person when they cough or sneeze or by touching objects and surfaces that have been contaminated with the virus. Clean your hands often and wear a mask if you have a fever or respiratory symptoms.

This destination is in the African Meningitis Belt, an area which has the highest rates of meningococcal disease in the world. Meningococcal disease is a serious and sometimes fatal infection. 

Travellers who are at higher risk should discuss vaccination with a health care provider. High-risk travellers include those living or working with the local population (e.g., health care workers) or those travelling to crowded areas or taking part in large gatherings.

Malaria is a serious and sometimes fatal disease that is caused by parasites spread through the bites of mosquitoes.

Malaria is a risk to travellers to this destination.   Antimalarial medication is recommended for most travellers to this destination and should be taken as recommended. Consult a health care professional or visit a travel health clinic before travelling to discuss your options. It is recommended to do this 6 weeks before travel, however, it is still a good idea any time before leaving.    Protect yourself from mosquito bites at all times: 

• Cover your skin and use an approved insect repellent on uncovered skin.
• Exclude mosquitoes from your living area with screening and/or closed, well-sealed doors and windows.
• Use insecticide-treated bed nets if mosquitoes cannot be excluded from your living area.
• Wear permethrin-treated clothing. 

 If you develop symptoms similar to malaria when you are travelling or up to a year after you return home, see a health care professional immediately. Tell them where you have been travelling or living. 

In this destination, rabies is commonly carried by dogs and some wildlife, including bats. Rabies is a deadly disease that spreads to humans primarily through bites or scratches from an infected animal. While travelling, take precautions , including keeping your distance from animals (including free-roaming dogs), and closely supervising children.

If you are bitten or scratched by a dog or other animal while travelling, immediately wash the wound with soap and clean water and see a health care professional. In this destination, rabies treatment may be limited or may not be available, therefore you may need to return to Canada for treatment.  

Before travel, discuss rabies vaccination with a health care professional. It may be recommended for travellers who are at high risk of exposure (e.g., occupational risk such as veterinarians and wildlife workers, children, adventure travellers and spelunkers, and others in close contact with animals). 

Polio (poliomyelitis) is an infectious disease that can be prevented by vaccination. It is caused by poliovirus type 1, 2 or 3. Circulating vaccine-derived poliovirus 2 (cVDPV2) is present in this country. Polio is spread from person to person and through contaminated food and water. Infection with the polio virus can cause paralysis and death in individuals of any age who are not immune.

Recommendations:

• Be sure that your polio vaccinations are up to date before travelling. Polio is part of the routine vaccine schedule for children in Canada.
• One booster dose of the polio vaccine is recommended as an adult .

Coronavirus disease (COVID-19) is an infectious viral disease. It can spread from person to person by direct contact and through droplets in the air.

It is recommended that all eligible travellers complete a COVID-19 vaccine series along with any additional recommended doses in Canada before travelling. Evidence shows that vaccines are very effective at preventing severe illness, hospitalization and death from COVID-19. While vaccination provides better protection against serious illness, you may still be at risk of infection from the virus that causes COVID-19. Anyone who has not completed a vaccine series is at increased risk of being infected with the virus that causes COVID-19 and is at greater risk for severe disease when travelling internationally.

Before travelling, verify your destination’s COVID-19 vaccination entry/exit requirements. Regardless of where you are going, talk to a health care professional before travelling to make sure you are adequately protected against COVID-19.

Safe food and water precautions

Many illnesses can be caused by eating food or drinking beverages contaminated by bacteria, parasites, toxins, or viruses, or by swimming or bathing in contaminated water.

• Learn more about food and water precautions to take to avoid getting sick by visiting our eat and drink safely abroad page. Remember: Boil it, cook it, peel it, or leave it!
• Avoid getting water into your eyes, mouth or nose when swimming or participating in activities in freshwater (streams, canals, lakes), particularly after flooding or heavy rain. Water may look clean but could still be polluted or contaminated.
• Avoid inhaling or swallowing water while bathing, showering, or swimming in pools or hot tubs. 

Cholera is a risk in parts of this country. Most travellers are at very low risk.

To protect against cholera, all travellers should practise safe food and water precautions .

Travellers at higher risk of getting cholera include those:

• visiting, working or living in areas with limited access to safe food, water and proper sanitation
• visiting areas where outbreaks are occurring

Vaccination may be recommended for high-risk travellers, and should be discussed with a health care professional.

Travellers' diarrhea is the most common illness affecting travellers. It is spread from eating or drinking contaminated food or water.

Risk of developing travellers' diarrhea increases when travelling in regions with poor standards of hygiene and sanitation. Practise safe food and water precautions.

The most important treatment for travellers' diarrhea is rehydration (drinking lots of fluids). Carry oral rehydration salts when travelling.

Typhoid   is a bacterial infection spread by contaminated food or water. Risk is higher among children, travellers going to rural areas, travellers visiting friends and relatives or those travelling for a long period of time.

Travellers visiting regions with a risk of typhoid, especially those exposed to places with poor sanitation, should speak to a health care professional about vaccination.  

There is a risk of schistosomiasis in this destination. Schistosomiasis is a parasitic disease caused by tiny worms (blood flukes) which can be found in freshwater (lakes, rivers, ponds, and wetlands). The worms can break the skin, and their eggs can cause stomach pain, diarrhea, flu-like symptoms, or urinary problems. Schistosomiasis mostly affects underdeveloped and r ural communities, particularly agricultural and fishing communities.

Most travellers are at low risk. Travellers should avoid contact with untreated freshwater such as lakes, rivers, and ponds (e.g., swimming, bathing, wading, ingesting). There is no vaccine or medication available to prevent infection.

Insect bite prevention

Many diseases are spread by the bites of infected insects such as mosquitoes, ticks, fleas or flies. When travelling to areas where infected insects may be present:

• Use insect repellent (bug spray) on exposed skin
• Cover up with light-coloured, loose clothes made of tightly woven materials such as nylon or polyester
• Minimize exposure to insects
• Use mosquito netting when sleeping outdoors or in buildings that are not fully enclosed

To learn more about how you can reduce your risk of infection and disease caused by bites, both at home and abroad, visit our insect bite prevention page.

Find out what types of insects are present where you’re travelling, when they’re most active, and the symptoms of the diseases they spread.

There is a risk of chikungunya in this country.  The risk may vary between regions of a country.  Chikungunya is a virus spread through the bite of an infected mosquito. Chikungunya can cause a viral disease that typically causes fever and pain in the joints. In some cases, the joint pain can be severe and last for months or years.

Protect yourself from mosquito bites at all times. There is no vaccine available for chikungunya.

• In this country, risk of  dengue  is sporadic. It is a viral disease spread to humans by mosquito bites.
• Dengue can cause flu-like symptoms. In some cases, it can lead to severe dengue, which can be fatal.
• The level of risk of dengue changes seasonally, and varies from year to year. The level of risk also varies between regions in a country and can depend on the elevation in the region.
• Mosquitoes carrying dengue typically bite during the daytime, particularly around sunrise and sunset.
• Protect yourself from mosquito bites . There is no vaccine or medication that protects against dengue fever.

Animal precautions

Some infections, such as rabies and influenza, can be shared between humans and animals. Certain types of activities may increase your chance of contact with animals, such as travelling in rural or forested areas, camping, hiking, and visiting wet markets (places where live animals are slaughtered and sold) or caves.

Travellers are cautioned to avoid contact with animals, including dogs, livestock (pigs, cows), monkeys, snakes, rodents, birds, and bats, and to avoid eating undercooked wild game.

Closely supervise children, as they are more likely to come in contact with animals.

Lassa fever is a risk in this country.

Lassa fever is caused by a virus carried by rodents. Humans get sick when they inhale or come into close contact with feces, saliva, or urine of infected rodents or the blood or bodily fluids of infected humans.

Lassa virus can be very serious. Avoid rodents and rodent-infested areas.

Mpox (monkeypox)   is a risk in this country. It is a viral disease that can cause serious illness in some circumstances. Risk is generally low for most travellers.

Mpox spreads in 3 ways:

• from animals to humans through direct contact or by eating or preparing undercooked meat of infected animals or coming into contact with an infected animal's body fluids
• from person to person through close contact, including direct contact with the skin lesions, blood, body fluids, or mucosal surfaces (such as eyes, mouth, throat, genitalia, anus, or rectum) of an infected person
• through direct contact with contaminated objects such as bedding and towels, or by sharing personal objects used by an infected person

Follow recommended public health measures   and avoid contact with animals such as rodents and primates to help prevent getting or spreading the infection.

Person-to-person infections

Stay home if you’re sick and practise proper cough and sneeze etiquette , which includes coughing or sneezing into a tissue or the bend of your arm, not your hand. Reduce your risk of colds, the flu and other illnesses by:

•   washing your hands often
• avoiding or limiting the amount of time spent in closed spaces, crowded places, or at large-scale events (concerts, sporting events, rallies)
• avoiding close physical contact with people who may be showing symptoms of illness 

Sexually transmitted infections (STIs) , HIV , and mpox are spread through blood and bodily fluids; use condoms, practise safe sex, and limit your number of sexual partners. Check with your local public health authority pre-travel to determine your eligibility for mpox vaccine.  

Tuberculosis is an infection caused by bacteria and usually affects the lungs.

For most travellers the risk of tuberculosis is low.

Travellers who may be at high risk while travelling in regions with risk of tuberculosis should discuss pre- and post-travel options with a health care professional.

High-risk travellers include those visiting or working in prisons, refugee camps, homeless shelters, or hospitals, or travellers visiting friends and relatives.

HIV (Human Immunodeficiency Virus)   is a virus that attacks and impairs the immune system, resulting in a chronic, progressive illness known as AIDS (Acquired Immunodeficiency Syndrome). 

High risk activities include anything which puts you in contact with blood or body fluids, such as unprotected sex and exposure to unsterilized needles for medications or other substances (for example, steroids and drugs), tattooing, body-piercing or acupuncture.

Medical services and facilities

Health care is inadequate outside Accra.

Emergency medical attention and serious illnesses require medical evacuation. Medical services usually require immediate cash payment.

Make sure you get travel insurance that includes coverage for medical evacuation and hospital stays.

Travel health and safety

If you take prescription medication, you’re responsible for determining their legality in Ghana.

• Bring sufficient quantities of your medication with you
• Always keep your medication in the original container
• Carry a copy of your prescription(s)
• Pack them in your carry-on luggage

You must abide by local laws.

Learn about what you should do and how we can help if you are arrested or detained abroad .

Penalties for possession, use or trafficking of illegal drugs are severe. Convicted offenders can expect jail sentences and heavy fines.

Drugs, alcohol and travel

Ghanaian law prohibits sexual acts between individuals of the same sex. Those convicted can face up to 25 years in prison.

Even though there are few convictions, 2SLGBTQI+ persons have been arrested and victims of extortion and discrimination based on their identity and sexual orientation.

Since the anti-LGBTI bill was introduced in August 2021, there is an increased risk of violence and discrimination against 2SLGBTQI+ persons and their allies.

2SLGBTQI+ travellers should:

• carefully consider the risks of travelling to Ghana
• be cautious and avoid public displays of affection with someone of the same sex

Dual citizenship

Dual citizenship is legally recognized in Ghana.

If you are a Canadian citizen, but also a citizen of Ghana, our ability to offer you consular services may be limited while you're there. You may also be subject to different entry/exit requirements .

Travellers with dual citizenship

International Child Abduction

The Hague Convention on the Civil Aspects of International Child Abduction is an international treaty. It can help parents with the return of children who have been removed to or retained in certain countries in violation of custody rights. It does not apply between Canada and Ghana.

If your child was wrongfully taken to, or is being held in Ghana by an abducting parent:

• act as quickly as you can
• consult a lawyer in Canada and in Ghana to explore all the legal options for the return of your child
• report the situation to the nearest Canadian government office abroad or to the Vulnerable Children’s Consular Unit at Global Affairs Canada by calling the Emergency Watch and Response Centre.

If your child was removed from a country other than Canada, consult a lawyer to determine if The Hague Convention applies.

Be aware that Canadian consular officials cannot interfere in private legal matters or in another country’s judicial affairs.

• International Child Abduction: A Guidebook for Left-Behind Parents
• Travelling with children
• Canadian embassies and consulates by destination
• Emergency Watch and Response Centre

Identification

Authorities can ask you to show identification at any time.

You should carry a photocopy of your travel documents and keep the originals in a secure place.

Minerals import and export

Gold, diamonds and other precious natural resources are subject to strict import and export regulations. Only agents licensed by the Ghana’s Minerals Commission are authorized to handle import-export transactions of these natural resources.

Individuals who commit offences may face prosecution, and penalties include imprisonment.

Smoking is prohibited in public areas. It’s sometimes permitted in private businesses, such as bars or restaurants.

Military clothing

Wearing military clothing or clothing that has military elements is prohibited.

Photography

Photography of sensitive installations is prohibited. This includes:

• military sites
• government buildings
• Accra's international airport

Seek permission before taking photos of official buildings and individuals.

Dress and behaviour

Ghana is a conservative society. To avoid offending local sensitivities:

• dress conservatively
• behave discreetly
• respect religious and social traditions.

You must carry an international driving permit. You can use it for up to 12 months. After 12 months, you will need to obtain a Ghanaian license.

If you have resident status in Ghana, you should request your Ghanaian license as soon as possible.

All cars must be equipped with:

• up-to-date road-worthy insurance stickers
•  a first aid kit
• a fire extinguisher
• a warning triangle

Vehicles with temporary license plates are prohibited from travelling anywhere in Ghana between 6 p.m. and 6 a.m. Vehicles may be seized for the night and fines imposed for non-compliance.

International Driving Permit

The currency of Ghana is the Ghanaian cedi (GHS).

There are no restrictions on the import and export of foreign currencies.  They must be declared upon arrival and exchanged for local currency at banks or foreign exchange bureaus only.

Upon arrival, you will receive an Exchange Control Form T-5. If not, you should request it. You must record foreign currency and all transactions made while in the country on this form.  The T-5 declaration form must show that the money obtained while in Ghana were from an authorized dealer in foreign exchange. Currency transactions with private citizens are illegal. Keep the form in a safe place to avoid trouble upon departure.

The export of cedis is prohibited. Before departure, you must spend unused cedis or reconvert them into foreign currency.

Rainy season

The rainy season extends from March to November.

Flooding is common in the Upper West, Upper East and Northern Regions during the rainy season. Seasonal flooding can hamper overland travel and reduce the provision of essential services. Roads may become impassable and bridges damaged.

• Monitor local media for the latest updates, including road conditions
• Stay away from flooded areas
• Follow instructions from local authorities, including evacuation orders

Seasonal wind

The harmattan, a burning, dusty and sand-filled wind, blows in from the Sahara from December to March.

The harmattan can cause disruptions to travel. It can also strongly affect the health of people with respiratory ailments.

• Consult a physician before departure to determine associated health risks
• Monitor local media for up-to-date information

Local services

Emergency services exist but may be limited.

In case of emergency, dial:

• emergency services: 112
• police: 191 or 18555
• ambulance: 193
• firefighters: 192

Consular assistance

Sierra Leone, Togo

For emergency consular assistance, call the High Commission of Canada to Ghana, in Accra, and follow the instructions. At any time, you may also contact the Emergency Watch and Response Centre in Ottawa.

The decision to travel is your choice and you are responsible for your personal safety abroad. We take the safety and security of Canadians abroad very seriously and provide credible and timely information in our Travel Advice to enable you to make well-informed decisions regarding your travel abroad.

The content on this page is provided for information only. While we make every effort to give you correct information, it is provided on an "as is" basis without warranty of any kind, expressed or implied. The Government of Canada does not assume responsibility and will not be liable for any damages in connection to the information provided.

If you need consular assistance while abroad, we will make every effort to help you. However, there may be constraints that will limit the ability of the Government of Canada to provide services.

Learn more about consular services .

Risk Levels

  take normal security precautions.

Take similar precautions to those you would take in Canada.

  Exercise a high degree of caution

There are certain safety and security concerns or the situation could change quickly. Be very cautious at all times, monitor local media and follow the instructions of local authorities.

IMPORTANT: The two levels below are official Government of Canada Travel Advisories and are issued when the safety and security of Canadians travelling or living in the country or region may be at risk.

  Avoid non-essential travel

Your safety and security could be at risk. You should think about your need to travel to this country, territory or region based on family or business requirements, knowledge of or familiarity with the region, and other factors. If you are already there, think about whether you really need to be there. If you do not need to be there, you should think about leaving.

  Avoid all travel

You should not travel to this country, territory or region. Your personal safety and security are at great risk. If you are already there, you should think about leaving if it is safe to do so.

How To Plan The Ultimate Trip To Ghana

These tips on planning a trip to Ghana can save travelers time, money, and stress when they decide to embark on a Ghanaian adventure.

Jasmine Osby • Apr 12, 2024

When Trina Diakabanzila, 38, left the Democratic Republic of The Congo at 10, she had no clue she wouldn’t return to Africa until decades later. As an adult serving in the U.S. military, she was able to further expand her horizons by seeing more of the world. However, an allure about Ghana kept the country at the top of her bucket list. 

In 2019, after her military career ended, Diakabanzila decided to finally make the voyage to Ghana. She’d recently divorced and had a new baby. But she was determined to journey back to home soil. Today, Diakabanzila has traveled to Ghana five times. She’s falling in love with the West African country and her experiences there are some of her fondest memories. 

Diakabanzila’s time spent in Ghana has made her an expert on traveling to the country. With plans to go back in the future, her tips on planning the ultimate trip to Ghana can save travelers time, money, and stress when they decide to embark on a Ghanaian adventure.

Keeping An Open Mind

Diakabanzila encourages every traveler to keep an open mind when traveling to Ghana. Every experience she’s had in the country has been magical. However, it’s important to keep in mind that Ghana is still a developing country. 

“A lot of people try to compare foreign countries to America but America is developed,” Diakabanzila said. “And I don’t want the people to be disappointed.” 

Some amenities that are readily available in America are extremely limited in Ghana. For Diakabanzila, an example is spotty electricity throughout the country. Instead of having access to electricity everywhere, some hotels and Airbnb’s would lose power throughout the day. These types of inconveniences could ruin someone’s trip. However, keeping an open mind and being open to having different experiences can help counteract any discomfort.  

“As long as you go with an open mind, you’re going to enjoy yourself and you’re going to learn so much,” she said.

Doing ample research before visiting Ghana is a great way to prevent frustration and disappointment once you land on the ground. Diakabanzila says she asks every question possible when booking accommodations to ensure she’s getting what she’s seeking. This includes inquiring about things like 24-hour generators for power lapses and distance from the airport and attractions before booking a stay.

Preparing For Your Trip 

A lot of time spent preparing for a trip to Ghana involves securing the correct paperwork to enter the country. For Diakabanzila, she had to secure a visa for her and her daughter to ensure they were legally able to travel there. She’s noticed that the country sometimes would waive visa requirements around December. However, most times, travelers have to apply in advance. 

She says it’s also important for travelers to decide what type of travelers they are. Some flights to Ghana can last more than 20 hours. For comfort’s sake, it’s important to determine your travel preferences beforehand. 

“Definitely decide what type of traveler you are,” she said. “Do you mind long layovers or are you more of a straight person like, ‘Get me to my destination.'”

Additionally, although the only immunization she was required to get was for Yellow Fever, Diakabanzila encourages travelers to look into the recommended immunizations as well. This could help prevent health issues that could potentially ruin a vacation experience in Ghana. She also keeps activated charcoal pills for malaria prevention handy on any trip to Ghana.

Dress Accordingly

When it comes to vacation attire in Ghana, Diakabanzila encourages travelers to dress weather-appropriate. The weather is extremely tropical with rainy seasons throughout the late spring and summer. But Diakabanzila assures travelers that it can get very hot, so pack light clothing. 

“As soon as you land at the airport, you will feel the heat,” she said. “It’s really hot in Ghana.” 

She also wants travelers to remember the importance of respectful attire when visiting Ghana. Certain fashion and cultural norms in America aren’t as socially accepted in African countries, such as dressing scantily or swimwear in public. Travelers should be smart about clothing choices.

When visiting Ghana, Diakabanzila usually books her Airbnb in Accra. There are also many other incredible locations throughout the country with quality stays. She says travelers should explore accommodations outside of Accra including near the airport and Cape Coast. Travelers can also explore stays like Labadi Beach Hotel, where all-inclusive options are available. 

“I think the options are endless. It just depends on your budget and what type of traveler you are,” she said.

Don’t Be Surprised If Merchants Raise Praises

Visiting local markets is a major part of experiencing authentic Ghanaian culture. It’s also some of the best places to find street food vendors and others selling local fare, clothing, jewelry, and more. However, Diakabanzila says don’t be surprised if merchants raise the praises. Despite being Congolese, she’s even had to negotiate down the cost of goods when visiting Ghanaian markets. She suggests working with someone you know in Ghana or a local to help negotiate with merchants.  

Keep Safety First

Although traveling to Ghana can seem overwhelming, Diakabanzila knows firsthand that it’s worth it. No matter where someone is from, she believes it’s important that all children of the African diaspora visit the continent. Whether you’re traveling to Ghana or another country, everyone deserves to go home at least once. 

“It’s imperative to know where you came from, to know your people, and to know your history,” she said.

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Measles — United States, January 1, 2020–March 28, 2024

Weekly / April 11, 2024 / 73(14);295–300

Adria D. Mathis, MSPH 1 ; Kelley Raines, MPH 1 ; Nina B. Masters, PhD 1 ; Thomas D. Filardo, MD 1 ; Gimin Kim, MS 1 ; Stephen N. Crooke, PhD 1 ; Bettina Bankamp, PhD 1 ; Paul A. Rota, PhD 1 ; David E. Sugerman, MD 1 ( View author affiliations )

What is already known about this topic?

Although endemic U.S. measles was declared eliminated in 2000, measles importations continue to occur. Prolonged outbreaks during 2019 threatened the U.S. measles elimination status.

What is added by this report?

During January 1, 2020–March 28, 2024, a total of 338 U.S. measles cases were reported; 29% of these cases occurred during the first quarter of 2024, almost all in persons who were unvaccinated or whose vaccination status was unknown. As of the end of 2023, U.S. measles elimination status was maintained.

What are the implications for public health practice?

Risk for widespread U.S. measles transmission remains low because of high population immunity. Enhanced efforts are needed to increase routine U.S. vaccination coverage, encourage vaccination before international travel, identify communities at risk for measles transmission, and rapidly investigate suspected measles cases to reduce cases and complications of measles.

• Article PDF
• Full Issue PDF

Measles is a highly infectious febrile rash illness and was declared eliminated in the United States in 2000. However, measles importations continue to occur, and U.S. measles elimination status was threatened in 2019 as the result of two prolonged outbreaks among undervaccinated communities in New York and New York City. To assess U.S. measles elimination status after the 2019 outbreaks and to provide context to understand more recent increases in measles cases, CDC analyzed epidemiologic and laboratory surveillance data and the performance of the U.S. measles surveillance system after these outbreaks. During January 1, 2020–March 28, 2024, CDC was notified of 338 confirmed measles cases; 97 (29%) of these cases occurred during the first quarter of 2024, representing a more than seventeenfold increase over the mean number of cases reported during the first quarter of 2020–2023. Among the 338 reported cases, the median patient age was 3 years (range = 0–64 years); 309 (91%) patients were unvaccinated or had unknown vaccination status, and 336 case investigations included information on ≥80% of critical surveillance indicators. During 2020–2023, the longest transmission chain lasted 63 days. As of the end of 2023, because of the absence of sustained measles virus transmission for 12 consecutive months in the presence of a well-performing surveillance system, U.S. measles elimination status was maintained. Risk for widespread U.S. measles transmission remains low because of high population immunity. However, because of the increase in cases during the first quarter of 2024, additional activities are needed to increase U.S. routine measles, mumps, and rubella vaccination coverage, especially among close-knit and undervaccinated communities. These activities include encouraging vaccination before international travel and rapidly investigating suspected measles cases.

Introduction

Measles is a highly infectious acute, febrile rash illness with a >90% secondary attack rate among susceptible contacts ( 1 ). High national 2-dose coverage with the measles, mumps, and rubella (MMR) vaccine led to the declaration of U.S. measles elimination* in 2000 ( 2 ). However, this elimination status was threatened in 2019 because of two prolonged outbreaks among undervaccinated communities in New York and New York City; these outbreaks accounted for 29% of all reported cases during 2001–2019 ( 2 ). To assess U.S. measles elimination status after the 2019 outbreaks and to provide context for understanding more recent increases in measles cases in 2024, † CDC assessed the epidemiologic and laboratory-based surveillance of measles in the United States and the performance of the U.S. measles surveillance system during January 1, 2020–March 28, 2024.

Reporting and Classification of Measles Cases

Confirmed measles cases § ( 1 ) are reported to CDC by state health departments through the National Notifiable Disease Surveillance System and directly (by email or telephone) to the National Center for Immunization and Respiratory Diseases. Measles cases are classified by the Council of State and Territorial Epidemiologists as import-associated if they were internationally imported, epidemiologically linked to an imported case, or had viral genetic evidence of an imported measles genotype ( 1 ); cases with no epidemiologic or virologic link to an imported case are classified as having an unknown source ( 1 ). For this analysis, unique sequences were defined as those differing by at least one nucleotide in the N-450 sequence (the 450 nucleotides encoding the carboxyl-terminal 150 nucleoprotein amino acids) based on the standard World Health Organization (WHO) recommendations for describing sequence variants ¶ ( 3 ). Unvaccinated patients were classified as eligible for vaccination if they were not vaccinated according to Advisory Committee on Immunization Practices recommendations ( 4 ). A well-performing surveillance system was defined as one with ≥80% of cases meeting each of the following three criteria: classified as import-associated, reported with complete information on at least eight of 10 critical surveillance indicators (i.e., place of residence, sex, age, occurrence of fever and rash, date of rash onset, vaccination status, travel history, hospitalization, transmission setting, and whether the case was outbreak-related) ( 5 ), and laboratory-confirmed.

Assessment of Chains of Transmission

Cases were classified into chains of transmission on the basis of known epidemiologic linkages: isolated (single) cases, two-case chains (two epidemiologically linked cases), and outbreaks (three or more epidemiologically linked cases). The potential for missed cases within two-case chains and outbreaks was assessed by measuring the interval between measles rash onset dates in each chain; chains with more than one maximum incubation period (21 days) between cases could indicate a missing case in the chain. This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.**

Reported Measles Cases and Outbreaks

CDC was notified of 338 confirmed measles cases with rash onset during January 1, 2020–March 28, 2024 ( Figure ); cases occurred in 30 jurisdictions. During 2020, 12 of 13 cases preceded the commencement of COVID-19 mitigation efforts in March 2020. Among the 170 cases reported during 2021 and 2022, 133 (78%) were associated with distinct outbreaks: 47 (96%) of 49 cases in 2021 occurred among Afghan evacuees temporarily housed at U.S. military bases during Operation Allies Welcome, and 86 (71%) of 121 cases in 2022 were associated with an outbreak in central Ohio. During 2023, 28 (48%) of 58 cases were associated with four outbreaks. As of March 28, 2024, a total of 97 cases have been reported in 2024, representing 29% of all 338 measles cases reported during January 1, 2020–March 28, 2024, and more than a seventeenfold increase over the mean number of cases reported during the first quarter of 2020–2023 (five cases).

Characteristics of Reported Measles Cases

The median patient age was 3 years (range = 0–64 years); more than one half of cases (191; 58%) occurred in persons aged 16 months–19 years ( Table ). Overall, 309 (91%) patients were unvaccinated (68%) or had unknown vaccination status (23%); 29 (9%) had previously received ≥1 MMR vaccine dose. Among the 309 cases among unvaccinated persons or persons with unknown vaccination status, 259 (84%) patients were eligible for vaccination, 40 (13%) were aged 6–11 months and therefore not recommended for routine MMR vaccination, and 10 (3%) were ineligible for MMR because they were aged <6 months. †† Among 155 (46%) hospitalized measles patients, 109 (70%) cases occurred in persons aged <5 years; 142 (92%) hospitalized patients were unvaccinated or had unknown vaccination status. No measles-associated deaths were reported to CDC.

Imported Measles Cases

Among all 338 cases, 326 (96%) were associated with an importation; 12 (4%) had an unknown source. Among the 326 import-associated cases, 200 (61%) occurred among U.S. residents who were eligible for vaccination but who were unvaccinated or whose vaccination status was unknown. Among 93 (28%) measles cases that were directly imported from other countries, 34 (37%) occurred in foreign visitors, and 59 (63%) occurred in U.S. residents, 53 (90%) of whom were eligible for vaccination but were unvaccinated or whose vaccination status was unknown. One (2%) case in a U.S. resident occurred in a person too young for vaccination, two (3%) in persons who had previously received 1 MMR vaccine dose, and three (5%) in persons who had previously received 2 MMR vaccine doses. The most common source for internationally imported cases during the study period were the Eastern Mediterranean (48) and African (24) WHO regions. During the first quarter of 2024, a total of six internationally imported cases were reported from the European and South-East Asia WHO regions, representing a 50% increase over the mean number of importations from these regions during 2020–2023 (mean of two importations per year from each region).

Surveillance Quality Indicators

Overall, all but two of the 338 case investigations included information on ≥80% of the critical surveillance indicators; those two case investigations included information on 70% of critical surveillance indicators. Date of first case report to a health department was available for 219 (65%) case investigations; 127 (58%) cases were reported to health departments on or before the day of rash onset (IQR = 4 days before to 3 days after). Overall, 314 (93%) measles cases were laboratory confirmed, including 16 (5%) by immunoglobulin M (serologic) testing alone and 298 (95%) by real-time reverse transcription–polymerase chain reaction (rRT-PCR). Among 298 rRT-PCR–positive specimens, 221 (74%) were successfully genotyped: 177 (80%) were genotype B3, and 44 (20%) were genotype D8. Twenty-two distinct sequence identifiers (DSIds) ( 3 ) for genotype B3 and 13 DSIds for genotype D8 were detected (Supplementary Figure, https://stacks.cdc.gov/view/cdc/152776 ). The longest period of detection for any DSId was 15 weeks (DSId 8346).

Chains of Transmission

The 338 measles cases were categorized into 92 transmission chains (Table); 62 (67%) were isolated cases, 10 (11%) were two-case chains, and 20 (22%) were outbreaks of three or more cases. Seven (35%) of 20 outbreaks occurred during 2024. §§ The median outbreak size was six cases (range = three–86 cases) and median duration of transmission was 20 days (range = 6–63 days). Among the 30 two-case chains and outbreaks, more than one maximum incubation period (21 days) did not elapse between any two cases.

Because of the absence of endemic measles virus transmission for 12 consecutive months in the presence of a well-performing surveillance system, as of the end of 2023, measles elimination has been maintained in the United States. U.S. measles elimination reduces the number of cases, deaths, and costs that would occur if endemic measles transmission were reestablished. Investigation of almost all U.S. measles cases reported since January 2020 were import-associated, included complete information on critical surveillance variables, were laboratory-confirmed by rRT-PCR, and underwent genotyping; these findings indicate that the U.S. measles surveillance system is performing well. A variety of transmission chain sizes were detected, including isolated cases, suggesting that sustained measles transmission would be rapidly detected. However, the rapid increase in the number of reported measles cases during the first quarter of 2024 represents a renewed threat to elimination.

Most measles importations were cases among persons traveling to and from countries in the Eastern Mediterranean and African WHO regions; these regions experienced the highest reported measles incidence among all WHO regions during 2021–2022 ( 6 ). During November 2022–October 2023, the number of countries reporting large or disruptive outbreaks increased by 123%, from 22 to 49. Global estimates suggest that first-dose measles vaccination coverage had declined from 86% in 2019 to 83% in 2022, leaving almost 22 million children aged <1 year susceptible to measles ( 6 ).

As has been the case in previous postelimination years ( 7 ), most imported measles cases occurred among unvaccinated U.S. residents. Increasing global measles incidence and decreasing vaccination coverage will increase the risk for importations into U.S. communities, as has been observed during the first quarter of 2024, further supporting CDC’s recommendation for persons to receive MMR vaccine before international travel ( 4 ).

Maintaining high national and local MMR vaccination coverage remains central to sustaining measles elimination. Risk for widespread U.S. measles transmission remains low because of high population immunity; however, national 2-dose MMR vaccination coverage has remained below the Healthy People 2030 target of 95% (the estimated population-level immunity necessary to prevent sustained measles transmission) ( 8 ) for 3 consecutive years, leaving approximately 250,000 kindergarten children susceptible to measles each year ( 9 ). Furthermore, 2-dose MMR vaccination coverage estimates in 12 states and the District of Columbia were <90%, and during the 2022–23 school year, exemption rates among kindergarten children exceeded 5% in 10 states ( 9 ). Clusters of unvaccinated persons placed communities at risk for large outbreaks, as occurred during the central Ohio outbreak in 2022: 94% of measles patients were unvaccinated and 42% were hospitalized ( 10 ). Monitoring MMR vaccination coverage at county and zip code levels could help public health agencies identify undervaccinated communities for targeted interventions to improve vaccination coverage while preparing for possible measles outbreaks. As of March 28, 2024, a total of 97 confirmed measles cases have been reported in the United States in 2024, compared with a mean of five cases during the first quarter of each year during 2020–2023. Similar to cases reported during 2020–2023, most cases reported during 2024 occurred among patients aged <20 years who were unvaccinated or whose vaccination status was unknown, and were associated with an importation. Rapid detection of cases, prompt implementation of control measures, and maintenance of high national measles vaccination coverage, including improving coverage in undervaccinated populations, is essential to preventing measles and its complications and to maintaining U.S. elimination status.

Limitations

The findings in this report are subject to at least three limitations. First, importations might have been underreported: 4% of reported cases during the study period had no known source. Second, case investigations resulting in discarded measles cases (i.e., a diagnosis of measles excluded) are not nationally reportable, which limits the ability to directly evaluate the sensitivity of measles case investigations. However, surveillance remains sufficiently sensitive to detect isolated cases and outbreaks, and robust molecular epidemiology provides further evidence supporting the absence of sustained measles transmission in the United States. Finally, the date of first case report to a health department was not available for 35% of case investigations.

Implications for Public Health Practice

The U.S. measles elimination status will continue to be threatened by global increases in measles incidence and decreases in global, national, and local measles vaccination coverage. Because of high population immunity, the risk of widespread measles transmission in the United States remains low; however, efforts are needed to increase routine MMR vaccination coverage, encourage vaccination before international travel, identify communities at risk for measles transmission, and rapidly investigate suspected measles cases to maintain elimination.

Corresponding author: Adria D. Mathis, [email protected] .

1 Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Stephen N. Crooke reports institutional support from PATH. No other potential conflicts of interest were disclosed.

* Elimination is defined as the absence of endemic measles virus transmission in a defined geographic area for ≥12 months in the presence of a well-performing surveillance system.

† https://emergency.cdc.gov/han/2024/han00504.asp

§ A confirmed measles case was defined as an acute febrile rash illness with laboratory confirmation or direct epidemiologic linkage to a laboratory-confirmed case. Laboratory confirmation was defined as detection of measles virus–specific nucleic acid from a clinical specimen using real-time reverse transcription–polymerase chain reaction or a positive serologic test for measles immunoglobulin M antibody.

¶ Genotyping was performed at CDC and at the Vaccine Preventable Disease Reference Centers of the Association of Public Health Laboratories.

** 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

†† MMR vaccine is not licensed for use in persons aged <6 months.

§§ At the time of this report, six measles outbreaks have ended, and one outbreak is ongoing. A measles outbreak is considered to be over when no new cases have been identified during two incubation periods (42 days) since the rash onset in the last outbreak-related case.

• Gastañaduy PA, Redd SB, Clemmons NS, et al. Measles [Chapter 7]. In: Manual for the surveillance of vaccine-preventable diseases. Atlanta, GA: US Department of Health and Human Services, CDC; 2023. https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html
• Mathis AD, Clemmons NS, Redd SB, et al. Maintenance of measles elimination status in the United States for 20 years despite increasing challenges. Clin Infect Dis 2022;75:416–24. https://doi.org/10.1093/cid/ciab979 PMID:34849648
• Williams D, Penedos A, Bankamp B, et al. Update: circulation of active genotypes of measles virus and recommendations for use of sequence analysis to monitor viral transmission. Weekly Epidemiologic Record 2022;97(39):481–92. https://reliefweb.int/report/world/weekly-epidemiological-record-wer-30-september-2022-vol-97-no-39-2022-pp-481-492-enfr
• McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS; CDC. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013;62(No. RR-4):1–34. PMID:23760231
• World Health Organization. Measles: vaccine preventable diseases surveillance standards. Geneva, Switzerland: World Health Organization; 2018. https://www.who.int/publications/m/item/vaccine-preventable-diseases-surveillance-standards-measles
• Minta AA, Ferrari M, Antoni S, et al. Progress toward measles elimination—worldwide, 2000–2022. MMWR Morb Mortal Wkly Rep 2023;72:1262–8. https://doi.org/10.15585/mmwr.mm7246a3 PMID:37971951
• Lee AD, Clemmons NS, Patel M, Gastañaduy PA. International importations of measles virus into the United States during the postelimination era, 2001–2016. J Infect Dis 2019;219:1616–23. https://doi.org/10.1093/infdis/jiy701 PMID:30535027
• Truelove SA, Graham M, Moss WJ, Metcalf CJE, Ferrari MJ, Lessler J. Characterizing the impact of spatial clustering of susceptibility for measles elimination. Vaccine 2019;37:732–41. https://doi.org/10.1016/j.vaccine.2018.12.012 PMID:30579756
• Seither R, Yusuf OB, Dramann D, Calhoun K, Mugerwa-Kasujja A, Knighton CL. Coverage with selected vaccines and exemption from school vaccine requirements among children in kindergarten—United States, 2022–23 school year. MMWR Morb Mortal Wkly Rep 2023;72:1217–24. https://doi.org/10.15585/mmwr.mm7245a2 PMID:37943705
• Tiller EC, Masters NB, Raines KL, et al. Notes from the field: measles outbreak—central Ohio, 2022–2023. MMWR Morb Mortal Wkly Rep 2023;72:847–9. https://doi.org/10.15585/mmwr.mm7231a3 PMID:37535476

FIGURE . Confirmed measles cases, by month of rash onset (N = 338) — United States, January 1, 2020–March 28, 2024

Abbreviations: IgM = immunoglobulin M; rRT-PCR = real-time reverse transcription–polymerase chain reaction; WHO = World Health Organization. * A case resulting from exposure to measles virus outside the United States as evidenced by at least some of the exposure period (7–21 days before rash onset) occurring outside the United States and rash onset occurring within 21 days of entering the United States without known exposure to measles during that time. † A case in a transmission chain epidemiologically linked to an internationally imported case. § A case for which an epidemiologic link to an internationally imported case was not identified, but for which viral sequence data indicate an imported measles genotype (i.e., a genotype that is not detected in the United States with a pattern indicative of endemic transmission). ¶ A case for which an epidemiologic or virologic link to importation or to endemic transmission within the United States cannot be established after a thorough investigation. ** Percentage is percentage of international importations. Four cases among persons who traveled to both the Eastern Mediterranean and African regions and one case in a person who traveled to both the Eastern Mediterranean and European regions were counted twice. †† Place of residence, sex, age or date of birth, fever and rash, date of rash onset, vaccination status, travel history, hospitalization, transmission setting, and whether the case was outbreak related. §§ Includes 65 cases among patients who received both positive rRT-PCR and positive IgM results. ¶¶ Percentage is percentage of total chains.

Suggested citation for this article: Mathis AD, Raines K, Masters NB, et al. Measles — United States, January 1, 2020–March 28, 2024. MMWR Morb Mortal Wkly Rep 2024;73:295–300. DOI: http://dx.doi.org/10.15585/mmwr.mm7314a1 .

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New treatments for rare diseases in Ghana still inaccessible

• Ridwan Karim Dini-Osman

There are some diseases around the world that are so rare; only a few thousand people suffer from them. That makes funding research difficult. New medical innovations have led to new treatments. But as Ridwan Karim Dini-Osman reported from Ghana, many living with rare diseases around the world still struggle to access them.

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• Section 5 - Perspectives : Testing Travelers for Mycobacterium Tuberculosis Infection
• Section 5 - Yersiniosis

Typhoid & Paratyphoid Fever

Cdc yellow book 2024.

Author(s): Michael Hughes, Grace Appiah, Louise Francois Watkins

Infectious Agent

Transmission, epidemiology, clinical presentation, typhoid fever.

INFECTIOUS AGENT:  Salmonella enterica serotype Typhi

Latin America

Asia (greatest risk for infection is in South Asia)

TRAVELER CATEGORIES AT GREATEST RISK FOR EXPOSURE & INFECTION

PREVENTION METHODS

Follow safe food and water precautions

Typhoid fever is a vaccine-preventable disease

DIAGNOSTIC SUPPORT

Paratyphoid Fever

INFECTIOUS AGENT: Salmonella enterica serotypes Paratyphi A, B, C

Salmonella enterica serotypes Typhi, Paratyphi A, Paratyphi B, and Paratyphi C cause potentially severe and occasionally life-threatening bacteremic illnesses referred to as typhoid fever (for Typhi serotype) and paratyphoid fever (for Paratyphi serotypes), and collectively as enteric fever. Paratyphi B strains are differentiated into 2 distinct pathotypes on the basis of their ability to ferment tartrate: the first pathotype, Paratyphi B, is unable to ferment tartrate and is associated with paratyphoid fever; the second pathotype, Paratyphi B var. L(+) tartrate(+), ferments tartrate and is associated with gastroenteritis typical of nontyphoidal salmonellosis. For more details on nontyphoidal salmonellosis, see the Sec. 5, Part 1, Ch. 19, Nontyphoidal Salmonellosis .

Humans are the only source of the bacteria that cause enteric fever; no animal or environmental reservoirs have been identified. Typhoid and paratyphoid fever are acquired through consumption of water or food contaminated by feces of an acutely infected or convalescent person, or a person with chronic, asymptomatic carriage. Risk for infection is high in low- and middle-income countries with endemic disease and poor access to safe food and water, and poor sanitation. Sexual contact, particularly among men who have sex with men, has been documented as a rare route of transmission.

An estimated 11–21 million cases of typhoid fever and 5 million cases of paratyphoid fever occur worldwide each year, causing an estimated 135,000–230,000 deaths. In the United States during 2016–2018, ≈400 culture-confirmed cases of typhoid fever and 50–100 cases of paratyphoid fever caused by Paratyphi A were reported each year; paratyphoid fever caused by Paratyphi B and Paratyphi C is rarely reported. Approximately 85% of typhoid fever and 92% of paratyphoid fever cases in the United States occur among international travelers; most are in travelers returning from South Asia, primarily Bangladesh, India, and Pakistan. Other high-risk regions for infection include Africa, Latin America, and Southeast Asia; lower-risk regions include East Asia and the Caribbean.

Travelers visiting friends and relatives are at increased risk because they might be less careful with food and water while abroad than other travelers and might not seek pretravel health consultation or typhoid vaccination (see Sec. 9, Ch. 9, Visiting Friends & Relatives: VFR Travel ). Although the risk of acquiring illness increases with the duration of stay, travelers have acquired typhoid fever even during visits of <1 week to countries where the disease is highly endemic (e.g., Bangladesh, India, Pakistan).

The incubation period of both typhoid and paratyphoid infections is 6–30 days. The onset of illness is insidious, with gradually increasing fatigue and a fever that increases daily from low-grade to 102°F–104°F (38°C–40°C) by the third or fourth day of illness. Fever is commonly lowest in the morning, peaking in the late afternoon or evening. Anorexia, headache, and malaise are nearly universal, and abdominal pain, constipation, or diarrhea are common. Diarrhea and vomiting are more common in children than in adults. People also can have dry cough, fatigue, myalgias, and sore throat. Hepatosplenomegaly often can be detected. A transient, maculopapular rash of rose-colored spots can occasionally be seen on the trunk.

The clinical presentation is often confused with malaria. Suspect enteric fever in a person with a history of travel to an endemic area who is not responding to antimalarial medication. Untreated, the disease can last for a month, and reported case-fatality ratios are 10%–30%. By comparison, the case-fatality ratio in patients treated early is usually <1%. Serious complications of typhoid fever occur in 10%–15% of hospitalized patients, generally after 2–3 weeks of illness, and include life-threatening gastrointestinal hemorrhage, intestinal perforation, and encephalopathy. Paratyphoid fever appears to have a lower case-fatality ratio than typhoid fever; however, severe cases do occur.

Typhoid and paratyphoid fever are nationally notifiable diseases in the United States. Clinicians should report cases to their state or local health department. Identification of a domestically acquired case should prompt a public health investigation to prevent other cases.

Blood Culture

Patients with typhoid or paratyphoid fever typically have bacteremia; blood culture is therefore the preferred method of diagnosis. A single culture is positive in only ≈50% of cases, however. Multiple blood cultures increase the sensitivity and might be required to make the diagnosis. Depending on the blood culture system used, cultures might need to be held and observed for up to 7 days before reporting a negative result. Although bone marrow culture is more invasive (and therefore less commonly performed), it increases the sensitivity to ≈80% of cases and is relatively unaffected by previous or concurrent antibiotic use. Stool culture is not usually positive during the first week of illness and has less diagnostic sensitivity than blood culture. Urine culture has a lower diagnostic yield than stool culture.

Rapid Diagnostic Tests

Globally, several commercial rapid diagnostic tests for typhoid fever are available, but their sensitivity and specificity are not optimal. The Widal test measures elevated antibody titers; it is unreliable but widely used in developing countries because of its low cost. Serologic tests do not distinguish acute from past infection or vaccination and lack specificity; thus, blood culture remains the preferred method to diagnose acute infections.

Clinical Diagnosis

Poor sensitivity and specificity of rapid antibody tests and the time it takes to obtain a positive culture mean that the initial diagnosis must often be made clinically. Typhoid and paratyphoid fever are clinically indistinguishable. The combination of risk factors for infection and gradual onset of fever that increases in severity over several days should raise suspicion of enteric fever.

Antibiotic therapy shortens the clinical course of enteric fever and reduces the risk for death. Treatment decisions are complicated by high rates of resistance to many antimicrobial agents, and antimicrobial treatment should be guided by susceptibility testing. A careful travel history can inform empiric treatment choices while awaiting culture results.

Multidrug-Resistant Infection

Established resistance to older antibiotics (e.g., ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole) has led to these agents being recommended only as alternative antibiotics for infections with known susceptibility. Multidrug-resistant (MDR) Typhi with resistance to all 3 of these antibiotics has been present for decades. Regional estimates for MDR Typhi range from 9% in South Asia (2015–2018) to 35%–59% in parts of Africa (2010–2014).

Fluoroquinolones (e.g., ciprofloxacin) are still considered the treatment of choice for fluoroquinolone-susceptible infections in adults. Most Typhi and Paratyphi A infections in the United States are fluoroquinolone-nonsusceptible, however, and most (>90%) have occurred among travelers returning from South Asia. Fluoroquinolone-nonsusceptible infections have been associated with treatment failure or delayed clinical response. Therefore, azithromycin and ceftriaxone, antibiotics with historically low rates of resistance globally, are increasingly being used as empiric treatment for enteric fever.

Extensively Drug-Resistant Infection

In 2017, among all Typhi and Paratyphi A isolates tested by CDC’s National Antimicrobial Resistance Monitoring System (NARMS), <1% were resistant to azithromycin or to ceftriaxone, based on resistance criteria for Typhi. Resistance to both agents is emerging, however. In 2016, an outbreak of extensively drug-resistant (XDR) typhoid fever began in Sindh Province, Pakistan. These XDR Salmonella Typhi isolates are typically resistant to ampicillin, ceftriaxone, chloramphenicol, ciprofloxacin, and trimethoprim-sulfamethoxazole, but susceptible to azithromycin and carbapenem antibiotics.

The first US cases of XDR typhoid fever associated with travel to Pakistan were diagnosed in 2018, and by early 2021 >70 XDR infections had been documented among residents of the United States, including 9 cases among patients who did not travel internationally in the 30 days before illness began. Ceftriaxone resistance also has been identified in Typhi isolates from US travelers returning from Iraq. Additionally, resistance to azithromycin has been identified among Typhi and Paratyphi strains isolated from patients in Bangladesh, Cambodia, India, Nepal, Pakistan, Saudi Arabia, and the United States.

Empiric treatment should be guided by the patient’s travel history. For patients with suspected typhoid fever who traveled to Iraq or Pakistan, or who did not travel internationally before their illness began, empirically treat uncomplicated illness with azithromycin, and treat complicated illness with a carbapenem. Ceftriaxone remains an appropriate empiric treatment option for travelers returning from most other countries. Once culture results are available, use susceptibility information to guide treatment. Case reports have suggested that patients with XDR Typhi infection who do not improve on a carbapenem alone might benefit from the addition of a second antibiotic (e.g., azithromycin). Updated information about antimicrobial resistance among isolates from US patients with enteric fever in the United States can be found at the NARMS website .

Cases Unresponsive to Treatment

Patients treated with antimicrobial agents can continue to have fever for 3–5 days, but the maximum temperature generally decreases each day. Patients sometimes feel worse during the first few days after commencing antibiotic treatment. If fever in a person with typhoid or paratyphoid infection does not subside within 5 days of initiating antibiotic therapy, however, consider treatment with alternative antibiotics or begin looking for a persistent focus of infection (e.g., an abscess, or an infection in a bone, joint, or other extraintestinal site).

Relapse, Reinfection & Chronic Carriage

Relapse, reinfection, and chronic carriage also can occur. Relapse occurs in ≤10% of patients 1–3 weeks after clinical recovery, requiring further antibiotic treatment. An estimated 1%–4% of treated patients become asymptomatic chronic carriers (defined as people who excrete the organism in stool for ≥12 months); a prolonged antibiotic course is usually required to eradicate the organism.

Food & Water Precautions

Safe food and water precautions and frequent handwashing, especially before meals, are important in preventing both typhoid and paratyphoid fever (see Sec. 2, Ch. 8, Food & Water Precautions ). Although recommended by the Advisory Committee on Immunization Practices (ACIP), typhoid vaccines are not 100% effective, and a large bacterial inoculum can overwhelm vaccine-induced immunity. Therefore, vaccinated travelers should follow recommended food and water precautions to prevent enteric fever and other infections. No vaccines are available for paratyphoid fever; thus, food and water precautions are the only prevention methods.

Indications

The ACIP recommends typhoid vaccine for travelers going to areas where risk for exposure to Typhi is recognized. Destination-specific vaccine recommendations are available at the CDC Travelers’ Health website. Two typhoid vaccines are licensed for use in the United States: Vi capsular polysaccharide vaccine (ViCPS) (Typhim Vi, manufactured by Sanofi Pasteur) for intramuscular use; and live attenuated vaccine (Vivotif, manufactured from the Ty21a strain of serotype Typhi by PaxVax) for oral use. Both vaccines are unconjugated, which means the polysaccharide antigens are not paired with a protein to elicit a strong response from the immune system. Because these vaccines protect 50%–80% of recipients, remind travelers that typhoid immunization is not 100% effective, and take the opportunity to reinforce safe food and water precautions. Neither vaccine is licensed to prevent paratyphoid fever, although limited data from efficacy trials suggest that the Ty21a vaccine might provide some cross-protection against Paratyphi B.

Newer, protein conjugated Vi vaccines have greater efficacy in children <2 years old and protect people for longer than Vi unconjugated polysaccharide vaccines. Three typhoid Vi conjugate vaccines (TCV) have been licensed in India: Peda Typh (manufactured by Biomed); Typbar-TCV (manufactured by Bharat Biotech); and Zyvac TCV (manufactured by Zydus Cadila). Typbar-TCV also is licensed in Cambodia, Nepal, and Nigeria. Although none of these vaccines are licensed or available in the United States, Tybar-TCV received prequalification from the World Health Organization in 2018. The vaccine is approved for use in people ≥6 months old. In a human challenge study, Typbar-TCV had ≈87% protective efficacy. Interim analysis from a large field study in Nepal has shown Typbar-TCV effectiveness of 81.6% in children after 15 months of follow-up.

Administration

For information on dosage, administration, and revaccination for the 2 typhoid vaccines licensed in the United States, see Table 5-07 . The time required for primary vaccination differs, as do the lower age limits for each.

Table 5-07 Typhoid fever vaccines

Abbreviations: IM, intramuscular; NA, not applicable.

1 Vaccine must be kept refrigerated at 35°F–46°F (2°C–8°C).

2 Capsules should be taken with cool liquid, no warmer than 98.6°F (37°C)

VI Capsular Polysaccharide Vaccine

Primary vaccination with ViCPS consists of one 0.5-mL (25-μg) dose administered intramuscularly ≥2 weeks before travel. The vaccine is approved for use in people ≥2 years old. A dose is recommended every 2 years for those who remain at risk.

Live Attenuated Ty21A Vaccine

Primary vaccination with Ty21a vaccine consists of 4 capsules, 1 taken every other day. The capsules should be kept refrigerated (not frozen), and all 4 doses must be taken to achieve maximum efficacy. Each capsule should be swallowed whole (not chewed) and taken with cool liquid no warmer than 98.6°F (37°C), approximately 1 hour before a meal and ≥2 hours after a previous meal. The manufacturer recommends avoiding alcohol consumption 1 hour before and 2 hours after administration, because alcohol can disintegrate the enteric coating.

Travelers should complete the Ty21a vaccine regimen ≥1 week before potential exposure. The approach for addressing a missed oral vaccine dose or taking a dose late is undefined. Some suggest that minor deviations in the dosing schedule (e.g., taking a dose 1 day late) might not alter vaccine efficacy; no studies have shown the effect of such deviations, however. If travelers do not complete 4 doses as directed, they might not achieve an optimal immune response. The vaccine is approved for use in people ≥6 years old. A booster dose is recommended every 5 years for those who remain at risk.

Adverse Reactions

Adverse reactions most often associated with ViCPS vaccine include headache, injection-site reactions, fever, and general discomfort. Adverse reactions to Ty21a vaccine are rare and mainly consist of abdominal discomfort, diarrhea, fever, headache, nausea, vomiting, and rash. Report adverse reactions to the Vaccine Adverse Event Reporting System at the website or by calling 800-822-7967.

Precautions & Contraindications

Neither the ViCPS nor the Ty21a vaccine should be given to people with an acute febrile illness; in addition, Ty21a is not recommended for use in people with acute gastroenteritis. Live vaccines, including Ty21a vaccine, should not be given to pregnant or immunocompromised people, including those with HIV. No information is available on the safety of the inactivated vaccine (ViCPS) in pregnancy; consider ViCPS for pregnant people when the benefits of vaccination outweigh potential risks (e.g., when the likelihood of exposure to Typhi is high).

The intramuscular vaccine (ViCPS) presents a theoretically safer alternative than the live, oral vaccine (Ty21a) for immunocompromised travelers. The Ty21a vaccine can be administered to household contacts of immunocompromised people; although vaccine organisms can be shed transiently in the stool of vaccine recipients, secondary transmission of vaccine organisms has not been documented. The only contraindication to vaccination with ViCPS vaccine is a history of severe local or systemic reactions after a previous dose.

Theoretical concerns have been raised about the immunogenicity of Ty21a vaccine in people concurrently receiving antimicrobial agents, live vaccines, or immune globulin. The growth of the live Ty21a strain is inhibited in vitro by various antimicrobial agents. The manufacturer advises that vaccination with the Ty21a vaccine should be delayed for >72 hours after the administration of any antimicrobial agent, and antibiotics should not be given to a patient ≤72 hours after the last dose of the Ty21a vaccine.

Ty21a vaccine can be administered simultaneously or at any interval before or after live virus vaccines (e.g., measles-mumps-rubella, oral polio, or yellow fever vaccines). Available data do not suggest that simultaneous administration of live virus vaccines decreases the immunogenicity of the Ty21a vaccine. If typhoid vaccination is warranted, it should not be delayed because of administration of viral vaccines. No data are available on coadministration of the Ty21a vaccine and the oral cholera vaccine (lyophilized CVD 103-HgR [Vaxchora]); taking the first Ty21a vaccine dose ≥8 hours after oral cholera vaccine might decrease potential interference between the vaccines. Simultaneous administration of the Ty21a vaccine and immune globulin does not appear to pose a problem.

CDC website: Typhoid fever and paratyphoid fever

The following authors contributed to the previous version of this chapter: Grace D. Appiah, Michael J. Hughes, Kevin Chatham-Stephens

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Crump JA. Progress in typhoid fever epidemiology. Clin Infect Dis. 2019;68(Suppl 1):S4–9.

Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM. Epidemiology, clinical presentation, laboratory diagnosis, antimicrobial resistance, and antimicrobial management of invasive Salmonella infections. Clin Microbiol Rev. 2015;28(4):90137.

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Effa EE, Lassi ZS, Critchley JA, Garner P, Sinclair D, Olliaro P, Bhutta ZA. Fluoroquinolones for treating uncomplicated typhoid and paratyphoid fever (enteric fever). Cochrane Database Syst Rev. 2011(10):CD004530.

François Watkins LK, Winstead A, Appiah GD, Friedman CR, Medalla F, Hughes MJ, et al. Update on extensively drug-resistant Salmonella serotype Typhi infections among travelers to or from Pakistan and report of ceftriaxone-resistant Salmonella serotype Typhi infections among travelers to Iraq—United States, 2018–2019. MMWR Morb Mortal Wkly Rep. 2020;69(20):618–22.

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Pope Will Travel to Indonesia, Papua New Guinea, East Timor and Singapore in Longest Trip of Papacy

The Vatican says Pope Francis will visit Indonesia, East Timor, Papua New Guinea and Singapore in September

Andrew Medichini

FILE -Pope Francis waves as he leaves after his weekly general audience in St. Peter's Square at The Vatican, Wednesday, April 10, 2024. Pope Francis will visit Indonesia, East Timor, Papua New Guinea and Singapore in September, the Vatican announced Friday, April 12 ,2024, confirming the longest trip of Francis’ papacy that is sure to test his health, stamina and mobility. (AP Photo/Andrew Medichini, File)

VATICAN CITY (AP) — Pope Francis will visit Indonesia, East Timor, Papua New Guinea and Singapore in September, the Vatican announced Friday, confirming the longest trip of Francis’ papacy that is sure to test his health, stamina and mobility.

The Vatican confirmed the Sept. 2-13 visit, saying the 87-year-old pope would visit Jakarta, Indonesia; Port Moresby and Vanimo, Papua New Guinea; Dili, East Timor; and Singapore. Further details will be announced later.

Francis' health has become a source of increasing concern and speculation, even though the pontiff is able to carry on with a rigorous schedule of meetings at the Vatican and even excursions to local parishes.

Francis, who had part of one lung removed as a young man, had to cancel a planned visit to Dubai late last year after he came down with a bad case of bronchitis. He suffered from respiratory problems all winter and had to curtail his participation in Holy Week events to save his energy for Easter.

Francis has also been using a wheelchair for nearly two years because of bad knee ligaments, and has said that traveling has become increasingly more difficult.

And yet at 11 days, the trip would be the longest of Francis’ papacy, outpacing by a few days some of his long trips to the Americas early on in his 11-year papacy. It will bring the Argentine Jesuit to the world’s most populous Muslim nation, Indonesia, as well as the former Portuguese colony of East Timor, where the Catholic Church wields enormous influence.

Photos You Should See - April 2024

There is also a chance of another leg to the trip being added later: This week, the Vatican foreign minister, Archbishop Paul Gallagher, was in Vietnam and discussed a papal visit, Vatican News reported, without providing details.

In a statement announcing the visit, the Indonesian foreign ministry welcomed the visit and recalled that it had originally been scheduled for 2020 but was postponed because of the COVID-19 pandemic.

“The visit of Pope Francis to Indonesia holds significant importance to the Indonesian people, not only for Catholics but also for all religious communities. The visit is also expected to strengthen the message of tolerance, unity and world peace,” the statement said.

Indonesia is home to roughly 242 million Muslims and 29 million Christians — 8.5 million of whom are Catholics — according to a 2022 report by the Religious Affairs Ministry.

East Timor, which today has a population of about 1.2 million people, is Southeast Asia’s only predominantly Christian nation with the exception of the Philippines. According to the 2015 census, 97.6% of East Timor’s population is Catholic.

The visit to East Timor will likely reignite attention over a clergy sex abuse scandal involving its revered independence hero and Nobel Peace Prize winner. The Vatican confirmed in 2022 that it had sanctioned Bishop Carlos Ximenes Belo following allegations that he sexually abused boys there during the 1990s. Belo is believed to now be living in Portugal.

Francis will be the first pope to visit Papua New Guinea since St. John Paul II went there in 1984. The country, in a strategically important part of the South Pacific, has struggled with tribal violence and civil unrest.

John Paul also visited Singapore, in 1986. The country today is home to 395,000 Catholics and Francis in 2022 made its archbishop Singapore's first cardinal.

In a statement welcoming the visit, Cardinal William Goh, said it “will bring renewed fervor to all Catholics in Singapore, uniting them in faith and mission, especially in these most challenging of times.”

The Vatican has planned only one other papal trip this year — to Belgium to celebrate the anniversary of the country’s Catholic university. Francis has also said he wants to return to his native Argentina , but no plans or dates have been announced.

Karmini contributed from Jakarta, Indonesia.

Copyright 2024 The  Associated Press . All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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