Yellow fever travel vaccination — DTM&H MCQ

Correct answer: A — Yellow fever vaccination at an authorised centre before travel

The correct answer is A, yellow fever vaccination at an authorised centre before travel. Ghana lies within the yellow fever endemic zone of West Africa, and this traveller has no documented prior vaccination, no contraindication to live vaccines, and is heading to rural areas in the wet season when mosquito (Aedes) activity and transmission risk are highest. In the UK, yellow fever vaccine is a live attenuated vaccine that can only be administered at a registered Yellow Fever Vaccination Centre, and it is recommended for most travellers to Ghana, in addition to being an entry requirement enforced via the International Certificate of Vaccination. Since he has no contraindications, the single most appropriate action is to arrange vaccination at such a centre well before departure to allow time for immunity to develop and for certificate issue. Why the other options are wrong: D. Japanese encephalitis vaccine as the priority vaccine: Japanese encephalitis is a risk in parts of Asia associated with rice paddy and pig farming ecology, not West Africa, so it is irrelevant to a Ghana itinerary and does not address the yellow fever risk highlighted in the stem. E. Oral cholera vaccine as a substitute for yellow fever vaccine: cholera vaccine protects against a different pathogen entirely and has no effect on yellow fever virus transmission; it cannot substitute for a mandatory yellow fever vaccination in an endemic country. B. Rabies immunoglobulin before departure: immunoglobulin is used post-exposure after a bite, not as pre-travel prophylaxis, and rabies is unrelated to the yellow fever risk described. C. Doxycycline as protection against yellow fever: doxycycline is malaria chemoprophylaxis and has no antiviral activity against yellow fever, which is prevented only by vaccination. Key point: Unvaccinated travellers with no contraindications heading to yellow fever endemic areas such as rural Ghana in the wet season need yellow fever vaccination at an authorised centre, since it is both a live-vaccine requirement restricted to registered sites and often a certificate mandated for entry or transit.

Reference: NaTHNaC TravelHealthPro, Ghana country information: yellow fever vaccine recommendations and requirement for registered Yellow Fever Vaccination Centres, https://travelhealthpro.org.uk/country/89/ghana