Sustaining vaccine gains through stronger rotavirus surveillance in Ghana

Rotavirus surveillance continues to demonstrate the positive impact of vaccination in Ghana. The World Health Organization (WHO) convened a rotavirus surveillance review meeting in Koforidua that brought together surveillance focal points from collaborating health facilities, the sentinel site at Komfo Anokye Teaching Hospital (KATH), the Regional Reference Laboratory at the Noguchi Memorial Institute for Medical Research (NMIMR), and the Ghana Health Service (GHS).

Rotavirus remains a leading cause of severe diarrhoeal disease among children under age five years globally, and while the introduction of vaccines in 2006 has significantly reduced hospitalisations and deaths, sustained surveillance is essential to maintain impact and guide policy. In Ghana, the vaccine, introduced in 2012, has averted over 1.8 million cases and reduced rotavirus-related hospitalisations by 42%. These gains are supported by sentinel surveillance systems anchored at two sites, including the Komfo Anokye Teaching Hospital (KATH), established in collaboration with WHO in 2008. The site, together with five affiliate hospitals, enrolls children under age five years with acute gastroenteritis for laboratory testing and strain characterisation.

Performance at KATH has improved consistently, with enrolment rates increasing from 84% in 2024 to 86% in 2025, with over 96% of stool samples collected within 24 hours in both years. The review meeting in Koforidua provided a platform to examine three-year performance trends, validate data, share lessons learned, and jointly develop context-specific strategies to overcome bottlenecks such as intermittent ELISA test kit shortages, data entry inconsistencies, and shipment delays.

Speaking at the opening session, Dr. Michael Rockson Adjei, New Vaccine Initiative Officer at WHO Ghana, underscored the importance of surveillance in sustaining vaccine impact.

"Introducing a vaccine is only the beginning. What sustains impact is strong, reliable surveillance. The data generated from this sentinel site does not only inform Ghana's immunisation programme, but contributes to global evidence on vaccine performance, strain circulation, and future vaccine design. Strengthening this system is an investment in child survival", he said.

He commended the site for its improved enrolment rates and timely sample collection but emphasized the need for data accuracy and uninterrupted laboratory testing to maintain credibility and scientific value.

Ghana operates several rotavirus sentinel surveillance sites across the country to monitor disease trends and assess the continued impact of the rotavirus vaccine. With support from the World Health Organization, these sites play a critical role in generating data that informs national and global immunization policies. The review meeting in Koforidua focused on the surveillance network anchored at Komfo Anokye Teaching Hospital in Kumasi, and similar performance review meetings will be held with other sentinel sites to strengthen surveillance systems nationwide.

The meeting provided a platform to review three-year performance trends, validate data, share lessons learned, and jointly develop context-specific strategies to overcome bottlenecks such as intermittent shortages of ELISA test kits, data entry inconsistencies, and shipment delays.

Representing KATH rotavirus sentinel site, Professor Emmanuel Addo-Yobo, the site coordinator, highlighted the importance of laboratory quality and strain characterisation.

"Beyond detecting rotavirus, we are interested in understanding which strains are circulating and whether they are changing over time. This information is critical for global vaccine policy and for anticipating potential shifts in disease patterns. Timely sample shipment and consistent availability of test kits are therefore not operational details - they are scientific necessities", he noted.

Participants engaged in in-depth discussions and group work sessions focused on integrating sentinel surveillance into routine hospital systems and strengthening immunization data documentation for enrolled children. Health facilities shared practical lessons on improving case identification, documentation, and collaboration between clinical and laboratory teams.

Jacqueline Tawia, a Nurse at Asokwa Children's Hospital reflected on the value of the review meeting.

"Sometimes we focus so much on daily service delivery that we do not step back to see the bigger picture. This meeting has helped us understand how our documentation and timely sample collection contribute to national and global health decisions. We are leaving here with clearer strategies and renewed commitment", she said.

The review also strengthened coordination between WHO, KATH, NMIMR, and GHS to address operational challenges, including integration of rotavirus surveillance into routine systems, stockouts of ELISA kits and regulatory delays affecting shipment of laboratory supplies.

As Ghana continues to build resilient health systems, the rotavirus sentinel surveillance platform demonstrates how collaboration, data-driven decision-making, and continuous quality improvement can protect children from preventable diseases.

By strengthening laboratories, improving data systems, and fostering partnerships across institutions, Ghana is not only safeguarding the impact of the rotavirus vaccine but also reinforcing the foundation for broader vaccine-preventable disease surveillance, ensuring that every child has a better chance to survive and thrive.