Evaluating the landscape of the 1918 influenza and the 2019 coronavirus pandemics in mapping potential sentinel surveillance sites for emerging and re-emerging infectious diseases in Ghana

Background/objectives: Ghana, a major travel hub in West Africa, faces a high risk of infectious disease transmission due to frequent travel and cross-border movement. The 2019 coronavirus pandemic, like the 1918 influenza pandemic, highlighted gaps in infectious disease surveillance and outbreak response systems. This study aimed to assess how Ghana can better monitor and respond to emerging and re-emerging infectious diseases (ERIDs) by evaluating its existing surveillance infrastructure. Method: Focusing on Influenza-Like Illness (ILI) and Severe Acute Respiratory Infections (SARI) - key targets for pandemic surveillance - the study analysed the diffusion patterns of the 1918 influenza and 2019 coronavirus in Ghana. Existing surveillance sites were reviewed to identify potential new sites for optimal sentinel surveillance. Results: The first month of the 1918 influenza and 2019 coronavirus outbreaks in Ghana covered 31.8 % and 22.2 % of districts, with full-country spread taking 15 and 13 weeks respectively. The analysis further revealed that towns, villages, and socio-economic routes, particularly in the middle belt and Accra, were high-risk areas. Based on the findings, an additional 369 primary, 610 secondary, and 3176 tertiary surveillance sites were proposed to supplement the current 31 ILI and SARI sites. Conclusion: Expanding the current surveillance system to include ERIDs will enhance Ghana's capacity to efficiently monitor and respond to future outbreaks, improving health security in resource-limited settings.