Health authorities in Togo are carrying out a vaccination campaign in the north after the first outbreak of yellow fever in that region in more than 20 years.

The World Health Organisation (WHO) confirmed four cases of the disease in the regions of Savanes and Kara in December and January. About 1.6 million doses of the vaccine have been provided for the campaign, which began on Monday and will target children over nine months of age.

Another case was reported in the southern Maritime region in January. WHO said containment measures there, including possible vaccinations, were currently being assessed.

“We intend to do everything to stop it from spreading before the next rainy season,” Health Minister Charles Kondi Agba told reporters.

The last vaccination campaign in Togo against the mosquito-borne illness was carried out in 1987; therefore the population is highly susceptible to the disease, according to WHO. Vaccinations are to continue until 25 February. About 1.3 million people live in the targeted northern regions.

“Ideally vaccinations should be carried out in the whole country and we wouldn’t worry but it is a question of cost,” said Dr. Kadri Tankari, the WHO representative in Togo.

Yellow fever vaccination was compulsory in Francophone West Africa prior to the 1960s and mass vaccination campaigns were carried out until the disease nearly disappeared from the region. But it has slowly reemerged, with outbreaks in Guinea and Cote d’Ivoire in 2006, because of lack of vaccinations, WHO said.

Yellow fever is a viral haemorrhagic fever. Jaundice affects some patients, causing yellow eyes and yellow skin. Other symptoms can include fever, muscle pain, nausea, headache and shivers. There is no treatment for it other than supportive care.

The vaccines for the Togo outbreak, at a cost of about US$791,000, were provided by the GAVI Alliance emergency stockpile through the International Coordinating Group on Vaccine Provision for Yellow Fever Control. The European Commission has provided funding for the campaign. It is being carried out by the Togolese Ministry of Health in collaboration with WHO, the United Nations children’s agency and the Red Cross.