Innovative strategies developed to mitigate the impact of COVID-19 pandemic on polio surveillance in Nigeria, 2020

Introduction: following the spread of the COVID-19 pandemic to Nigeria, the Federal Government of Nigeria restricted human and vehicular movements to curb the spread of the disease. This action had a negative impact on Acute Flaccid Paralysis (AFP) surveillance, with a resultant reduction in the number of AFP cases reported. This paper describes the impact of the COVID-19 pandemic on poliovirus surveillance in Nigeria and the proactive interventions by Nigeria´s polio program to mitigate the impact of COVID-19 on polio surveillance. Methods: nine innovative strategies were implemented in all 774 Local Government Areas (LGA) of the 36 states and Federal Capital Territory (FCT) of the country. These strategies were developed by the national surveillance officers and operationalized by sub-national surveillance officers with different strategies starting at different epidemiological weeks from week 14 to 23, 2020. Many of the strategy innovations were technology-based and included: the use of mobile phones to send the AFP case definition and video by WhatsApp or by SMS, the use of state-specific toll-free numbers and Mobile Telephone Network (MTN) (mobile service provider) CallerfeelTM to community informants (CI) who were the main targets of the interventions to increase case detection and reporting. Others included the use of abridged e-surveillance integrated supportive supervision (ISS) checklists, virtual monthly DSNO meetings, and batched AFP stool specimen transportation network. Results: compared to the same period in 2019, the cumulative rate of AFP case detection and reporting had gradually declined from 39.1% in January to 16.7% before the commencement of the interventions in week 20, 2020. However, the detection and reporting increased by 57.% from week 20 to week 47 compared to the same period in 2019. This is because with COVID-19, hospital visitation dropped, and the sick remained in the communities, so the CI network was relied on to detect and report AFP cases. The cumulative proportion of AFP cases reported by community informants as of week 47 increased from 13% in 2018 to 21% in 2020. This indicates an increase of 38%. Thirty-five AFP cases were detected and reported using the MTN Caller Feel strategy, while 15 cases were reported through state-specific toll-free numbers. Conclusion: the implementation of the innovative strategies was able to mitigate the low AFP case detection and reporting observed at the initial stage of the COVID-19 pandemic. The use of technology facilitated reaching the CI network, which was more instrumental in detecting and reporting the cases.

A rapid increase in coverage of COVID-19 vaccination, Central African Republic

Problem In 2021, Central African Republic was facing multiple challenges in vaccinating its population against coronavirus disease 2019 (COVID-19), including inadequate infrastructure and funding, a shortage of health workers and vaccine hesitancy among the population. Approach To increase COVID-19 vaccination coverage, the health ministry used three main approaches: (i) task shifting to train and equip existing community health workers (CHWs) to deliver COVID-19 vaccination; (ii) evidence gathering to understand people's reluctance to be vaccinated; and (iii) bundling of COVID-19 vaccination with the polio vaccination programme. Local setting Central African Republic is a fragile country with almost two thirds of its population in need of humanitarian assistance. Despite conducting two major COVID-19 vaccination campaigns, by January 2022 only 9% (503 000 people) of the 5 570 659 general population were fully vaccinated. Relevant changes In the 6 months from February to July 2022, Central African Republic tripled its coverage of COVID-19 vaccination to 29% (1 615 492 out of 5 570 659 people) by August 2022. The integrated polio­COVID-19 campaign enabled an additional 136 040 and 218 978 people to be vaccinated in the first and second rounds respectively, at no extra cost. Evidence obtained through surveys and focus group discussions enabled the health ministry to develop communication strategies to dispel vaccine hesitancy and misconceptions. Lessons learnt Task shifting COVID-19 vaccination to CHWs can be an efficient solution for rapid scaling-up of vaccination campaigns. Building trust with the community is also important for addressing complex health issues such as vaccine hesitancy. Collaborative efforts are necessary to provide access to COVID-19 vaccines for high-risk and vulnerable populations.

Using the polio programme to deliver primary health care in Nigeria: implementation research

Objective To evaluate a project that integrated essential primary health-care services into the oral polio vaccine programme in hard-toreach, underserved communities in northern Nigeria.Methods In 2013, Nigeria's polio emergency operation centre adopted a new approach to rapidly raise polio immunity and reduce newborn, child and maternal morbidity and mortality. We identified, trained and equipped eighty-four mobile health teams to provide free vaccination and primary-care services in 3176 hard-to-reach settlements. We conducted cross-sectional surveys of women of childbearing age in households with children younger than 5 years, in 317 randomly selected settlements, pre- and post-intervention (March 2014 and November 2015, respectively). Findings From June 2014 to September 2015 mobile health teams delivered 2 979 408 doses of oral polio vaccine and dewormed 1 562 640 children younger than 5 years old; performed 676 678 antenatal consultations and treated 1 682 671 illnesses in women and children, including pneumonia, diarrhoea and malaria. The baseline survey found that 758 (19.6%) of 3872 children younger than5 years had routine immunization cards and 690/3872 (17.8%) were fully immunized for their age. The endline survey found 1757/3575 children (49.1%) with routine immunization cards and 1750 (49.0%) fully immunized. Children vaccinated with 3 or more doses of oral polio vaccine increased from 2133 (55.1%) to 2666 (74.6%). Households' use of mobile health services in the previous 6 months increased from 509/1472 (34.6%) to 2060/2426(84.9%). Conclusion Integrating routine primary-care services into polio eradication activities in Nigeria resulted in increased coverage for supplemental oral polio vaccine doses and essential maternal, newborn and child health intervention

Poliovirus neutralizing antibody levels among individuals in three regions of Ghana

Introduction: Ghana was declared polio-free in 2015 after the last polio case in 2008. We determined the poliovirus neutralizing antibody levels among individuals to identify possible immunity gaps. Methods: A cross-sectional, hospital-based study was undertaken in Northern, Ashanti and Greater Accra regions of Ghana. Individuals referred for haematology at the teaching hospitals' laboratories were invited to participate in our study. Neutralizing-antibody titers to poliovirus serotypes 1,2 & 3 were assayed by WHO-standards. Antibody titers of ≥8 were considered protective. Bivariate and multivariate analyses were conducted on subject characteristics to assess potential factors for failure to seroconvert. P-values < 0.05 were considered statistically significant. Results: Poliovirus (PV) neutralizing-antibody serotypes 1, 2 and 3 were detected in 86.0% (264/307), 84% (258/307) and 75% (230/307) of samples respectively. 60.1% (185/307) were seropositive for the three poliovirus serotypes. Neutralizing poliovirus antibodies for PV1 and PV2 were higher than for PV3. Seroprevalence of poliovirus-neutralizing antibodies among males (PV1=51.9%, PV2= 51.6% and PV3= 52.6%) were higher than in females. Seroprevalence rates of poliovirus-neutralizing antibodies (PV1, PV2, and PV3) were highest in the Northern region (90%, 81%, and 77%). Poliovirus neutralizing-antibodies (PV1and PV2) decreased with age [p< 0.001]. Low seroprevalence of poliovirus-neutralizing antibodies was significantly associated with low school attendance of mothers (p<0.001). Conclusion: Our study population has some protection from polio. However, immunity appears to be lower with a higher age or low Mother's education. This may suggest the need for young-adult booster-dose to minimize the risk of wild poliovirus infection

L'intégration communautaire dans les journées nationales de vaccination au poliovirus : cas de Dschang

Introduction : L'épidémie de poliomyélite déclenchée en fin 2013 à l'Ouest Cameroun avait conduit à plusieurs Journées Nationales de Vaccination de Riposte (JNVr). Le district de Dschang avec ses 22 aires de santé est l'un des plus vastes de l'Ouest Cameroun. Durant les campagnes de vaccination de riposte au poliovirus, les chefs des aires utilisent différentes approches pour d'optimiser la couverture vaccinale. L'objectif principal de l'étude était d'analyser la participation communautaire dans les activités de vaccination supplémentaire, lors de la riposte contre l'épidémie de poliomyélite au Cameroun.Matériel et méthode : Une étude transversale descriptive à été menée en août 2014 dans les aires de santé de Baleveng ; Mbeng ; Fialah-Foreke ; Ndoh-Djutitsa et Fondonera, du district de santé de Dschang. Le statut vaccinal de 136 enfants de 0 à 59 mois a été étudié et 60 parents interviewés dans les ménages. La méthode des enquêtes "Lot Quality Assurance Sampling (LQAS)" a été utilisée. Le marquage de l'auriculaire gauche de l'enfant avec l'encre noire par les vaccinateurs indiquait l'état vaccinal de l'enfant. Résultats : Il ressort que, seules les aires de Mbeng et Fometa avaient des couvertures vaccinales satisfaisantes(respectivement 100% et 95%), alors que Baleveng (80%) ; Fondonera (88,8%) ; Ndoh-Djutitsa (81%) et Fialah-Foréké (88,9%) avaient des couvertures intermédiaires. Les canaux de communication les plus accessible étaient, les mobilisateurs et centres de santé ; les médias et les crieurs. Les canaux les plus sollicités par les parents étaient : les mobilisateurs (20%) ; les affiches (16,7%) et le téléphone (15%). Les aires de santé de Mbeng et Ndoh enregistrent les taux les plus élevés de parents informés (respectivement 9/10 et 8/10). Discussion : Un vaccinateur pour 185 enfants, suite à l'injection des fonds communautaires, permet d'obtenir des couvertures vaccinales > 90%. Des parents informés bien avant le passage des vaccinateurs pourrait conduire à des couvertures vaccinales satisfaisantes. Nous recommandons plus de ressources communautaires et mobilisation sociale dans la mise œuvre des activités vaccinales supplémentaires de riposte à la poliomyélite

Polio Eradication in the African Region: Progress and Way Forward

In 2012 the declaration of global polio eradication as a programmatic emergency for public health targets resulted in the setting of objectives and a schedule for eradication. Innovative approaches were taken to address the polio situation in the African Region. Supplementary immunization activities; planning; monitoring and surveillance have all been stepped up; and technological advances such as GPS and the use of polio dashboards to monitor key performance data have been employed. Key priority countries (Angola; Chad; Democratic Republic of the Congo; Nigeria) and communities (including nomadic groups) have been targeted.Great progress has been documented; for example routine immunization has risen from less than10 in 1980 to 77 in 2013. However; there are still some challenges to overcome; notably wild poliovirus outbreaks and three remaining foci of transmission - Nigeria; the Central Africa subregion and the Horn of Africa. This article charts the steps taken and the continuing action needed to realise the aim of polio eradication

Overview of the WHO Polio Laboratory Network in the African Region

The Polio Laboratory Network has always played a critical role in diagnosing poliovirus disease (poliomyelitis) and the detection of poliovirus transmission. In the new millennium; the strength of the laboratory network is often a direct reflection of the success of the Polio Eradication Initiative (PEI) programme. The network has taken advantage of new technologies that provide speedy turnaround times for results reporting thus contributing to the success of the PEI programme. This article presents a brief overview of the work of the network

Cross-Border Initiative on Polio Eradication in the Horn of Africa

Community-based surveillance complements the existing surveillance systems in the mission to control and eradicate polioviruses. It is a cost effective method and has a number of benefits. It was introduced in Ethiopia in 2003 and in the South Sudan CORE Group Polio Project areas in 2010. As well as the results obtained from this initiative; the report looks at the challenges; lessons learned and suggests some ways to strengthen the programme

The National Stop Transmission of Polio (STOP) Programme in Uganda 2012-2014

In 2012 Uganda established a pool of national STOP (Stop Transmission of Polio) volunteers who assist subnational staff in strengthening surveillance - detection and reporting. In addition to surveillance activities; the volunteers have built capacity of operational health workers in basic skills for routine immunization. This article gives a brief overview of the initiative and the impressive achievements it is making

All-Age Group Polio Supplementary Immunization Activities; Garissa County; Kenya

The Polio Eradication Initiative (PEI) has made significant progress towards attaining the poliomyelitis targets in the African Region and research; among other activities; has played a critical role. An overview of the contribution of a select few operational research (OR) activities undertaken is given in this article. These mainly concern social research targeted at understanding and changing behaviour to enhance effective intervention uptake. Lessons learned from this research for the planning and implementation of interventions are also discussed

Polio Eradication Initiative (PEI) Emergency Plan: A Panacea for Polio Eradication in Nigeria

BACKGROUND.Nigeria has persistently fallen short of the goal to halt and eradicate the transmission of the poliomyelitis virus. The most recent failure of yet again another major polio eradication program under the Global Polio Emergency Initiative 2010-2012 calls for a review of the Nigerian Polio Eradication Initiative Emergency Plan developed under this scheme and time period. This is to determine whether the deployed strategies were optimum to tackle and surmount the intractable problem of sub- optimal vaccine coverage which has remained a critical bottleneck in the successful eradication of the polio virus in Nigeria. It becomes pertinent therefore; to appraise this latest effort to avoid a recurrence of failure in subsequent polio eradication programs.METHODS.A review of related and available literature was conducted on the subject matter using the Google search engine; Google Scholar; and PubMed using the key words polio; eradication; Nigeria; and Global Polio Eradication Initiative.RESULT.Much progress has been made towards achieving the required coverage threshold to completely eradicate polio but the inherent weaknesses and gaps in the Polio Eradication Initiative Emergency Plan plugs eradication efforts back into the vicious cycle of recurrent failure.CONCLUSION. Successful polio eradication efforts through the Polio Eradication Initiative Emergency Plan need to target realistic goals. Current efforts and strategies need to be scaled up and sustained to permanently address the persistent issue of sub optimal coverage of polio immunization

Poliomyelitis eradication remains a challenge in Africa

During the last two decade; twelve wild type 1 poliovirus genotypes have been characterized in Africa. Several distinct clusters have been identified within some of them and appeared to be segregated geographically. This distribution could represent newly emerging genotypes and independent sustained circulation of these lineages or cross border transmission between countries of a single genotype followed by a different natural evolution in each country. Concurrent circulation of more than one poliovirus genotype was seen in Nigeria; Togo; Central Africa Republic and South Africa. The present study which has generated a meaningful overview of the endemic circulation of wild type 1 poliovirus in Africa; could be a basis for further evaluation of the impact of mass vaccination campaigns on wild type 1 poliovirus

Media and Interpersonal Persuasions in the Polio Eradication Campaign in Northern Nigeria

This study is premised on the increasing global concerns over the widespread resistance to polio eradication campaign in northern Nigeria. It aims to determine the level of campaign acceptance and compare the influences of mass media and interpersonal communication sources in Zaria local government area; being one of the high-risk (WPV-endemic) areas in northern Nigeria; where campaign resistance is known to be high. By way of quantitative survey; the study utilized 10sample of the populations of eight out of the thirteen Wards in Zaria local government area; with a response rate of 78.6. Findings reveal close ranks between campaign acceptance and resistance in the local government area; thus further confirming the difficulties still faced in polio eradication campaign in the region. This study also indicates higher performance of Interpersonal than Mass Media sources in influencing campaign acceptance and resistance in the local communities. Contact with friends and relations was rated the most influential interpersonal sources in the acceptance and resistance decision of individuals; while newspapers and magazines were rated most influential media sources that influenced campaign resistance in the local communities. The study concludes that a polio eradication campaign; backed with competent and sufficient communication expertise that utilizes knowledge- based indigenous interpersonal communication strategies will likely result in greater community acceptance in northern Nigeria

Poliomyelitis: Pattern and Treatment Outcome in Niger Delta; Nigeria

Background: Poliovirus is an enterovirus in the family of Picornaviridae and consists of three antigenic types; 1; 2; and 3. All three types cause paralysis. It is a major cause of musculoskeletal deformity in many African communities including Nigeria. The deformities include muscle weakness; contractures; grotesque foot deformities and angular deformities around the knee; amongst others. Aim: To highlight 20 children with musculoskeletal deformities due to poliomyelitis treated in a private hospital in Port Harcourt. Methods: Twenty children with musculoskeletal deformities due to poliomyelitis were retrospectively studied. Results: The patients' ages ranged from1 to 16 years; with 95of them under 15 years of age. More than 50of the study group had poor immunisation status as 6 of them were unimmunised (30) and 5 (25) of them were incompletely immunised. Even though all school strata were represented; most of them were not schooling. The commonest deformity was contracture of the knees (100) and muscle wasting in the affected limbs. All of them had loss of muscle power in the lower limbs. Surgical correction was achieved by soft tissue release in 95of them and osteotomy in 5. The outcome was good; as acceptable extension of the knee was achieved post operatively. Conclusion: The musculoskeletal abnormalities of poliomyelitis contribute highly to physical disability. All patients affected by paralytic poliomyelitis become disabled to some extent and this increases the disease burden in Nigeria

Epidemiology and control of poliomyelitis

The World Health Assembly (WHA) declared that the World Health Organization (WHO) was committed to the global eradication of poliomyelitis. As with smallpox; eradication involves the additionalcriterion of the elimination of indigenous transmission of wild virus. This article reviews the epidemiology of poliomyelitis; strategies for polio eradication and the progress made so far. Threats to eradication objectives are identified and changes in polio eradication initiative deadline are outlined

Impact des journees nationales de vaccination contre la poliomyelite dans la redynamisation du programme elargi de vaccination dans la commune IV du District de Bamako

Au terme de cette etude au cours de laquelle nous nous etions donne comme objectif principal de mesurer l' impact des Journees Nationales de Vaccination sur les activites de routine du Programme Elargi de Vaccination nous retiendrons que la periode qui a couvert les JNV a ete caracterisee par un taux de couverture vaccinale superieur a 70p.100 par rapport au DTCP3. Les centres de sante de reference continuent a recueillir le plus grand nombre d'enfants en age d'etre vaccines

Surveillance virologique des paralysies flasques aiguës en Republique Démocratique du Congo (RDC) 1997-2001

Lesauteursrap p o rtent les résultatsde l'analyse de la surveillance viro l ogiquedespara lysies flasques aiguës (PFA )en République Démocratique du Congo (RDC),pays longtemps ravagé par des conflits armés. Au total,3658 échantillons deselles de cas de PFA en provenance des provinces sous contrôle gouvernemental,ont été analysés selon les méthodes recom-mandées par l'OMS. L' a m é l i o ration de la surveillance épidémiologique des PFA s'est traduite par l'accroissement sensible dunombre d'échantillons traités qui est passé de 32 en 1997 à 2471 en 2001. Les performances du laboratoire national de réfé-rence accrédité en 1999,ontétéappréciées par le taux annuel d'isolement desentérov i rusnon poliov i rus qui estpassé de10%en 1999 à 20% en 2001,et par le rendu des résultats qui est passé de 50% en 1999 pour dépasser en 2001 le seuil de 80% exigépar l'OMS. De 1997 à 2001,68 souches de poliovirus sauvages ont été isolées dont 52 souches de type 1,une souche de type 2et 15de type 3. Quat re-vingt un pour cent des casdepoliomyélitesurve nus entre 1997 et 2001ontétéobservés chezdes enfa n t sâgés de 0 à 5 ans. Seulement 12% ont été détectés chez des enfants âgés de 6 à 14 ans contre 3% chez de jeunes adolescents.Soixante-sept pour cent des 45 sujets atteints de poliomyélite et dont l'état vaccinal était connu,avaient reçu 0 à 3 doses devaccinanti-poliomyélitiqueoral. Parcontre15sujets(33%) bien qu'ayant reçuplusde4 dosesrequises deva c c i n ,avaient quandmême développélamaladie. Depuis1997,t roisprovinces dela RDC sontexemptesde poliov i russauvage :la ville deKinshasa,leBas-Congoet leNord - K ivu. En 2001,lacirc u l ation depoliov i russauvage aétéinterrompuesurtoutel'étenduedupaysgr â c eaux activités de vaccination de routine et surtout à l'organisation des journées nationales de vaccination