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Braka F, Adamu U, Siddique A, Bolu O, Damisa E, Banda R, Gerald S, Korir C, Usman S, Mohammed A, Aladeshawe S, Tegegne S, Nomhwange T, Waziri E, Nguku P, Erbeto T, Nsubuga P, Shuaib F. The role of polio emergency operations centers: perspectives for future disease control initiatives in Nigeria. Pan Afr Med J 2023; 45:8. [PMID: 38370098 PMCID: PMC10874100 DOI: 10.11604/pamj.supp.2023.45.2.41308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 02/20/2024] Open
Abstract
The Nigeria Polio Emergency Operations Centre (EOC) was established in October 2012 to strengthen coordination, provide strategic direction based on real-time data analysis, and manage all operational aspects of the polio eradication program. The establishment of seven state-level polio EOCs followed. With success achieved in the interruption of wild poliovirus (WPV) transmission as certified in 2020, the future direction of the polio EOC is under consideration. This paper describes the role of the polio EOC in other emergencies and perspectives on future disease control initiatives. A description of the functionality and operations of the polio EOC and a review of documentation of non-polio activities supported by the EOC was done. Key informant insights of national and state-level stakeholders were collected through an electronic questionnaire to determine their perspectives on the polio EOC's contributions and its future role in other public health interventions. The polio EOC structure is based on an incident management system with clear terms of reference and accountability and with full partner coordination. A decline in WPV1 cases was observed from 122 cases in 2012 to 0 in 2015; previously undetected transmission of WPV1 was confirmed in 2016 and all transmission was interrupted under the coordination of the EOCs at national and state levels. During 2014-2019, the polio EOC infrastructure and staff expertise were used to investigate and respond to outbreaks of Ebola, measles, yellow fever, and meningitis and to oversee maternal and neonatal tetanus elimination campaigns. The EOC structure at the national and state levels has contributed to the positive achievements in the polio eradication program in Nigeria and further in the coordination of other disease control and emergency response activities. The transition of the polio EOCs and their capacities to support other non-polio programs will contribute to harnessing the country's capacity for effective coordination of public health initiatives and disease outbreaks.
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Affiliation(s)
- Fiona Braka
- World Health Organization Country Office, Abuja, Nigeria
| | - Usman Adamu
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Anis Siddique
- United Nations Children Education Fund, Abuja, Nigeria
| | - Omotayo Bolu
- United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Eunice Damisa
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Richard Banda
- World Health Organization Country Office, Abuja, Nigeria
| | - Sume Gerald
- World Health Organization Country Office, Abuja, Nigeria
| | - Charles Korir
- World Health Organization Country Office, Abuja, Nigeria
| | | | | | | | - Sisay Tegegne
- World Health Organization Country Office, Abuja, Nigeria
| | | | - Endie Waziri
- Africa Field Epidemiology Network, Abuja, Nigeria
| | | | - Tesfaye Erbeto
- World Health Organization Country Office, Abuja, Nigeria
| | - Peter Nsubuga
- Global Public Health Solutions, Atlanta Georgia, United States
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
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Bammeke P, Adamu US, Bolu O, Waziri N, Erberto T, Aregay A, Nsubuga P, Wiesen E, Shuaib F. Descriptive epidemiology of poliomyelitis cases due to wild poliovirus type 1 and wild poliovirus type 3 in Nigeria, 2000-2020. Pan Afr Med J 2023; 45:4. [PMID: 38370099 PMCID: PMC10874097 DOI: 10.11604/pamj.supp.2023.45.2.38079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/18/2022] [Indexed: 02/20/2024] Open
Abstract
Introduction in August 2020, the World Health Organization African Region was certified free of wild poliovirus (WPV) when Nigeria became the last African country to interrupt wild poliovirus transmission. The National Polio Emergency Operations Center instituted in 2012 to coordinate and manage Nigerian polio eradication efforts reviewed the epidemiology of WPV cases during 2000-2020 to document lessons learned. Methods we analyzed reported WPV cases by serotype based on age, oral poliovirus vaccine immunization history, month and year of reported cases, and annual geographic distribution based on incidence rates at the Local Government Area level. The observed trends of cases were related to major events and the poliovirus vaccines used during mass vaccination campaigns within the analysis period. Results a total of 3,579 WPV type 1 and 1,548 WPV type 3 laboratory-confirmed cases were reported with onset during 2000-2020. The highest WPV incidence rates per 100,000 population in Local Government Areas were 19.4, 12.0, and 11.3, all in 2006. Wild poliovirus cases were reported each year during 2000-2014; the endemic transmission went undetected throughout 2015 until the last cases in 2016. Ten events/milestones were highlighted, including insurgency in the northeast which led to a setback in 2016 with four cases from children previously trapped in security-compromised areas. Conclusion Nigeria interrupted WPV transmission despite the challenges faced because of the emergency management approach, implementation of mass vaccination campaigns, the commitment of the government agencies, support from global polio partners, and special strategies deployed to conduct vaccination and surveillance in the security-compromised areas.
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Affiliation(s)
- Philip Bammeke
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | | | - Omotayo Bolu
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | | | | | | | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, Georgia, United States
| | - Eric Wiesen
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Faisal Shuaib
- National Primary Healthcare Development Agency, Abuja, Nigeria
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Maleghemi S, Tegegne AA, Ferede M, Bassey BE, Akpan GU, Bello IM, Ticha JM, Anyuon A, Waya JL, Okiror SO, Ndoutabe M, Berta KK, Ndenzako F, Mkanda P, Olu OO. Polio eradication in a chronic conflict setting lessons from the Republic of South Sudan, 2010-2020. Pan Afr Med J 2022; 42:3. [PMID: 36158939 PMCID: PMC9474935 DOI: 10.11604/pamj.supp.2022.42.1.32922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/10/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION in 1988 the World Health Assembly set an ambitious target to eradicate Wild Polio Virus (WPV) by 2000, following the successful eradication of the smallpox virus in 1980. South Sudan and the entire African region were certified WPV free on August 25, 2020. South Sudan has maintained its WPV free status since 2010, and this paper reviewed the country's progress, outlined lessons learned, and describes the remaining challenges in polio eradication. METHODS secondary data analysis was conducted using the Ministry of Health and WHO polio surveillance datasets, routine immunisation coverage, polio campaign data, and surveys from 2010 to 2020. Relevant technical documents and reports on polio immunisation and surveillance were also reviewed. Data analysis was conducted using EPI Info 7 software. RESULTS administrative routine immunisation coverage for bivalent Oral Polio Vaccine (OPV) 3rd dose declined from 77% in 2010 to 56% in 2020. In contrast, the administrative and post-campaign evaluation coverage recorded for the nationwide supplemental polio campaigns since 2011 was consistently above 85%; however, campaigns declined in number from four in 2011 to zero in 2020. Overall, 76% of notified cases of Acute Flaccid Paralysis (AFP) received three or more doses of the oral polio vaccine. The Annualized Non-AFP rate ranged between 4.0 to 5.4 per 100,000 under 15 years populations, and stool adequacy ranged from 83% to 94%. CONCLUSION South Sudan's polio-free status documentation was accepted by the ARCC in 2020, thereby enabling the African Region to be certified WPV free on August 25, 2020. However, there are concerns as the country continues to report low routine immunisation coverage and a reduction in the number of polio campaigns conducted each year. It is recommended that the country conduct high-quality nationwide supplemental polio campaigns yearly to achieve and maintain the required herd immunity. It invests in its routine immunisation program while ensuring optimal AFP surveillance performance indicators.
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Affiliation(s)
- Sylvester Maleghemi
- World Health Organization, WHO Country Office, Ministerial Complex, Juba, South Sudan,,Corresponding author Sylvester Maleghemi, World Health Organization, WHO Country Office, Ministerial Complex, Juba, South Sudan.
| | | | - Melisachew Ferede
- World Health Organization, WHO Country Office, Ministerial Complex, Juba, South Sudan
| | | | - Godwin Ubong Akpan
- World Health Organization, Regional Office for Africa, Cite de Djoue, Brazzaville, Congo
| | - Isah Mohammed Bello
- World Health Organization, Inter-Country Support Team office for East and Southern Africa, P.O. Box 5160, Harare, Zimbabwe
| | - Johnson Muluh Ticha
- World Health Organization, Regional Office for Africa, Cite de Djoue, Brazzaville, Congo
| | - Atem Anyuon
- Ministry of Health, Ministerial Complex, Juba, South Sudan
| | - Joy Luba Waya
- World Health Organization, WHO Country Office, Ministerial Complex, Juba, South Sudan
| | - Samuel Oumo Okiror
- World Health Organization, Regional Office for Africa, Cite de Djoue, Brazzaville, Congo
| | - Modjirom Ndoutabe
- World Health Organization, Regional Office for Africa, Cite de Djoue, Brazzaville, Congo
| | - Kibebu Kinfu Berta
- World Health Organization, WHO Country Office, Ministerial Complex, Juba, South Sudan
| | - Fabian Ndenzako
- World Health Organization, WHO Country Office, Ministerial Complex, Juba, South Sudan
| | - Pascal Mkanda
- World Health Organization, Regional Office for Africa, Cite de Djoue, Brazzaville, Congo
| | - Olushayo Oluseun Olu
- World Health Organization, WHO Country Office, Ministerial Complex, Juba, South Sudan
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Alleman MM, Coulliette-Salmond AD, Wilnique P, Belgasmi-Wright H, Sayyad L, Wong K, Gue E, Barrais R, Rey-Benito G, Burns CC, Vega E. Environmental Surveillance for Polioviruses in Haïti (2017-2019): The Dynamic Process for the Establishment and Monitoring of Sampling Sites. Viruses 2021; 13:v13030505. [PMID: 33803868 PMCID: PMC8003210 DOI: 10.3390/v13030505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
Haïti is at risk for wild poliovirus (WPV) importation and circulation, as well as vaccine-derived poliovirus (VDPV) emergence. Environmental surveillance (ES) for polioviruses was established in Port au Prince and Gonaïves in 2016. During 2017–2019, initial ES sites were re-evaluated, and ES was expanded into Cap Haïtien and Saint Marc. Wastewater samples and data on weather, hour of collection, and sample temperature and pH were collected every 4 weeks during March 2017–December 2019 (272 sampling events) from 21 sites in Cap Haïtien, Gonaïves, Port au Prince, and Saint Marc. Samples were processed for the detection of polio and non-polio enteroviruses using the two-phase and “Concentration and Filter Elution” methodologies. Polioviruses were serotyped and underwent intra-typic characterization. No WPV or VDPVs were isolated. Sabin-like polioviruses (oral vaccine strain) of serotypes 1 and 3 were sporadically detected. Five of six (83%), one of six (17%), five of six (83%), and two of three (67%) sites evaluated in Cap Haïtien, Gonaïves, Port au Prince, and Saint Marc, respectively, had enterovirus isolation from >50% of sampling events; these results and considerations, such as watershed population size and overlap, influence of sea water, and excessive particulates in samples, were factors in site retention or termination. The evaluation of 21 ES sampling sites in four Haïtian cities led to the termination of 11 sites. Every-four-weekly sampling continues at the remaining 10 sites across the four cities as a core Global Polio Eradication Initiative activity.
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Affiliation(s)
- Mary M. Alleman
- Polio Eradication Branch, Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, GA 30329, USA
- Correspondence: ; Tel.: +1-404-639-8703
| | - Angela D. Coulliette-Salmond
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
- United States Public Health Service, Rockville, MD 20852, USA
| | - Pierre Wilnique
- Laboratory and Research, Division of Epidemiology, Ministère de la Santé Publique et de la Population (Ministry of Public Health and Population (MSPP)), Port au Prince HT6110, Haiti; (P.W.); (R.B.)
| | | | | | - Kimberly Wong
- IHRC, Inc., Atlanta, GA 30346, USA; (H.B.-W.); (K.W.)
- Cherokee Nation Assurance, Catoosa, OK 74015, USA;
| | - Edmund Gue
- Pan American Health Organization, World Health Organization, Region of the Americas, Port au Prince HT6110, Haiti;
| | - Robert Barrais
- Laboratory and Research, Division of Epidemiology, Ministère de la Santé Publique et de la Population (Ministry of Public Health and Population (MSPP)), Port au Prince HT6110, Haiti; (P.W.); (R.B.)
| | - Gloria Rey-Benito
- Pan American Health Organization, World Health Organization, Washington, DC 20037, USA;
| | - Cara C. Burns
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
| | - Everardo Vega
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
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Johnson Muluh T, Hamisu AW, Craig K, Mkanda P, Andrew E, Adeniji J, Akande A, Musa A, Ayodeji I, Nicksy G, Banda R, Tegegne SG, Nsubuga P, Oyetunji A, Diop O, Vaz RG, Muhammad AJG. Contribution of Environmental Surveillance Toward Interruption of Poliovirus Transmission in Nigeria, 2012-2015. J Infect Dis 2016; 213 Suppl 3:S131-5. [PMID: 26908747 PMCID: PMC4818559 DOI: 10.1093/infdis/jiv767] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cases of paralysis caused by poliovirus have decreased by >99% since the 1988 World Health Assembly's resolution to eradicate polio. The World Health Organization identified environmental surveillance (ES) of poliovirus in the poliomyelitis eradication strategic plan as an activity that can complement acute flaccid paralysis (AFP) surveillance. This article summarizes key public health interventions that followed the isolation of polioviruses from ES between 2012 and 2015. METHODS The grap method was used to collect 1.75 L of raw flowing sewage every 2-4 weeks. Once collected, samples were shipped at 4 °C to a polio laboratory for concentration. ES data were then used to guide program implementation. RESULTS From 2012 to 2015, ES reported 97 circulating vaccine-derived polioviruses (cVDPV2) and 14 wild polioviruses. In 2014 alone, 54 cVDPV type 2 cases and 1 WPV type 1 case were reported. In Sokoto State, 58 cases of AFP were found from a search of 9426 households. A total of 2 252 059 inactivated polio vaccine and 2 460 124 oral polio vaccine doses were administered to children aged <5 year in Borno and Yobe states. CONCLUSIONS This article is among the first from Africa that relates ES findings to key public health interventions (mass immunization campaigns, inactivated polio vaccine introduction, and strengthening of AFP surveillance) that have contributed to the interruption of poliovirus transmission in Nigeria.
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Affiliation(s)
| | | | - Kehinde Craig
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Pascal Mkanda
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Etsano Andrew
- National Primary Health Care Development Agency, Abuja
| | | | - Adefunke Akande
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Audu Musa
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Isiaka Ayodeji
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Gumede Nicksy
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Richard Banda
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Sisay G Tegegne
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | | | - Ajiboye Oyetunji
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Ousmane Diop
- World Health organization, Head Quarters, Geneva, Switzerland
| | - Rui G Vaz
- World Health Organization, Country Representative Office, Abuja, Nigeria
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Deshpande JM, Bahl S, Sarkar BK, Estívariz CF, Sharma S, Wolff C, Sethi R, Pathyarch SK, Jain V, Gary HE, Pallansch MA, Jafari H. Assessing population immunity in a persistently high-risk area for wild poliovirus transmission in India: a serological study in Moradabad, Western Uttar Pradesh. J Infect Dis 2014; 210 Suppl 1:S225-33. [PMID: 25316839 DOI: 10.1093/infdis/jiu204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Moradabad district in Uttar Pradesh reported the highest number of paralytic polio cases in India during 2001-2007. We conducted a study in Moradabad in 2007 to assess seroprevalence against poliovirus types 1, 2, and 3 in children 6-12 and 36-59 months of age to guide future strategies to interrupt wild poliovirus transmission in high-risk areas. METHODS Children attending 10 health facilities for minor illnesses who met criteria for study inclusion were eligible for enrollment. We recorded vaccination history, weight, and length and tested sera for neutralizing antibodies to poliovirus types 1, 2, and 3. RESULTS Poliovirus type 1, 2, and 3 seroprevalences were 88% (95% confidence interval [CI], 84%-91%), 70% (95% CI, 66%-75%), and 75% (95% CI, 71%-79%), respectively, among 467 in the younger age group (n=467), compared with 100% (95% CI, 99%-100%), 97% (95% CI, 95%-98%), and 93% (91%-95%), respectively, among 447 children in the older age group (P<.001 for all serotypes). CONCLUSIONS This seroprevalence study provided extremely useful information that was used by the program in India to guide immunization policies, such as optimizing the use of different OPV formulations in vaccination campaigns and strengthening routine immunization services. Similar surveys in populations at risk should be performed at regular intervals in countries where the risk of persistence or spread of indigenous or imported wild poliovirus is high.
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Affiliation(s)
| | - Sunil Bahl
- National Polio Surveillance Project, World Health Organization (WHO) Country Office for India
| | | | | | | | | | - Raman Sethi
- National Polio Surveillance Project, World Health Organization (WHO) Country Office for India
| | - Surendra K Pathyarch
- National Polio Surveillance Project, World Health Organization (WHO) Country Office for India
| | - Vibhor Jain
- National Polio Surveillance Project, World Health Organization (WHO) Country Office for India
| | - Howard E Gary
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Gumede N, Jorba J, Deshpande J, Pallansch M, Yogolelo R, Muyembe-Tamfum JJ, Kew O, Venter M, Burns CC. Phylogeny of imported and reestablished wild polioviruses in theDemocratic Republic of the Congo from 2006 to 2011. J Infect Dis 2014; 210 Suppl 1:S361-7. [PMID: 25316856 DOI: 10.1093/infdis/jiu375] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The last case of polio associated with wild poliovirus (WPV) indigenous to the Democratic Republic of the Congo (DRC) was reported in 2001, marking a major milestone toward polio eradication in Africa. However, during 2006-2011, outbreaks associated with WPV type 1 (WPV1) were widespread in the DRC, with >250 reported cases. METHODS WPV1 isolates obtained from patients with acute flaccid paralysis (AFP) were compared by nucleotide sequencing of the VP1 capsid region (906 nucleotides). VP1 sequence relationships among isolates from the DRC and other countries were visualized in phylogenetic trees, and isolates representing distinct lineage groups were mapped. RESULTS Phylogenetic analysis indicated that WPV1 was imported twice in 2004-2005 and once in approximately 2006 from Uttar Pradesh, India (a major reservoir of endemicity for WPV1 and WPV3 until 2010-2011), into Angola. WPV1 from the first importation spread to the DRC in 2006, sparking a series of outbreaks that continued into 2011. WPV1 from the second importation was widely disseminated in the DRC and spread to the Congo in 2010-2011. VP1 sequence relationships revealed frequent transmission of WPV1 across the borders of Angola, the DRC, and the Congo. Long branches on the phylogenetic tree signaled prolonged gaps in AFP surveillance and a likely underreporting of polio cases. CONCLUSIONS The reestablishment of widespread and protracted WPV1 transmission in the DRC and Angola following long-range importations highlights the continuing risks of WPV spread until global eradication is achieved, and it further underscores the need for all countries to maintain high levels of poliovirus vaccine coverage and sensitive surveillance to protect their polio-free status.
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Affiliation(s)
- Nicksy Gumede
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Jaume Jorba
- Division of Viral Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Mark Pallansch
- Division of Viral Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Riziki Yogolelo
- National Institute for Biomedical Research, Kinshasa/Gombe, Democratic Republic of the Congo
| | | | - Olen Kew
- Division of Viral Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marietjie Venter
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Cara C Burns
- Division of Viral Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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8
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Alleman MM, Meyer SA, Mulumba A, Nyembwe M, Riziki Y, Mbule A, Mayenga M, Coulibaly T. Improved acute flaccid paralysis surveillance performance in the Democratic Republic of the Congo, 2010-2012. J Infect Dis 2014; 210 Suppl 1:S50-61. [PMID: 25316874 PMCID: PMC10448638 DOI: 10.1093/infdis/jit670] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Democratic Republic of the Congo (DRC) began polio eradication activities in 1996. By 2001, DRC was no longer polio endemic. However, wild poliovirus (WPV) transmission was reestablished in 2006 continuing through 2011 (last WPV case onset 20 December 2011), and vaccine-derived poliovirus type 2 (VDPV2) outbreaks occurred during 2004-2012 (last VDPV2 case onset 4 April 2012). Gaps in acute flaccid paralysis (AFP) surveillance have been consistently documented. METHODS AFP surveillance indicators were assessed at the national, provincial, and zone de santé (ZS) levels for 2010-2012. A spatiotemporal analysis of compatible, WPV type 1 (WPV1), and VDPV2 cases was performed. RESULTS During 2010-2012, AFP cases were reported from all provinces but not every ZS, particularly in Equateur province and Province Orientale. A spatiotemporal relationship between compatible, WPV1, and VDPV2 cases was noted. Nonpolio AFP rates met objectives at national and provincial levels but were sub-optimal in certain ZS. National and provincial trends in timely stool collection, stool condition, adequate stool, and 60-day follow-up exams improved. CONCLUSIONS DRC's AFP surveillance system is functional and improved during 2010-2012. Maintaining improvements and strengthening AFP case detection at the ZS level will provide further support for the apparent interruption of WPV and VDPV2 transmission.
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Affiliation(s)
- Mary M. Alleman
- Global Immunization Division, Centers for Disease Control
and Prevention, Atlanta, Georgia
| | - Sarah A. Meyer
- Epidemic Intelligence Service, and Centers for Disease
Control and Prevention, Atlanta, Georgia
- Division of Bacterial Diseases, Centers for Disease Control
and Prevention, Atlanta, Georgia
| | - Audry Mulumba
- Expanded Programme on Immunization, Kinshasa, Democratic Republic of the Congo
| | - Michel Nyembwe
- Expanded Programme on Immunization, Kinshasa, Democratic Republic of the Congo
| | - Yogolelo Riziki
- Institut National de Recherche Biomédicale, Ministry of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Albert Mbule
- Immunization, Vaccines, and Emergencies Cluster, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - May Mayenga
- Immunization, Vaccines, and Emergencies Cluster, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Tiekoura Coulibaly
- Immunization, Vaccines, and Emergencies Cluster, World Health Organization, Kinshasa, Democratic Republic of the Congo
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Kamadjeu R, Mahamud A, Webeck J, Baranyikwa MT, Chatterjee A, Bile YN, Birungi J, Mbaeyi C, Mulugeta A. Polio outbreak investigation and response in Somalia, 2013. J Infect Dis 2014; 210 Suppl 1:S181-6. [PMID: 25316834 PMCID: PMC10548859 DOI: 10.1093/infdis/jiu453] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND For >2 decades, conflicts and recurrent natural disasters have maintained Somalia in a chronic humanitarian crisis. For nearly 5 years, 1 million children <10 years have not had access to lifesaving health services, including vaccination, resulting in the accumulation by 2012 of the largest geographically concentrated cohort of unvaccinated children in the world. This article reviews the epidemiology, risk, and program response to what is now known as the 2013 wild poliovirus (WPV) outbreak in Somalia and highlights the challenges that the program will face in making Somalia free of polio once again. METHODS A case of acute flaccid paralysis (AFP) was defined as a child <15 years of age with sudden onset of fever and paralysis. Polio cases were defined as AFP cases with stool specimens positive for WPV. RESULTS From 9 May to 31 December 2013, 189 cases of WPV type 1 (WPV1) were reported from 46 districts of Somalia; 42% were from Banadir region (Mogadishu), 60% were males, and 93% were <5 years of age. All Somalian polio cases belonged to cluster N5A, which is known to have been circulating in northern Nigeria since 2011. In response to the outbreak, 8 supplementary immunization activities were conducted with oral polio vaccine (OPV; trivalent OPV was used initially, followed subsequently by bivalent OPV) targeting various age groups, including children aged <5 years, children aged <10 years, and individuals of any age. CONCLUSIONS The current polio outbreak erupted after a polio-free period of >6 years (the last case was reported in March 2007). Somalia interrupted indigenous WPV transmission in 2002, was removed from the list of polio-endemic countries a year later, and has since demonstrated its ability to control polio outbreaks resulting from importation. This outbreak reiterates that the threat of large polio outbreaks resulting from WPV importation will remain constant unless polio transmission is interrupted in the remaining polio-endemic countries.
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Affiliation(s)
- Raoul Kamadjeu
- Somalia Liaison, World Health Organization, Nairobi, Kenya
| | - Abdirahman Mahamud
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jenna Webeck
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Yassin Nur Bile
- Health Directorate, Somalia Ministry of Human Development and Public Services, Mogadishu
| | - Julianne Birungi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chukwuma Mbaeyi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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Gidado SO, Ohuabunwo C, Nguku PM, Ogbuanu IU, Waziri NE, Biya O, Wiesen ES, Mba-Jonas A, Vertefeuille J, Oyemakinde A, Nwanyanwu O, Lawal N, Mahmud M, Nasidi A, Mahoney FJ. Outreach to underserved communities in northern Nigeria, 2012-2013. J Infect Dis 2014; 210 Suppl 1:S118-24. [PMID: 25316825 PMCID: PMC10546473 DOI: 10.1093/infdis/jiu197] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Persistent wild poliovirus transmission in Nigeria constitutes a major obstacle to global polio eradication. In August 2012, the Nigerian national polio program implemented a strategy to conduct outreach to underserved communities within the context of the country's polio emergency action plans. METHODS A standard operating procedure (SOP) for outreach to underserved communities was developed and included in the national guidelines for management of supplemental immunization activities (SIAs). The SOP included the following key elements: (1) community engagement meetings, (2) training of field teams, (3) field work, and (4) acute flaccid paralysis surveillance. RESULTS Of the 46,437 settlements visited and enumerated during the outreach activities, 8607 (19%) reported that vaccination teams did not visit their settlements during prior SIAs, and 5112 (11.0%) reported never having been visited by polio vaccination teams. Fifty-two percent of enumerated settlements (23,944) were not found in the existing microplan used for the immediate past SIAs. CONCLUSIONS During a year of outreach to >45,000 scattered, nomadic, and border settlements, approximately 1 in 5 identified were missed in the immediately preceding SIAs. These missed settlements housed a large number of previously unvaccinated children and potentially served as reservoirs for persistent wild poliovirus transmission in Nigeria.
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Affiliation(s)
- Saheed O. Gidado
- Nigeria Field Epidemiology and Laboratory Training Programme, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Chima Ohuabunwo
- Nigeria Field Epidemiology and Laboratory Training Programme, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Patrick M. Nguku
- Nigeria Field Epidemiology and Laboratory Training Programme, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Ikechukwu U. Ogbuanu
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Ndadilnasiya E. Waziri
- Nigeria Field Epidemiology and Laboratory Training Programme, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Oladayo Biya
- Nigeria Field Epidemiology and Laboratory Training Programme, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Eric S. Wiesen
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Adamma Mba-Jonas
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - John Vertefeuille
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | | | - Namadi Lawal
- Nigeria National Primary Health Care Development Agency, Abuja, Nigeria
| | - Mustapha Mahmud
- Nigeria National Primary Health Care Development Agency, Abuja, Nigeria
| | | | - Frank J. Mahoney
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Bahl S, Gary HE, Jafari H, Sarkar BK, Pathyarch SK, Sethi R, Deshpande J. An acute flaccid paralysis surveillance-based serosurvey of poliovirus antibodies in Western Uttar Pradesh, India. J Infect Dis 2014; 210 Suppl 1:S234-42. [PMID: 25316841 PMCID: PMC10544142 DOI: 10.1093/infdis/jiu379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite intensified use of monovalent oral poliovirus type 1 vaccine and improved coverage of immunization campaigns, wild poliovirus type 1 persisted in Indian states of Uttar Pradesh and Bihar during 2006 to 2009. METHODS A serosurvey was conducted among cases of acute flaccid paralysis in the 25 high-polio-incidence districts of western Uttar Pradesh. Children were recruited by age group (6-11 months, 12-24 months, and 25-69 months) from among cases reported through the acute flaccid paralysis surveillance system between November 2008 and August 2009. RESULTS Seroprevalence for type 1 wild poliovirus was >96.4% for each age group. The seroprevalence of wild poliovirus types 2 and 3 increased with age, from 36.7% to 73.4% for type 2 and from 39.0% to 74.1% for type 3. In addition to the number of type-specific vaccine doses, father's level of education, being from a Muslim family, height for age, and female sex were the socioeconomic risk factors associated with seronegativity to poliovirus. CONCLUSIONS The seroprevalence and risk factors identified in this study were consistent with the epidemiology of polio, and the findings were instrumental in optimizing vaccination strategy in western Uttar Pradesh with respect to the choice of OPV types, the frequency of supplementary immunization campaigns, and the urgency to improve routine immunization services.
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Affiliation(s)
- Sunil Bahl
- National Polio Surveillance Project, WHO Country Office for India, New Delhi
| | - Howard E. Gary
- Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, Georgia
| | | | - Bidyut K. Sarkar
- Department of Epidemiology and Public Health, University College London, United Kingdom
| | | | - Raman Sethi
- National Polio Surveillance Project, WHO Country Office for India, New Delhi
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Gouandjika-Vasilache I, Mazitchi A, Gumede N, Manirakiza A, Manenegu C, Koyazegbe TD, Burns C. Wild poliovirus importation, Central African Republic. Emerg Infect Dis 2013; 19:1012-3. [PMID: 23735864 PMCID: PMC3713836 DOI: 10.3201/eid1906.121821] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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