Search

Since its launch in 1988, the Global Polio Eradication Initiative (GPEI) has made substantial progress towards eradication of wild poliovirus (WPV), including eradicating 2 of the 3 serotypes and reducing the number of countries with ongoing endemic transmission of WPV type 1 (WPV1) to Afghanistan and Pakistan. The two countries are considered a single epidemiological block. Despite the occurrence of only a single confirmed WPV1 case during the first half of 2023, Pakistan experienced widespread circulation of WPV1 during the subsequent 12 months, specifically in the historical reservoirs of the cities of Quetta, Karachi and Peshawar. As of 30 June 2024, 8 WPV1 cases had been reported in Pakistan, as compared with 6 reported during all of 2023. These cases, and >300 WPV1-positive environmental surveillance (sewage) samples reported during 2023-2024, indicate that Pakistan is not on track to interrupt WPV1 transmission. The country's complex sociopolitical and security environment continues to pose formidable challenges to poliovirus elimination. To interrupt WPV1 transmission, sustained political commitment to polio eradication, including increased accountability at all levels is necessary. Systematic tracking and vaccination of children who are continually missed during polio vaccination activities should be enhanced by better addressing operational issues and the underlying reasons for community resistance to vaccination and vaccine hesitancy. Depuis le lancement de l'Initiative mondiale pour l'eradication de la poliomyelite (IMEP) en 1988, des progres substantiels ont ete accomplis vers l'eradication des poliovirus sauvage (PVS). Ainsi, 2 des 3 serotypes sont desormais eradiques et seuls l'Afghanistan et le Pakistan enregistrent encore une transmission endemique du PVS de type 1 (PVS1). Ces deux pays forment un bloc epidemiologique unique. Bien qu'ayant observe un seul cas confirme de poliomyelite due au PVS1 au premier semestre 2023, le Pakistan a connu une circulation a grande echelle du PVS1 au cours des 12 mois suivants, en particulier dans les villes de Quetta, Karachi et Peshawar, qui constituent des reservoirs traditionnels du virus. Au 30 juin 2024, 8 cas de PVS1 avaient ete signales au Pakistan depuis le debut de l'annee, contre 6 notifies sur l'ensemble de l'annee 2023. Ces cas, ainsi que les >300 echantillons de surveillance environnementale (eaux usees) positifs pour le PVS1 qui ont ete recenses en 20232024, indiquent que le Pakistan n'est pas en voie d'interrompre la transmission du PVS1. Le contexte sociopolitique et securitaire complexe du pays demeure un obstacle majeur a l'elimination des poliovirus. Pour interrompre la transmission du PVS1, un engagement politique durable en faveur de l'eradication de la poliomyelite, assorti d'une responsabilisation accrue a tous les niveaux, est indispensable. Des efforts plus soutenus doivent etre deployes pour suivre et vacciner de maniere systematique les enfants qui continuent d'echapper aux activites de vaccination antipoliomyelitique, ce qui implique d'apporter de meilleures solutions aux problemes operationnels existants, ainsi qu'aux facteurs qui sous-tendent la reticence a la vaccination et la resistance des communautes., Introduction Although the GPEI has achieved substantial progress since its establishment in 1988, the goal of polio eradication has remained elusive. Indigenous WPV1 circulation has never been interrupted in Pakistan, [...]

Objective To evaluate a project that integrated essential primary health-care services into the oral polio vaccine programme in hard-to-reach, 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 than 5 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 interventions. [phrase omitted] [phrase omitted] Objectif Evaluer un projet qui integrait des services de soins de sante primaires essentiels au programme d'administration du vaccin antipoliomyelitique oral au sein de communautes difficiles a atteindre et mal desservies au nord du Nigeria. Methodes En 2013, le centre d'intervention d'urgence pour la lutte contre la poliomyelite du Nigeria a adopte une nouvelle approche visant a augmenter rapidement l'immunite contre la poliomyelite et a reduire la morbidite et la mortalite neonatales, infantiles et maternelles. Nous avons selectionne, forme et equipe quatre-vingt-quatre equipes sanitaires mobiles afin d'offrir des services de vaccination et de soins primaires gratuits dans 3176 zones de peuplement difficiles a atteindre. Nous avons mene des enquetes transversales avant et apres l'intervention (en mars 2014 et novembre 2015, respectivement) aupres de femmes en age de procreer dans des familles comptant des enfants Ages de moins de 5 ans, au sein de 317 zones de peuplement selectionnees aleatoirement. Resultats Entre juin 2014 et septembre 2015, les equipes sanitaires mobiles ont fourni 2 979 408 doses de vaccins antipoliomyelitiques oraux et deparasite 1 562 640 enfants Ages de moins de 5 ans; elles ont tenu 676 678 consultations antenatales et soigne 1 682 671 maladies affectant des femmes et des enfants, parmi lesquelles la pneumonie, la diarrhee et le paludisme. Lenquete initiale a revele que sur 3872 enfants Ages de moins de 5 ans, 758 (19,6%) avaient des fiches de vaccination systematique et 690 (17,8%) avaient recu toutes les vaccinations correspondant a leur Age. Lenquete finale a revele que 1757 enfants sur 3575 (49,1%) avaient des fiches de vaccination systematique et que 1750 (49,0%) avaient recu toutes les vaccinations correspondant a leur Age. Le nombre d'enfants ayant recu 3 doses ou plus de vaccins antipoliomyelitiques oraux est passe de 2133 (55,1%) a 2666 (74,6%). Le nombre d'utilisations par les familles des services de sante mobiles au cours des 6 mois precedents est passe de 509 sur 1472 (34,6%) a 2060 sur 2426 (84,9%). Conclusion Lintegration des services de soins primaires systematiques dans les activites d'eradication de la poliomyelite au Nigeria a entraine une augmentation du nombre de beneficiaires de doses supplementaires de vaccins antipoliomyelitiques oraux et des interventions essentielles en sante maternelle, neonatale et infantile. [phrase omitted] Objetivo Evaluar un proyecto que integro los servicios esenciales de atencion primaria en el programa de vacunacion oral contra la polio en comunidades de dificil acceso y desatendidas del norte de Nigeria. Metodos En 2013, el centro de operaciones de emergencia contra la polio de Nigeria adopto un nuevo enfoque para aumentar rapidamente la inmunidad a la enfermedad y reducir la morbilidad y la mortalidad de recien nacidos, ninos y madres. Se identificaron, formaron y equiparon ochenta y cuatro equipos sanitarios moviles para proporcionar servicios gratuitos de vacunacion y atencion primaria en 3176 asentamientos de dificil acceso. Se realizaron encuestas transversales de mujeres en edad fertil en hogares con ninos menores de 5 anos, en 317 asentamientos seleccionados al azar, antes y despues de la intervencion (marzo de 2014 y noviembre de 2015, respectivamente). Resultados Entre junio de 2014 y septiembre de 2015, los equipos sanitarios moviles administraron 2 979 408 dosis de la vacuna oral contra la polio y desparasitaron a 1 562 640 ninos menores de 5 anos, realizaron 676 678 consultas prenatales y trataron 1 682 671 enfermedades de mujeres y ninos, incluidas la neumonia, la diarrea y el paludismo. La encuesta de referencia concluyo que 758 (19,6 %) de 3872 ninos menores de 5 anos tenian tarjetas de vacunacion de rutina y 690/3872 (17,8 %) estaban totalmente inmunizados para su edad. La encuesta final revelo 1757/3575 ninos (49,1 %) con tarjetas de vacunacion de rutina y 1750 (49,0 %) totalmente inmunizados. Los ninos vacunados con tres o mas dosis de la vacuna oral contra la polio aumentaron de 2133 (55,1 %) a 2666 (74,6 %). El uso de los servicios sanitarios moviles por parte de los hogares en los seis meses anteriores aumento de 509/1472 (34,6 %) a 2060/2426 (84,9 %). Conclusion La integracion de los servicios de atencion primaria de rutina en las actividades de erradicacion de la polio en Nigeria dio lugar a un aumento de la cobertura de las dosis suplementarias de la vacuna oral contra la polio y de las intervenciones esenciales de salud materna, neonatal e infantil., Abstracts in [phrase omitted], Francais, [phrase omitted] and Espanol at the end of each article. Introduction The World Health Organization (WHO) has called for universal health coverage (UHC) to be [...]

Since the launch of the Global Polio Eradication Initiative in 1988, 4 of the 6 WHO Regions have been certified polio-free. (1) With Afghanistan and Pakistan, Nigeria is one of [...]

Since 1997, the Global Polio Eradication Initiative has sponsored regular door-to-door polio immunisation campaigns in northern Nigeria. On 30 July 2015, the country was finally declared poliofree, a hard won success. At various times, polio eradication has been threatened by rumours and community tensions. For example, in 2003, local Imams, traditional leaders and politicians declared a polio campaign boycott, due to the concerns about the safety of the polio vaccine. Although the campaigns resumed in 2004, many parents continued to refuse vaccination because of the persistence of rumours of vaccine contamination, and anger about the poor state of health services for conditions other than polio. To address this, UNICEF and Nigerian Government partners piloted two interventions: (1) mobile ‘health camps’ to provide ambulatory care for conditions other than polio and (2) an audiovisual clip about vaccine safety and other health issues, shareable on multimedia mobile phones via Bluetooth pairing. The mobile phone survey found that Bluetooth compatible messages could rapidly spread behavioural health messages in low-literacy communities. The health camps roughly doubled polio vaccine uptake in the urban ward where it was piloted. This suggests that polio eradication would have been accelerated by improving primary health care services. [ABSTRACT FROM PUBLISHER]

The use of Inactivated Polio Vaccine (IPV) in routine immunization to replace Oral Polio Vaccine (OPV) is crucial in eradicating polio. In June 2014, Nigeria launched an IPV campaign in the conflict-affected states of Borno and Yobe, the largest ever implemented in Africa. We present the initiatives and lessons learned. The 8-day event involved two parallel campaigns. OPV target age was 0-59 months, while IPV targeted all children aged 14 weeks to 59 months. The Borno state primary health care agency set up temporary health camps for the exercise and treated minor ailments for all. The target population for the OPV campaign was 685,674 children in Borno and 113,774 in Yobe. The IPV target population for Borno was 608,964 and for Yobe 111,570. OPV coverage was 105.1 per cent for Borno and 103.3 per cent for Yobe. IPV coverage was 102.9 per cent for Borno and 99.1 per cent for Yobe. (Where we describe coverage as greater than 100 per cent, this reflects original underestimates of the target populations.) A successful campaign and IPV immunization is viable in conflict areas. [ABSTRACT FROM AUTHOR]

Background: Unvaccinated children contribute to accumulation of susceptible persons and the continued transmission of wild poliovirus in Nigeria. In September 2012, the Expert Review Committee (ERC) on Polio Eradication and Routine Immunization in Nigeria recommended that social research be conducted to better understand why children are missed during supplementary immunization activities (SIAs), also known as "immunization plus days (IPDs)" in Nigeria.Methods: Immediately following the SIA in October 2012, polio eradication partners and the government of Nigeria conducted a study to assess why children are missed. We used semistructured questionnaires and focus group discussions in 1 rural and 1 urban local government area (LGA) of Katsina State.Results: Participants reported that 61% of the children were not vaccinated because of poor vaccination team performance: either the teams did not visit the homes (25%) or the children were reported absent and not revisited (36%). This lack of access to vaccine was more frequently reported by respondents from scattered/nomadic communities (85%). In 1 out of 4 respondents (25%), refusal was the main reason their child was not vaccinated. The majority of respondents reported they would have consented to their children being vaccinated if the vaccine had been offered.Conclusions: Poor vaccination team performance is a major contributor to missed children during IPD campaigns. Addressing such operational deficiencies will help close the polio immunity gap and eradicate polio from Nigeria. [ABSTRACT FROM AUTHOR]

Objective To evaluate a project that integrated essential primary health-care services into the oral polio vaccine programme in hard-to-reach, 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 than 5 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 interventions. [ABSTRACT FROM AUTHOR]

Background: Elimination of poliovirus from endemic countries is a crucial step in eradication; however, vaccination programmes in these areas face challenges, especially in regions with conflict. We analysed interviews with caregivers of children living in two polio-endemic countries to assess whether these challenges are largely operational or also driven by resistance or misinformation in the community.Methods: We designed and analysed polls based on face-to-face interviews of a random sample of parents and other caregivers of children younger than 5 years in regions of Pakistan and Nigeria at high risk for polio transmission. In both countries, the sample was drawn via a stratified multistage cluster design with random route household selection. The questionnaire covered awareness, knowledge, and attitudes about polio and oral polio vaccine (OPV), trust in vaccination efforts, and caregiver priorities for government action. We assessed experiences of caregivers in accessible higher-conflict areas and compared their knowledge and attitudes with those in lower-conflict areas. Differences were tested with two-sample t tests.Findings: The poll consisted of 3396 caregivers from Pakistan and 2629 from Nigeria. About a third of caregivers who responded in higher-conflict areas of Pakistan (Federally Administered Tribal Areas [FATA], 30%) and Nigeria (Borno, 33%) were unable to confirm that their child was vaccinated in the previous campaign. In FATA, 12% of caregivers reported that they were unaware of polio, and in Borno 12% of caregivers reported that vaccinators visited but their child did not receive the vaccine or they did not know whether the child was vaccinated. Additionally, caregivers in higher-conflict areas are less likely to hold beliefs about OPV that could motivate acceptance and are more likely to hold concerns than are caregivers in lower-conflict areas.Interpretation: Beyond the difficulties in reaching homes with OPV, challenges for vaccination programmes in higher-conflict areas extend to limited awareness, negative attitudes, and gaps in trust. Vaccination efforts might need to address underlying attitudes of caregivers through direct communications and the selection and training of local vaccinators.Funding: Harvard T H Chan School of Public Health and UNICEF. [ABSTRACT FROM AUTHOR]

Since its launch in 1988, the Global Polio Eradication Initiative has made substantial progress toward the eradication of wild poliovirus (WPV), including eradicating two of the three serotypes, and reducing the countries with ongoing endemic transmission of WPV type 1 (WPV1) to just Afghanistan and Pakistan. Both countries are considered a single epidemiologic block. Despite the occurrence of only a single confirmed WPV1 case during the first half of 2023, Pakistan experienced widespread circulation of WPV1 over the subsequent 12 months, specifically in the historical reservoirs of the cities of Karachi, Peshawar, and Quetta. As of June 30, 2024, eight WPV1 cases had been reported in Pakistan in 2024, compared with six reported during all of 2023. These cases, along with more than 300 WPV1-positive environmental surveillance (sewage) samples reported during 2023-2024, indicate that Pakistan is not on track to interrupt WPV1 transmission. The country's complex sociopolitical and security environment continues to pose formidable challenges to poliovirus elimination. To interrupt WPV1 transmission, sustained political commitment to polio eradication, including increased accountability at all levels, would be vital for the polio program. Efforts to systematically track and vaccinate children who are continually missed during polio vaccination activities should be enhanced by better addressing operational issues and the underlying reasons for community resistance to vaccination and vaccine hesitancy., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Since the 1988 launch of global poliomyelitis eradication efforts, four of the six World Health Organization (WHO) regions have been certified polio-free. Nigeria is one of only three countries, along with Afghanistan and Pakistan, where transmission of wild poliovirus (WPV) has never been interrupted. During 2003-2013, northern Nigeria served as a reservoir for WPV reintroduction into 26 previously polio-free countries. In 2012, the Nigerian government launched a national polio eradication emergency plan to intensify efforts to interrupt WPV transmission. This report describes polio eradication activities and progress in Nigeria during January 2014-July 2015 and updates previous reports. No WPV cases have been reported to date in 2015, compared with a total of six cases reported during 2014. Onset of paralysis in the latest reported WPV type 1 (WPV1) case was July 24, 2014. Only one case of circulating vaccine-derived poliovirus type 2 (cVDPV2) has been reported to date in 2015, compared with 20 cVDPV2 cases during the same period in 2014. Pending final laboratory testing of 218 remaining specimens of 16,617 specimens collected since January 2015, Nigeria could be removed from the WHO list of polio-endemic countries in September 2015. Major remaining challenges to the national polio eradication program include sustaining political support and program funding in the absence of active WPV transmission, maintaining high levels of population immunity in hard-to-reach areas, and accessing children in security-compromised areas of the northeastern states.

In 1988, the World Health Assembly resolved to interrupt wild poliovirus (WPV) transmission worldwide. By 2013, only three countries remained that had never interrupted WPV transmission: Afghanistan, Nigeria, and Pakistan. Since 2003, northern Nigeria has been a reservoir for WPV reintroduction into 26 previously polio-free countries. In May 2014, the World Health Organization declared the international spread of polio a Public Health Emergency of International Concern. Nigeria's main strategic goal is to interrupt WPV type 1 (WPV1) transmission by the end of 2014, which is also a main objective of the Global Polio Eradication Initiative's Polio Eradication and Endgame Strategic Plan for 2013-2018. This report updates previous reports (4-6) and describes polio eradication activities and progress in Nigeria during January 2013-September 30, 2014. Only six WPV cases had been reported in 2014 through September 30 compared with 49 reported cases during the same period in 2013. The quality of supplemental immunization activities (SIAs) improved during this period; the proportion of local government areas (LGAs) within 11 high-risk states with estimated oral poliovirus vaccine (OPV) campaign coverage at or above the 90% threshold increased from 36% to 67%. However, the number of reported circulating vaccine-derived poliovirus type 2 (cVDPV2) cases increased from four in 2013 to 21 to date in 2014, and surveillance gaps are suggested by genomic sequence analysis and continued detection of WPV1 by environmental surveillance. Interrupting all poliovirus circulation in Nigeria is achievable with continued attention to stopping cVDPV2 transmission, improving the quality of acute flaccid paralysis (AFP) surveillance, increasing vaccination coverage by strengthened routine immunization services, continuing support from all levels of government, and undertaking special initiatives to provide vaccination to children in conflict-affected areas in northeastern Nigeria.