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BackgroundAs we move toward a polio-free world, the challenge for the polio program is to create an unrelenting focus on smaller areas where the virus is still present, where children are being repeatedly missed, where immunity levels are low, and where surveillance is weak. ObjectiveThis article aimed to describe a possible solution to address weak surveillance systems and document the outcomes of the deployment of the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) project. MethodsThis intervention was implemented in 99 targeted high-risk districts with concerns for silent polio circulation from eight countries in Africa between August 1, 2017, and July 31, 2018. A total of 6954 persons (5390 community informants and 1564 health workers) were trained and equipped with a smartphone on which the AVADAR app was configured to allow community informants to send alerts on suspected acute flaccid paralysis (AFP) and allow health worker to use electronic checklists for investigation of such alerts. The AVADAR and Open Data Kit ONA servers were at the center of the entire process. A dashboard system and coordination teams for monitoring and supervision were put in place at all levels. ResultsOverall, 96.44% (24,142/25,032) of potential AFP case alerts were investigated by surveillance personnel, yielding 1414 true AFP cases. This number (n=1414) reported through AVADAR was higher than the 238 AFP cases expected during the study period in the AVADAR districts and the 491 true AFP cases reported by the traditional surveillance system. A total of 203 out of the 1414 true AFP cases reported were from special population settings, such as refugee camps and insecure areas. There was an improvement in reporting in silent health areas in all the countries using the AVADAR system. Finally, there were 23,473 reports for other diseases, such as measles, diarrhea, and cerebrospinal meningitis, using the AVADAR platform. ConclusionsThis article demonstrates the added value of AVADAR to rapidly improve surveillance sensitivity. AVADAR is capable of supporting countries to improve surveillance sensitivity within a short interval before and beyond polio-free certification.

Background Novel oral poliovirus vaccine (OPV) type 2 (nOPV2) has been made available for outbreak response under an emergency use listing authorization based on supportive clinical trial data. Since 2021 more than 350 million doses of nOPV2 were used for control of a large outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) in Nigeria. Methods Using a bayesian time-series susceptible-infectious-recovered model, we evaluate the field effectiveness of nOPV2 immunization campaigns in Nigeria compared with campaigns using monovalent OPV type 2 (mOPV2). Results We found that both nOPV2 and mOPV2 campaigns were highly effective in reducing transmission of cVDPV2, on average reducing the susceptible population by 42% (95% confidence interval, 28–54%) and 38% (20–51%) per campaign, respectively, which were indistinguishable from each other in this analysis (relative effect, 1.1 [.7–1.9]). Impact was found to vary across areas and between immunization campaigns. Conclusions These results are consistent with the comparable individual immunogenicity of nOPV2 and mOPV2 found in clinical trials but also suggest that outbreak response campaigns may have small impacts in some areas requiring more campaigns than are suggested in current outbreak response procedures. [ABSTRACT FROM AUTHOR]

Background: This was a cross-sectional community-based survey to study the prevalence of serum antibodies against the severe acute respiratory syndrome coronavirus 1 (SARS-COV-1) and determine possible source of antibodies as to whether from vaccination or from natural infection as well as attempt to compare antibody levels in response to the different four types of vaccines administered in Nigeria. Methods: A cross-sectional community-based study of the prevalence of serum antibodies against all four vaccine types used in Nigeria amongst a representative sample of people aged 18 years and above in the six geopolitical zones of the country using a multistage sampling technique covering 12 states of the country with two states being randomly selected from each geopolitical zone. High-throughput Roche electrochemiluminescence immunoassay system (Elecsys Anti-SARS-COV-1 Cobas) was used for qualitative and quantitative detection of antibodies to SARS-COV-1 in human plasma. Results: There was no statistically significant difference between the proportions with seropositivity for both the vaccinated and the unvaccinated (P = 0.95). The nucleocapsid antibody (anti-Nc) titres were similar in both the vaccinated and the unvaccinated, whereas the Spike protein antibody (anti-S) titres were significantly higher amongst the vaccinated than amongst the unvaccinated. Antibody levels in subjects who received different vaccines were compared to provide information for policy. Conclusion: While only 45.9% of the subjects were reported to have been vaccinated, 98.7% of the subjects had had contact with the SARS-COV-1 as evidenced by the presence of nucleocapsid (NC) antibodies in their plasma. The 1.3% who had not been exposed to the virus, had spike protein antibodies which most likely resulted from vaccination in the absence of NC antibodies. Successive vaccination and booster doses either through heterogeneous or homologous vaccines increased antibody titres, and this stimulation of immune memory may offer greater protection against coronavirus disease 2019. [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. [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 [...]

In 1988, the World Health Assembly resolved to eradicate poliomyelitis worldwide. In 2016, only 2 countries, Afghanistan and Pakistan, have endemic wild poliovirus (WPV) transmission. Nigeria was removed from the [...]

Purpose: In the Alabama Black Belt, poverty is high, and the educational level is low. Studies have found increased tobacco use among individuals exposed to high levels of stress. Few studies have been conducted in this region to measure smoking status, its sociodemographic determinants, and how smoking status relates to stressful environmental conditions. Methods: A cross-sectional questionnaire survey of 1,387 individuals. Findings: Approximately 25% of the respondents currently smoked cigarettes. Females were less likely to smoke compared to males (OR, 0.29; 95% CI, 0.23-0.38). Blacks were less likely to smoke cigarettes compared to whites (OR, 0.64; 95% CI, 0.43-0.95). Compared to individuals who were employed, participants who were unemployed or retired had increased odds of smoking (OR, 1.68; 95% CI, 1.15-2.20). The odds of being a current smoker were increased in the presence of moderate level stress (OR, 2.06; 95% CI, 1.38-3.07) or when there was a high level of stress (OR, 2.21; 95% CI, 1.47-3.31). Smoking was associated with increased odds of having a moderate level (OR, 2.06; 95% CI, 1.38-3.08) and a high level of stress (OR, 2.21; 95% CI, 1.47-3.32). Females who reported moderate to high levels of stress had increased odds of being smokers compared to males. Interaction between gender and stress showed deviation from additivity. Conclusion: Our findings suggest a high rate of cigarette use in the area. Increased stress levels appear to predispose females more than males to cigarette smoking. The implications of this association may guide interventions targeted at reducing smoking and its complications. (Contains 4 tables.)

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 [...]

Serological surveys provide an objective biological measure of population immunity, and tetanus serological surveys can also assess vaccination coverage. We undertook a national assessment of immunity to tetanus and diphtheria among Nigerian children aged <15 years using stored specimens collected during the 2018 Nigeria HIV/AIDS Indicator and Impact Survey, a national cross-sectional household-based survey. We used a validated multiplex bead assay to test for tetanus and diphtheria toxoid-antibodies. In total, 31,456 specimens were tested. Overall, 70.9% and 84.3% of children aged <15 years had at least minimal seroprotection (≥0.01 IU/mL) against tetanus and diphtheria, respectively. Seroprotection was lowest in the north west and north east zones. Factors associated with increased tetanus seroprotection included living in the southern geopolitical zones, urban residence, and higher wealth quintiles (p < 0.001). Full seroprotection (≥0.1 IU/mL) was the same for tetanus (42.2%) and diphtheria (41.7%), while long-term seroprotection (≥1 IU/mL) was 15.1% for tetanus and 6.0% for diphtheria. Full- and long-term seroprotection were higher in boys compared to girls (p < 0.001). Achieving high infant vaccination coverage by targeting specific geographic areas and socio-economic groups and introducing tetanus and diphtheria booster doses in childhood and adolescence are needed to achieve lifelong protection against tetanus and diphtheria and prevent maternal and neonatal tetanus. [ABSTRACT FROM AUTHOR]

Introduction: In Nigeria, immunisation with coronavirus disease 2019 (COVID‑19) vaccines commenced in March 2021. COVISHIELD from AstraZeneca (AZ), a viral vector vaccine, was the brand administered in the first phase of vaccinations for pre‑determined eligible adults 18 years and above. As more brands of COVID‑19 vaccines have been introduced in Nigeria, identifying effective and safe vaccine brands is essential to pharmacovigilance and public health. The current study assessed the safety of the AZ‑AZD1222 (ChAdOx1) COVID‑19 vaccine in adults during the first phase of the vaccination exercise in Nigeria. Methodology: We conducted a descriptive analysis of safety data from selected vaccination sites across six states in Nigeria between June 2021 and September 2021. Respondents were monitored over 3 months for local and systemic reactions, as well as hospitalisation and mortality. Measures obtained from respondents include age, sex, pre‑existing comorbidity, local and systemic reactions to vaccines, timing onset of reactions, hospitalisation and mortality. Bivariate and multivariable regression models were used to assess factors associated with vaccine reactogenicity. Results: A total of 1284 individuals were enrolled in the cohort study from the six selected states (Anambra, Borno, Edo, Katsina, Lagos and Plateau) representing the geopolitical zones of Nigeria. A total of 675 individuals or 52.6% of enrolees reported non‑serious adverse effects, and only one individual or 0.08% reported a serious adverse event following immunisation in the first 7 days after vaccination. None of the enrolled participants reported adverse events requiring hospitalisation. The most common self‑reported symptoms amongst vaccine recipients were tenderness at the injection site 20.9% and fever 20.3%. A majority of symptoms (55.5%) occurred on or before the 3rd day after vaccination. Multivariable logistic regression model showed that age 60 years or above (vs. 18–24 years) was significantly associated with a lower likelihood of a vaccine‑related symptomatic reaction (adjusted odds ratio: 0.35; 95% confidence interval: 0.20–0.61). There was no reported mortality amongst all the enrolled and followed‑up vaccine recipients. Conclusion: Our findings suggest that the safety profile of the AZ vaccine is acceptable, and the observed symptoms were mild and mostly within the first 3 days following vaccination. Vaccine recipients will benefit from counselling about potential transient reactions, and improving public awareness can potentially encourage the uptake of vaccines and reduce the spread of the COVID‑19 pandemic. [ABSTRACT FROM AUTHOR]

Routine immunization (RI) delivery was declared a public health concern in Nigeria in 2017 because of persistently low immunization coverage rates reported in independent surveys. However, administrative coverage rates remain high, suggesting serious data quality issues. We posit that a shorter timespan between service provision and data reporting can improve the monitoring of RI data, and developed a short message system (SMS) text reporting strategy to generate daily RI data points from health facilities (HFs). The goal was to assess whether daily data collection produces complete, reliable and internally consistent data points. The SMS reporting platform was piloted between December 2017 and April 2018 in two Local Government Areas (LGAs, equivalent to districts) of Nasarawa state, Nigeria. The 145 healthcare workers from 55 HFs received one mobile phone and pre-configured SIM card, and were trained to send data through predefined codes. Healthcare workers compiled the data after each vaccination session and transmitted them via SMS. We analyzed completeness, number of weekly sessions, and supportive supervision conducted. During the pilot phase, we received data from 85% (n = 47) of the 55 HFs. We expected 66 fixed-post sessions and 30 outreach sessions per week, but received data for 33 fixed-post and 8 outreach weekly session on average. More HFs reported on Tuesdays compared to other days of the week. When assessing internal consistency, we observed that the reported number of children vaccinated was sometimes higher than the number of doses available from opening a given number of vaccine vials. When found, this discrepancy was noted for all antigens during fixed-post and outreach vaccination sessions. Despite these initial discrepancies, transmitting RI data sessions via texting is feasible and can provide real-time updates to the performance of the RI services at the HF level. [ABSTRACT FROM AUTHOR]