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Introduction: although the oral polio vaccine prevents virus transmission from person to person, it is crucial for poliovirus eradication. The continued use of live attenuated poliovirus poses an ongoing risk of circulating Vaccine Derived Poliovirus-2 (cVDPV2) outbreaks. This study assesses the response to the cVDPV2 outbreak in Dollo Zone, Somali Region, Ethiopia. Methods: after examining and verifying the occurrence of the outbreak, a team was established and prepared by resource mobilization, advocacy, and social mobilization. The group endorsed a four-step vaccination strategy, first the rapid response within 14-days by vaccinating a monovalent oral poliovirus-2 (mOPV2) to all under 5-year children in the Zone. The team further enhanced Supplementary Immunization Activities (SIA) for all under-five children with repeated doses of vaccines. At the same time, the team initiated community-based surveillance of Acute Flaccid Paralysis (AFP). Results: in the rapid-response immunization, an average of 91.4% of 0-11 months old and 90.2% of 12-59 months children were vaccinated. In SIA-1, the team vaccinated an average of 88% and 97%, and in SIA-2, 94.8% and 97.6% of children 0-11 months old and 12-59 months old, respectively. The active community-based surveillance of AFP revealed the existence of the disease in a sporadic form, of which two cases were found in Bokh district. Conclusion: the response to curb the outbreak of cVDPV2 has shown a flow of actions to combat the outbreak. Strengthening and formation of response teams at different levels, resource mobilization, advocacy, and social mobilization are all essential components in maximizing the response to the outbreak. [ABSTRACT FROM AUTHOR]

Background: Inadequate involvement of community volunteers in vaccine preventable disease surveillance and lack of uniformity in the reporting channel., Objective: To identify factors affecting linkage of Community Volunteers Surveillance focal Persons (CVSFP) and HEWs/Woreda Health Offices, identify feasible and acceptable solution for strong linkage and sustainable implementation of the project., Method: A qualitative study based on purposive convenient sampling method involving CVs, HEW, responsible officials on Health Extension Program (HEP) and CORE Group Ethiopia Polio Partner NGO's focal persons was conducted., Result: A total of 26 discussants were interviewed in the study woredas. Training of community volunteers at enrollment was not uniform. Health Extension workers and CVs plan together, visit the community together, have periodic meeting and both are supervised by the woreda health office. Community volunteers report to HEWs or woreda health office. The HEWs complain that CVs are not available as required; some are not reporting to HEWs, HEWs are not involved in the training of volunteers. Community volunteers complain distant travel to woreda and kebele to report and for meeting., Conclusion: The day to day working relation, the meeting forums, woreda level monitoring and feedback mechanism shows how well the work of CVs and relation with HEWs is recognized. No standard training procedure is followed. Volunteers are used as guide; distance travel with no/inadequate incentive can reduce commitment of volunteers. Misunderstanding of HEWs about the volunteers' private/obligatory work was a factor for loose relation.

Background: Awareness and service utilization are key to polio eradication., Objective: Assess the knowledge of mothers on polio and other vaccine preventable diseases, and utilization of immunization services in pastoralist and semi-pastoralist areas in Ethiopia., Methods: A community-based cross sectional study using a multistage cluster sampling method involving women who delivered during the previous one year was conducted., Results: A total of 600 women were interviewed. Three hundred-and-five (50.8%) women said they knew what polio was. The time to initiate polio vaccination was correctly indicated to be at birth or within 2 weeks of birth by 224 (37.4%) women. Four hundred forty five (74.2%) women said they did not know how polio is transmitted Polio birth dose (Polio 0) and Polio 3 vaccine coverage were estimated at 32% and 37% respectively. Adjusting for other factors, knowledge of when polio vaccination starts was significantly associated with having a child vaccinated for Polio 3 (OR 95% CI = 3.45 (2.33- 5.11)., Conclusion: Knowledge of mothers about polio is low and a little more than one third were aware of when the initial vaccine dose should be administered. Providing detailed information on polio and the recommended vaccination schedule can contribute to improve immunization and hasten polio eradication.

Background: Acute flaccid paralysis (AFP) surveillance is an essential component of the polio eradication strategy. The last laboratory confirmed wild poliovirus in Ethiopia was identified in April 2008. However, the country remains at risk for re-infection because of a number of silent areas and borders with high risk countries., Objective: Assess AFP surveillance status and community perception on AFP/Polio in semi pastoralist and pastoralist areas., Methods: Community and facility based cross-sectional survey was conducted complemented by Focus Group Discussions (FGD) from March - April, 2012. The study populations included District and health center AFP surveillance focal persons, WHO surveillance officers, community and religious leaders and women who delivered in the previous one year in purposively selected districts in Core Group Polio Project Implementation areas of Ethiopia., Result: Interviews with health center and district AFP surveillance focal persons revealed deficiencies in training, supervision and feedback. The performance of AFP detection varied in the study districts and knowledge about polio and AFP detection was found to be low in the study communities., Conclusion: There is a need to strengthen awareness of communities through targeted information, education and communication (IEC) interventions. Regular need-based training and supportive supervision should be conducted, involving all stakeholders including religious leaders and community leaders at each step of the awareness creation process, case detection and reporting and by giving special emphasis to silent and border districts.

Background: Strengthening routine immunization is one of the four pillars of the global polio eradication initiative., Objectives: To determine the magnitude and factors associated with vaccination coverage among children age 12 -23 months in Zone 4 of Afar Regional State, Ethiopia., Methods: A community based cross-sectional study using the WHO modified cluster sampling method was carried out in Zone 3 of Afar Regional State between January 01 and May 31, 2009. The calculated sample size was 762 and 740 were included in the analysis of vaccination status., Results: A total of 740 children aged 12-23 months were included in the study. Three hundred forty two (46%) respondents reported that their children were vaccinated at least once. Polio 3 coverage was found to be 35.0% and full immunization coverage was 20.6%. Respondents who could read and write had a higher likelihood of getting their children vaccinated compared to those who could not read or write [AOR = 0.18, 95% CI: 0.08-0.34]. Similarly age of the mother, husband's attitude and joint decision making by husband and wife were significantly associated with child immunization adjusted for other factors., Conclusion: The population immunity for polio measured by routine polio vaccine uptake in the study area indicated a high risk for wild polio virus outbreaks following importations, and the emergence and spread of circulating vaccine- derived polio virus. Literacy, positive attitude towards immunization and decision power are important factors to be addressed.

Background: Front line workers in pastoralist and semi pastoralist areas are expected to play a vital role in detecting cases of Acute Flaccid Paralysis., Objective: Assess knowledge and practice of Heath Extension Workers (HEWs) and Community Volunteer Surveillance Focal Persons (CVSFPs) on AFP case detection and reporting., Methods: A cross sectional survey involving 70 Health Extension Workers (HEWs) and 71 Community Volunteer Surveillance Focal Persons (CVSFPs) was conducted in 9 districts in Core Group Polio Project Implementation areas of Ethiopia from March 1-April 30, 2013. Data were entered and analyzed using SPSS version 17., Results: Thirty four HEWs (48.6%) searched for AFP cases by going from house to house, while 27 (38.6%) did not perform any function specific to AFP surveillance. Twenty (28.2%) and 7 (9.9%) of CVSFPs respectively, indicated using a case definition of AFP which included paralysis and acute paralysis. Nine (12.7%) of the CVSPF provided responses that did not include paralysis while 22 CVSFPs (31.0%) did not know the case definition of AFP. Three HEWs and 9 CVSFPs claimed to have detected and reported AFP cases. Thirty-eight (53.5%) CVSFPs had received training on community-based surveillance while 33 (46.5%) had none. Thirty nine (54.9%) of the CVSFPs reported having received supervision during the last six months, 22 (31.0%) of whom reported having received feedback., Conclusion: Inadequate pertinent knowledge on AFP and inadequate training and supervision appear to be obstacles for effective AFP detection by front line health workers in the study communities.

Background: Ethiopia interrupted indigenous polio transmission in April 2008. However, it remains at risk of reinfection because of importation of polio virus from bordering countries., Objectives: Assess polio immunization activities and risk of wild polio virus (WPV) importation in CORE Group Polio Project (CGPP) international border areas of Ethiopia., Methods: The study employed key informant interviews of community volunteers (CV), health extension workers (HEWs), program coordinators, managers and other stakeholders, as well as focus group discussions (FGDs) with community and religious leaders in six border districts (woredas) located in three regions of the country. It was conducted in March and April 2012., Results: Thirty-three key informant interviews and six FGDs were conducted. Immunization coverage was reported to be low and misconceptions about causes and transmission of polio were abundant. There was extensive cross-border movement of people for various reasons and mechanisms for prevention of cross-border polio transmission was almost non existent. AFP case detection and reporting was generally low., Conclusion and Recommendations: Cross-border transmission of polio can occur from several frontiers. Suggestions to control cross-border polio transmission included establishing and/or strengthening cross-border collaboration with responsible counterparts in neighboring countries by using existing cross-border forums and structures to create community awareness, share information and resources, design and implement strategies for identification of children who are eligible for vaccination or suspected AFP cases. In addition districts should coordinate supplemental immunization activities to coincide with when adjacent districts in neighboring countries are carrying out similar actions.

Background: In order to achieve immunization goals, two factors are necessary; the delivery of potent vaccines to children through properly maintained cold chain systems and achieving high vaccine coverage. Maintaining quality of vaccines has been one of the main challenges of immunization programs in Africa., Objective: To assess the cold chain status and practices in 116 health facilities located in three CCRDA/CORE Group Ethiopia operational districts (woredas)., Methodology: An institution based cross-sectional study was conducted in December 2011 and January 2012 in three districts (woredas) of Oromiya, SNNP and Amhara Regions of Ethiopia, data was collected from 116 health facilities and from the same number of immunization service providers. Multiple logistic regression analysis was carried out to identify factors related to knowledge of cold chain management., Result: Of 116 visited facilities, only 22 (19%) had functional refrigerators. The remaining facilities transported vaccines from nearby facilities having functional refrigerators. Complete temperature recording of the last month was observed in 13 (59.1%) facilities. Of 22 functional fridges, the thermometer reading was found to be outside the recommended range in 6 (27.3%) on the date of data collection. Vaccine storage in the refrigerator was not proper in 12 (54.5%) facilities. Sixty-five (56%) health workers had satisfactory knowledge on cold chain management. Professional qualification and year of service in the immunization program showed a statistically significant association with knowledge of cold chain management (P < 0.05)., Conclusion and Recommendations: Vaccines in some facilities were found to be at a high risk of losing their potency. There is an urgent need to improve knowledge and practice on cold chain management through improved supervision and training.

Background: Estimates of immunization coverage rates in Ethiopia varied widely, but were consistent in that polio birth dose coverage is much lower than other antigens, particularly in semi-pastoralist and pastoralist areas., Objective: Examine pregnancy and child delivery practices and identify mechanisms for improving polio birth dose coverage in CORE Group Polio Project implementation districts., Methods: A community based cross sectional study was conducted in March - April 2012 involving 600 women who delivered in the previous one year. Interviews were also conducted with key informants, Traditional Birth Attendants and, Health Extension Workers complemented by Focus Group Discussions (FGDs) with community leaders., Results: Three hundred twelve women (52.0%) had attended antenatal care at least once during the last pregnancy. Five hundred forty nine women (91.5%) delivered their last baby at home. Polio coverage was 29.7%, 19.7%, and 32.7% by history, by card and by history or card respectively. Antenatal care attendance was the main predictor of polio birth does utilization adjusted for other factors. Discussion with FGD participants revealed the prevailing knowledge on polio including misconceptions, and immunization service utilization., Conclusions: Newborn tracking for improving polio birth dose requires raising awareness among women and the community at large, strengthening mechanisms for identification and follow up of pregnant women at the community level, coordinating and strengthening the activities of front line health workers, and improving accessibility of health service.