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Nigeria swiftly moves to curtail polio outbreaks in vulnerable States

Abuja – 04 May 2021- When health teams discovered pockets of vaccine-derived poliovirus outbreaks in seven states in Nigeria (Lagos, Delta, Bayelsa, Zamfara, Niger, Sokoto and Kebbi), national and state authorities in collaboration with the World Health Organization (WHO) and partners quickly moved to quell the threat to the health of thousands of children.
In Lagos, Delta, Bayelsa, Zamfara and Niger, the cases were detected during the second half of 2020, while the remaining States reported cases in the first quarter of 2021.

In Lagos, the outbreak occurred in Makoko area, a network of landed and floating shanty communities on the Lagos Lagoon. Makoko houses more than 85,000 people and many are at risk of exposure to infections due to largely poor sanitation. 

The swiftness of the outbreak response was to prevent an accelerated spread of the virus, a scenario that would set Nigeria’s progress back a few years. In August 2020, after a long period of battling the polio virus, Africa was declared free of the wild poliovirus by the independent Africa Regional Certification Commission. 

Authorities are determined to keep the virus out of Nigeria’s borders. However, from time to time, vaccine-derived polio outbreaks occur in different parts of the country but are quickly addressed by health teams who are always on alert. There were only eight cVDPV2 cases reported from AFP in 2020 and 18 cVDPV2 cases reported in 2019.

The vaccine-derived virus, like the wild poliovirus, is a paralysing strain of the poliovirus that has mutated in low immunity settings affecting children who are not or under-immunized. Vaccines prevent children from infections and stop the virus from spreading.

Technical Contacts:
Dr Samuel Bawa; Email: bawas [at] who.int (bawas[at]who[dot]int); Tel: +234 810 221 0195

Lagos State Immunization Officer (SIO), Mrs Omobolanle Orefejo and other vaccinators paddle through Makoko community of Lagos
Lagos State Immunization Officer (SIO), Mrs Omobolanle Orefejo and other vaccinators paddle through Makoko community of Lagos
Lagos State Immunization Officer (SIO), Mrs Omobolanle Orefejo and other vaccinators paddle through Makoko community of Lagos to vaccinate children from 0-59 months old during the implementation of the second outbreak response in Lagos in December 2020.

The first outbreak response was implemented in October 2020 some weeks after environmental samples containing traces of circulating vaccine-derived poliovirus type two (cVDPV2) were detected by the surveillance team supported by WHO in the Lagos Mainland area.
Makoko Community is a habitat of mostly fishermen and fish traders, some areas of the community can only be navigated via canoes and boats.
Vaccination teams navigating with boats and canoes to Makoko community
Makoko Community is a habitat of mostly fishermen and fish traders, some areas of the community can only be navigated via canoes and boats. Vaccination teams are encouraged to use protective equipment including life jackets. In line with the COVID-19 pandemic prevention measures, immunization teams are also required to wear personal protective equipment like face masks. Here, Orefejo properly masked, gets on a canoe, with team of vaccinators attending to children in the region.
nOPV Immunizatio team at Okodi team in Ogbia LGA, Bayelsa State
nOPV Immunizatio team at Okodi team in Ogbia LGA, Bayelsa State
Meanwhile, a positive result of cVDPV2 from a stool sample from Bayelsa, necessitated a wide nOPV2 vaccination campaign in the state as well as neighboring Delta state.

In Bayelsa, the state team received a positive result of cVDPV2 in late January 2021, from a stool specimen of a 1-year old female child with acute flaccid paralysis (AFP) who resides in Ekeremor LGA that shares riverine borders with Delta state.

The case was genetically linked to a previous case of a 9-month-old boy from Delta state reported in August 2020. Just like Makoko, the vaccination team at Okodi town in Ogbia LGA, in Bayelsa have to cross the river using a canoe to get to the houses located within the riverine areas.
nOPV Immunization Team at Otuasega in Ogbia LGA, Bayelsa State.
nOPV Immunization Team at Otuasega in Ogbia LGA, Bayelsa State.
The cVDPV2 is usually a sign that a community is un or under-immunized. This strain of the virus can spread quickly, especially in areas of inadequate sanitation. When an outbreak is discovered anywhere, regardless of the strain of poliovirus, the recommended response is to execute two high-quality immunization rounds where all children below five years of age in the area are given drops of OPV within three months.

In Bayelsa, community elders and health workers, supported by WHO, have been sensitizing parents and families since August 2020 on the need to be cooperative with vaccine-teams once they arrive. That advocacy helped smoothen the path and made it faster to vaccinate the children in October during the first round of the campaign and again in December.

There are a few challenges with reaching all children in this community. The population in many of riverine areas is largely under-educated and myths and rumours surrounding vaccines are rife. Some rumours have it that vaccines can lead to infertility in children, while others say vaccines spread diseases, including COVID-19. Allaying these rumors is part of the communication and demand creation approach during the campaigns.
he WHO and state vaccination team went to schools, religious places, primary health care centres, markets and villages to get the children vaccinated.
vaccination team went to schools, religious places, primary health care centres, markets and villages to get the children vaccinated.
In Niger state, the WHO and state vaccination team went to schools, religious places, primary health care centres, markets and villages to get the children vaccinated. The need for continued surveillance of the poliovirus and the routine administration of OPV remains critical, despite the fact Nigeria has been declared polio-free. Dr Samuel Bawa, WHO Technical Officer said the re-emergence could cause another epidemic that could last for years and spread across countries. Before Nigeria was declared wild polio-free, the country had battled the poliovirus for more than three decades and the virus had spread from its borders as far as the Yemen.

However, experts say there is little chance of a reemergence, as Nigeria’s polio surveillance system has grown in strength over the years, comprising a range of experts, community workers and local leaders working together to achieve positive results and supported significantly by WHO. It is this surveillance system that helped the country defeat wild polio in 2020 and it is the same system that has been adapted to fight the COVID-19 disease which emerged in the country in March 2020. For example, COVID-19 responders are using active case search strategies, a method that was employed to fight polio by engaging local volunteers to search for cases of Acute Flaccid Paralysis (AFP) which is a clinical symptom of poliomyelitis.
Vaccinator in Niger returns to a school for mop up of missed children.
Vaccinator in Niger returns to a school for mop up of missed children.
Despite challenges faced in reaching some children, health workers say they will be back to press the families that were missed for their consent in mop-up immunization exercises. For this part of the immunization response, seeking the guidance of religious and community leaders again to help build trust will be key. Here, a vaccinator in Niger has gone back to a school for mop up of missed children.
A local government facilitator, Catherine Anyadiegwu, double-checks a house marking to ensure it is properly cleared.
A local government facilitator, Catherine Anyadiegwu, double-checks a house marking to ensure it is properly cleared.
With the second round of vaccinations done, teams can now focus on surveillance and monitoring for other possible traces of cVDPV2. If there is a need to visit the community again, it is important to know which homes have had their children vaccinated previously.

Back in Lagos, a local government facilitator, Catherine Anyadiegwu, double-checks a house marking to ensure it is properly cleared.
22-year-old Bose Awhanjojbe cradles her two-week-old daughter, Florence Awhanjojbe, after receiving vaccines in Makoko Community of Lagos
22-year-old Bose Awhanjojbe cradles her two-week-old daughter, Florence Awhanjojbe, after receiving vaccines in Makoko Community of Lagos
22-year-old Bose Awhanjojbe cradles her two-week-old daughter, Florence Awhanjojbe, after receiving vaccines in Makoko Community of Lagos during the implementation of the second outbreak response in Lagos. While getting children vaccinated is a controversial topic among some in the community, there are many parents who understand the need for immunization and for keeping diseases from spreading. Bose first heard about the importance of vaccines not too long ago. “I am thankful for the vaccine,” she said. “I first heard about the importance of immunization from the town announcer who passed through the front of our yard last week. Today is the first time I am immunizing any of my children,” said the mother of two.
For Additional Information or to Request Interviews, Please contact:
Hammanyero, Kulchumi Isa

Communications Officer
WHO Nigeria
Email: hammanyerok [at] who.int (hammanyerok[at]who[dot]int)