Nigeria not lowering guards against Polio, two years after last detection of cases in the Northeast.

Abuja, 13 September, 2018 - After two years without the detection of wild poliovirus (WPV) in Nigeria, the Government, in collaboration with Global Polio Eradication Initiative (GPEI) partner remain resolute not to lower guards against the paralyzing disease. 

Large-scale supplementary immunization activities (SIAs) have being implemented in seven (7) high-risk states in the Northeast (Bauchi, Borno and Yobe) and North West (Jigawa, Kano, Katsina and Sokoto). The states were prioritized following detection of circulating vaccine-derived poliovirus type 2 (cVDPV2) in acute flaccid paralysis (AFP) cases and environmental samples.

According to Dr Wondimagegnehu Alemu World Health Organization (WHO) Country Representative to Nigeria, “It is important to note that cVDPV2 outbreaks occur only in areas with under-immunized populations; hence the need to ensure high immunization coverage in all areas in order to protect against any form of polio – whether wild or vaccine-derived polio”.

Vaccination of 3.2 million children in the Northeast 
Recently in Bauchi, Borno and Yobe States, authorities in collaboration with the WHO have vaccinated three million, one hundred and ninety thousand, two hundred and four (3,190,204) children against polio in the just concluded cVDPV2 outbreak response (OBR) campaign. 

The OBR conducted from 01 – 04 September 2018 was implemented in 38 LGAs and 428 political wards in the wake of the outbreak of circulating Vaccine Derived Polio Virus (cVDPV) confirmed from the environment and AFP cases in Geidam, Yobe state.

Monitoring and Lot Quality Assurance (LQAS) results from the 3 northeastern states indicated that less than 5% of targeted children were missed. Key reasons for missing children include among others, child absence and pockets of vaccine refusals. Efforts are, however, under way to reach all missed children.

Speaking on the impact of the OBR, the Commissioner for Health, Yobe state, Dr Bello Kawuwa stated that “the State is determined now more than ever, to ensure every eligible child is reached and vaccinated. The implementation of strategies such as reaching every settlement and the engagement of vigilantes and security personnel to support the OBR teams is our determination to eradicate polio in the state”.

His counterpart in Borno, Dr Haruna Mshelia also reiterated the State Government commitment in ridding the state of any vestiges of the poliovirus. “The security challenge in the state notwithstanding, we are committed to working with partners, community leaders and security personnel to build immunity across all vulnerable communities to defeat the poliovirus. It’s not an easy task, but we are determined to do it”, Dr Mshelia remarked.

Prioritizing border settlements
To simultaneously reach all eligible children, innovative strategies such as intensive border synchronization activities were implemented. As a result of vaccination across interstates borders, a total of 591,750 children were vaccinated in 3,833 settlements of Jigawa, Kano, Katsina and Sokoto states. For the north east, Bauchi, Borno and Yobe collectively vaccinated 489,452 children in 5185 settlements. 

In all the seven states, vaccination teams were deployed to all the major exit and entry points into settlements to identify caregivers with eligible children who were in turn required to present their children for vaccination with potent oral polio vaccines at the borders.

Some of the challenges that characterized border settlements include difficult terrain for traversing, unpredictable influx of migrants; nomads and camels breeders along interstate/LGAs borders as well as non-adherence to the agreed daily implementation plan.

Mix community engagement activities for quality vaccination
To ensure the successful implementation of the campaign, a mix of community engagement activities were implemented across the three states. Advocacy was carried out with prominent traditional and migrant community leaders while sensitization activities were conducted in very high risk and vulnerable communities. Radio, television and town announcements were intensified throughout the campaign. To demonstrate strong government commitment, flag-offs were also conducted across the 3 states in various LGAs. While in Borno State, a state flag-off was conducted in Nganzai LGA with the Health Commissioner representing the Governor; in Yobe state 12 LGAs without security challenges held flag-off ceremonies with about 2000 children vaccinated. Working with Polio Survivors Groups (PSGs) and community entertainers also formed part of mobilization strategies implemented to increase access to children from non-compliant families.

States in the northwest involved traditional, religious and community influential leaders to mobilize and sensitize their communities on the importance of immunization.

Obtaining Polio-free certification
While no cases of wild polio have been detected since August 2016, Nigeria cannot afford to be complacent, due to the ongoing humanitarian crisis and the possibility of low-level transmission throughout the Lake Chad basin. 

Given these factors, Dr Alemu said Nigeria will remain on the endemic list until the WHO determines that all populations are fully reached with immunization services and quality surveillance is in place to ensure that no remaining areas of poliovirus transmission is missed. 

Support for Polio Eradication and Expanded Programme for Immunization to Government of Nigeria, through WHO is made possible by funding from the Bill & Melinda Gates Foundation, Department for International Development (DFID – UK), European Union, Gavi, the Vaccine Alliance, Government of Germany through KfW Bank, Global Affairs Canada, United States Agency for International Development (USAID), Rotary International and the World Bank.

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