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Winning the battle against the scourge of poliomyelitis in the African Region
Vaccine 34 (2016) 5142–5143
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Winning the battle against the scourge of poliomyelitis in the African Region Matshidiso Moeti WHO Regional Office for Africa, Congo
a r t i c l e
i n f o
Article history: Available online 27 August 2016 Keywords: Documentation Lessons learnt Practices Polio
a b s t r a c t Introduction: Recently we have recorded some progress against the transmission of poliovirus in the African Region. This is attributable to a number of factors, including commitment of global partnerships against polio, improvement of existing strategies as well as a number of innovations in response to the disease in the Region. Methods: The WHO Regional Office in Africa documented these practices that led to the noticeable progress in the polio eradication initiative in the African Region, as lessons learnt and as part of polio legacy planning. The documentation exercise covered eight countries, namely Angola, Chad, Cote d’Ivoire, Democratic Republic of Congo, Ethiopia, Nigeria, Tanzania and Togo. Results: A number of practices were identified. Some of these practices cut across countries while others were peculiar to specific countries. We have thus developed some manuscripts to capture these practices for publication in scientific journal so as to place them in the public domain for use. Conclusion: It is hoped that these practices will be deployed to other public health programmes in the Region and beyond. Ó 2016 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Successes recorded in polio eradication in the African Region As late as 2012, the African Region was home to more than half of global polio cases [1]. The beginning of 2016 marked an important milestone, because for more than twenty months in a stretch, no case of wild poliovirus (WPV) type has been reported in the African Region [2,3]. Nigeria, which for several years was the only country endemic for transmission of WPV in the Region, was removed from the list of endemic countries in September 2015 having reported no WPV case for more than a year with onset of the latest case on 24th July 2014 [3,4]. This signifies tremendous progress towards winning the battle, over the scourge of poliomyelitis, in the Region [1]. In September 2015, the Global Commission for Certification of Polio Eradication (GCC) declared that WPV type 2 had been eradicated globally. The African Region has not detected any WPV type 3 for more than 40 months since the onset of the latest case in November 2012 from Nigeria. Currently, there are few cases of circulating vaccine derived polio virus (cVDPV) reported in the Region [5]. These are also on the decline following the success of vaccination campaigns, using trivalent oral polio vaccine, and introduction of at least one dose of inactivated poliovirus vaccine (IPV) in routine immunization to
E-mail address: [email protected]
boost systemic immunity against the virus as well as the general improvement in the performance of routine immunization in the Region. As more countries introduce IPV and switch from trivalent oral poliovirus vaccine to bivalent oral poliovirus vaccine, it is expected that the cVDPV will also be stopped soon. To sustain the recent improvements in polio eradication activities and outcomes, steps are being taken to further strengthen surveillance for acute flaccid paralysis (AFP) to become highly sensitive, and communities involved in active search for cases of AFP and sample collection improved with quick turnover in laboratory processing to ensure prompt vaccination campaigns in response to any poliovirus outbreaks [6]. The Region is also expanding environmental surveillance to supplement AFP surveillance, so that any poliovirus circulation in the sewage systems and environment, in general, is not missed. When these are successfully instituted, the Region will be set to achieve victory over poliomyelitis and be certified polio free with no WPV case reported in three years.
2. Factors responsible for progress in the battle against poliomyelitis in the African Region The successes recorded are largely attributable to improvement of existing strategies as well as a number of innovations in response to the disease in the Region [2,7–13]. Some of these
http://dx.doi.org/10.1016/j.vaccine.2016.05.059 0264-410X/Ó 2016 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
M. Moeti / Vaccine 34 (2016) 5142–5143
include strong leadership and unwavering commitment of national governments, traditional and community leaders, dedicated partners, who never gave up even when the disease was unrelenting and polio eradication targets seemed unattainable. The field staff also demonstrated unprecedented courage, zeal and determination, often devising innovative ways to deliver polio vaccines to infants and children in insecure areas, resulting in some cases the ultimate sacrifice of their lives in the pursuit of this public health undertaking. Over time, the polio funded staff have become highly skilled and acquired experiences relevant for the attainment of not only the goals of polio eradication but of other public health interventions, in a Region with a huge share of the global burden of communicable diseases, weak health systems, and limited resources. The skills and innovative practices of these staff have made them attractive for deployment in response to other disease outbreaks or delivery of other public health interventions in the Region. As an example, the use of polio eradication initiative skills and coordination practices was crucial for containment and mitigation against the impact of the Ebola Virus Disease (EVD) outbreaks in Nigeria and other West African countries [13,14]. These best practices can be employed in public health programmes, especially routine immunization, measles elimination, control of other immunizable diseases and application pf the International Health Regulations (IHR). 3. Polio best practices and other public health initiatives The analysis of the contribution of the polio eradication initiative practices to other public health programmes in the African Region, together with discussion on their sustainability presented in this supplement is extremely useful and timely. The articles carefully document steps for the implementation of the different practices and strategies and also chart pathways for their successful adaptation to other public health intervention in the African Region and globally. This supplement is designed to sensitize all public health stakeholders – governments and people of the African Region as well as health partners – on these proven best practices and to encourage their adaptation to other public health challenges. Governments and partners should support the process of adaptation of these best practices, including training of public health and community personnel on the required skills. Armed with such effective practices we shall, together, ensure and secure our collective health stock in the Region. Let me end by noting that while the battle against the scourge of poliomyelitis seems won the war is still has to be won. There is need for vigilance and guarding of the seeming victory until
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the Region is certified polio free later in 2017, and the world also certified polio free in the near future. Conflict of interest There is no conflict to declare. References [1] Global Polio Eradication Initiative. Polio this week as of 21 May 2014. Geneva (Switzerland): World Health Organization, Global Polio Eradication Initiative; 2014. Available from:. [2] Okeibunor JC, Ota MC, Akanmori BD, Gumede N, Shaba K, Kouadio KI, et al. Polio eradication in the African region on course despite public health emergencies. Vaccine 2015. http://dx.doi.org/10.1016/j.vaccine.2015.08.024. [3] Etsano A, Gunnala R, Shuaib F, Damisa E, Mkanda P, Ticha JM, et al. Progress toward poliomyelitis eradication – Nigeria, January 2014 – July 2015. MMWR 2015;64(32):878–82. [4] Malara M. WHO: Nigeria no longer on polio endemic shortlist. UPI health news 2016. Available from: [Accessed February 29, 2016]. [6] Gitta SN, Mwesiga A, Kamadjeu R. Proceedings of the African Field Epidemiology Network (AFENET) scientific conference 17–22 November 2013 Addis Ababa, Ethiopia: plenaries and oral presentations. Pan Afr Med J 2015;21:208. [7] Razum O, Liyanage J, Nayar KR. Difficulties in polio eradication. Lancet 2001;357:476. [8] World Health Organization. Poliomyelitis: intensification of the global eradication initiative. In: Resolution WHA65.5. Geneva (Switzerland): World Health Organization; 2012. Available from: . [9] Closser S, Cox K, Parris TM, Landis RM, Justice J, Gopinath R, et al. The impact of polio eradication on routine immunisation and primary health care: a mixed methods study. J Infect Dis 2014(April). http://dx.doi.org/10.1093/infdis/ jit232:S1-S1. [10] Weiss WM, Choudhary M, Solomon R. Performance and determinants of routine immunisation coverage within the context of intensive polio eradication activities in Uttar Pradesh India: Social Mobilization Network (SM Net) and Core Group Polio Project (CGPP). BMC Int Health Hum Rights 2013;13:25. [11] World Health Organization. WHO vaccine-preventable diseases monitoring system: 2013 global summary [data as of October 16, 2013]. Geneva (Switzerland): World Health Organization; 2013. Available from: . [12] Levitt A, Diop OM, Tangermann RH. Surveillance systems to track progress toward global polio eradication—worldwide, 2012–2013. MMWR 2014;63:356–61. [13] World Health Organization. Poliomyelitis: intensification of the global eradication initiative. In: Resolution WHA65.5. Geneva (Switzerland): WorldHealth Organization; 2012. Available from: . [14] Shuaib F, Gunnala R, Musa EO, Mahoney FJ, Oguntimehin O, Nguku PM, et al. Ebola virus disease outbreak — Nigeria, July–September 2014. MMWR 2014;63(39):867–72.
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Winning the battle against the scourge of poliomyelitis in the African Region Matshidiso Moeti WHO Regional Office for Africa, Congo
a r t i c l e
i n f o
Article history: Available online 27 August 2016 Keywords: Documentation Lessons learnt Practices Polio
a b s t r a c t Introduction: Recently we have recorded some progress against the transmission of poliovirus in the African Region. This is attributable to a number of factors, including commitment of global partnerships against polio, improvement of existing strategies as well as a number of innovations in response to the disease in the Region. Methods: The WHO Regional Office in Africa documented these practices that led to the noticeable progress in the polio eradication initiative in the African Region, as lessons learnt and as part of polio legacy planning. The documentation exercise covered eight countries, namely Angola, Chad, Cote d’Ivoire, Democratic Republic of Congo, Ethiopia, Nigeria, Tanzania and Togo. Results: A number of practices were identified. Some of these practices cut across countries while others were peculiar to specific countries. We have thus developed some manuscripts to capture these practices for publication in scientific journal so as to place them in the public domain for use. Conclusion: It is hoped that these practices will be deployed to other public health programmes in the Region and beyond. Ó 2016 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Successes recorded in polio eradication in the African Region As late as 2012, the African Region was home to more than half of global polio cases [1]. The beginning of 2016 marked an important milestone, because for more than twenty months in a stretch, no case of wild poliovirus (WPV) type has been reported in the African Region [2,3]. Nigeria, which for several years was the only country endemic for transmission of WPV in the Region, was removed from the list of endemic countries in September 2015 having reported no WPV case for more than a year with onset of the latest case on 24th July 2014 [3,4]. This signifies tremendous progress towards winning the battle, over the scourge of poliomyelitis, in the Region [1]. In September 2015, the Global Commission for Certification of Polio Eradication (GCC) declared that WPV type 2 had been eradicated globally. The African Region has not detected any WPV type 3 for more than 40 months since the onset of the latest case in November 2012 from Nigeria. Currently, there are few cases of circulating vaccine derived polio virus (cVDPV) reported in the Region [5]. These are also on the decline following the success of vaccination campaigns, using trivalent oral polio vaccine, and introduction of at least one dose of inactivated poliovirus vaccine (IPV) in routine immunization to
E-mail address: [email protected]
boost systemic immunity against the virus as well as the general improvement in the performance of routine immunization in the Region. As more countries introduce IPV and switch from trivalent oral poliovirus vaccine to bivalent oral poliovirus vaccine, it is expected that the cVDPV will also be stopped soon. To sustain the recent improvements in polio eradication activities and outcomes, steps are being taken to further strengthen surveillance for acute flaccid paralysis (AFP) to become highly sensitive, and communities involved in active search for cases of AFP and sample collection improved with quick turnover in laboratory processing to ensure prompt vaccination campaigns in response to any poliovirus outbreaks [6]. The Region is also expanding environmental surveillance to supplement AFP surveillance, so that any poliovirus circulation in the sewage systems and environment, in general, is not missed. When these are successfully instituted, the Region will be set to achieve victory over poliomyelitis and be certified polio free with no WPV case reported in three years.
2. Factors responsible for progress in the battle against poliomyelitis in the African Region The successes recorded are largely attributable to improvement of existing strategies as well as a number of innovations in response to the disease in the Region [2,7–13]. Some of these
http://dx.doi.org/10.1016/j.vaccine.2016.05.059 0264-410X/Ó 2016 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
M. Moeti / Vaccine 34 (2016) 5142–5143
include strong leadership and unwavering commitment of national governments, traditional and community leaders, dedicated partners, who never gave up even when the disease was unrelenting and polio eradication targets seemed unattainable. The field staff also demonstrated unprecedented courage, zeal and determination, often devising innovative ways to deliver polio vaccines to infants and children in insecure areas, resulting in some cases the ultimate sacrifice of their lives in the pursuit of this public health undertaking. Over time, the polio funded staff have become highly skilled and acquired experiences relevant for the attainment of not only the goals of polio eradication but of other public health interventions, in a Region with a huge share of the global burden of communicable diseases, weak health systems, and limited resources. The skills and innovative practices of these staff have made them attractive for deployment in response to other disease outbreaks or delivery of other public health interventions in the Region. As an example, the use of polio eradication initiative skills and coordination practices was crucial for containment and mitigation against the impact of the Ebola Virus Disease (EVD) outbreaks in Nigeria and other West African countries [13,14]. These best practices can be employed in public health programmes, especially routine immunization, measles elimination, control of other immunizable diseases and application pf the International Health Regulations (IHR). 3. Polio best practices and other public health initiatives The analysis of the contribution of the polio eradication initiative practices to other public health programmes in the African Region, together with discussion on their sustainability presented in this supplement is extremely useful and timely. The articles carefully document steps for the implementation of the different practices and strategies and also chart pathways for their successful adaptation to other public health intervention in the African Region and globally. This supplement is designed to sensitize all public health stakeholders – governments and people of the African Region as well as health partners – on these proven best practices and to encourage their adaptation to other public health challenges. Governments and partners should support the process of adaptation of these best practices, including training of public health and community personnel on the required skills. Armed with such effective practices we shall, together, ensure and secure our collective health stock in the Region. Let me end by noting that while the battle against the scourge of poliomyelitis seems won the war is still has to be won. There is need for vigilance and guarding of the seeming victory until
5143
the Region is certified polio free later in 2017, and the world also certified polio free in the near future. Conflict of interest There is no conflict to declare. References [1] Global Polio Eradication Initiative. Polio this week as of 21 May 2014. Geneva (Switzerland): World Health Organization, Global Polio Eradication Initiative; 2014. Available from: