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Oral polio vaccine (OPV) coverage among individuals with acute flaccid paralysis (AFP), receipt of the third OPV dose (OPV3) through routine immunization activities (RI), and mean coverage by supplementary immunization activities (SIAs), Somalia 1998-2012.
Source publication
Since the 1988 resolution of the World Health Assembly to eradicate polio, significant progress has been made toward achieving this goal, with the result that only Afghanistan, Nigeria, and Pakistan have never successfully interrupted endemic transmission of wild poliovirus. However, one of the greatest challenges of the Global Polio Eradication In...
Contexts in source publication
Context 1
... immunization across Somalia is administered through maternal and child health centers, using the Expanded Pro- gramme on Immunization schedule, in which OPV is adminis- tered at birth (OPV0), 6 weeks (OPV1), 10 weeks (OPV2), and 14 weeks (OPV3). WHO-UNICEF estimates of OPV3 cov- erage remained consistently low (<50%) during 1998-2012 ( Figure 3). In 1998, OPV3 coverage was estimated at 35%; the coverage estimate fluctuated between 30% and 40% until 2006, when it reached a low of 26%. ...
Context 2
... 1998-2012, at least 2 rounds of SIAs targeting children aged <5 years were conducted in at least 2 administrative zones in each year under review (Figures 3 and 4). The number of SIAs conducted ranged from 2 rounds in multiple years to 9 rounds in 2007 for the Northwest and Northeast zones, except for 2004, when no SIAs were conducted in the Northwest zone. ...
Context 3
... ministrative SIA coverage estimates in all 3 zones were high- reaching or exceeding 100% on several occasions-during the period under review. During 1998During -2012, mean coverage estimates ranged from 73% (in 1999) to 106% (in 2011) in the Northeast zone; from 86% (in 2002) to 105% (in 1999) in the Northwest zone; and from 88% (in 2010) to 125% (in 1998) in South Central Somalia (Figure 3). For the years in which data were available (2006)(2007)(2008)(2009)(2010)(2011)(2012), vaccine refusals were consistently <1%. ...
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Citations
... The study showed that, although AFP cases were reported from all age groups in the state, the majority (79%) of them were children below the age of five years, this finding is consistent with other states within the country and similar studies conducted in Kenya, Ethiopia, Somalia, and Nigeria [1,3,13,14]. Besides, our findings of gender proportionality of reported AFP cases were consistent with studies conducted in Kenya, Ethiopia, Somalia, and Nigeria with proportions of 55%, 58%, 60%, and 56% respectively [ of immunization coverage compared to none-conflict affected states [15,16]. ...
Introduction:
South Sudan reported the last indigenous wild poliovirus (WPV) in 2001 in Unity State, while the country was part of Sudan. In addition, the country reported an imported case of WPV in 2004-2005 and 2008-2009. The WPV circulation in the state was interrupted in 2009 and the last case was reported in Ayod county. The country continues to be at risk of importation of circulating vaccine-derived poliovirus type 2 (cVDPV2). In 2014 and 2020 the country experienced an outbreak of cVDPV2, in which Jonglei state was one of the affected states. Four out of 50 (8%) cVDPV2 cases in 2020 were reported from Jonglei State. The purpose of this study is to review surveillance performance indicators of Jonglei and compare them with the WHO surveillance performance standard and other country´s surveillance performances.
Methods:
retrospective secondary data analysis was conducted using the Jonglei state Acute Flaccid Paralysis (AFP) surveillance case-based database from 2011 to 2020. The reason for selecting Jonglei is because it is one of the poor performing states and is chronically hit by flood and internal conflicts. Data analyses were carried out using the Microsoft Excel (2016) program, where descriptive analysis frequencies, tables, and graphs were generated.
Results:
the study revealed that 346 AFP cases were reported in the counties of Jonglei state from 2011 through 2020. Out of 11 counties, 11 (100%) of them have reported suspected AFP cases. Children under five years accounted for 275 (79%) of all cases. The male gender accounted for 175 (51%) of all cases. A total of 249 (72%) had received three or more doses of Oral Polio Vaccine (OPV). Non-Polio Acute Flaccid Paralysis (NPAFP) rate varies from 1.2 in 2014 to 4.4 cases per 100,000 children under 15 years in 2018. The stool adequacy ranges from 58% in 2020 to 100% in 2011.
Conclusion:
the performance of Jonglei´s AFP surveillance system did not meet the WHO recommended target for both major AFP surveillance indicators (non-polio AFP rate and stool adequacy) during the study period.
... Also, the use of innovative tools such as the ODK for reporting performance and, most importantly, institutional memory, as the country has extensive experience in conducting similar campaigns. The high coverage in polio campaigns has proven challenging to transfer to RI, and the same has been recorded in other conflict-affected countries such as Somalia and warrants additional investigations [39]. ...
... This is due to the significant investment made by donors and the GPEI collaboration and the limited reliance on the current government health system, which is based on a passive surveillance system. Conflicts appear to have little effect on the ability to detect AFP cases and meet standard indicators, with similar results reported in countries such as Pakistan, Afghanistan, and Nigeria [39,41,42] The program's ability to detect and report the presence or absence of poliovirus is contingent upon the laboratory's ability to isolate and identify enteroviruses from AFP samples. These are affected by the reverse cold chain, with a 10% NPEV isolation rate serving as a reference point [43]. ...
Introduction: in 1988 the World Health Assembly set an ambitious target to eradicate Wild Polio Virus (WPV) by 2000, following the successful
eradication of the smallpox virus in 1980. South Sudan and the entire African region were certified WPV free on August 25, 2020. South Sudan has
maintained its WPV free status since 2010, and this paper reviewed the country’s progress, outlined lessons learned, and describes the remaining
challenges in polio eradication.
Methods: secondary data analysis was conducted using the Ministry of Health and WHO polio surveillance datasets, routine immunisation coverage,
polio campaign data, and surveys from 2010 to 2020. Relevant technical documents and reports on polio immunisation and surveillance were also
reviewed. Data analysis was conducted using EPI Info 7 software.
Results: administrative routine immunisation coverage for bivalent Oral Polio Vaccine (OPV) 3rd dose declined from 77% in 2010 to 56% in 2020.
In contrast, the administrative and post-campaign evaluation coverage recorded for the nationwide supplemental polio campaigns since 2011 was
consistently above 85%; however, campaigns declined in number from four in 2011 to zero in 2020. Overall, 76% of notified cases of Acute Flaccid
Paralysis (AFP) received three or more doses of the oral polio vaccine. The Annualized Non-AFP rate ranged between 4.0 to 5.4 per 100,000 under 15
years populations, and stool adequacy ranged from 83% to 94%.
Conclusion: South Sudan’s polio-free status documentation was accepted by the ARCC in 2020, thereby enabling the African Region to be certified
WPV free on August 25, 2020. However, there are concerns as the country continues to report low routine immunisation coverage and a reduction
in the number of polio campaigns conducted each year. It is recommended that the country conduct high-quality nationwide supplemental polio
campaigns yearly to achieve and maintain the required herd immunity. It invests in its routine immunisation program while ensuring optimal AFP surveillance performance indicators.
... Also, the use of innovative tools such as the ODK for reporting performance and, most importantly, institutional memory, as the country has extensive experience in conducting similar campaigns. The high coverage in polio campaigns has proven challenging to transfer to RI, and the same has been recorded in other conflict-affected countries such as Somalia and warrants additional investigations [39]. ...
... This is due to the significant investment made by donors and the GPEI collaboration and the limited reliance on the current government health system, which is based on a passive surveillance system. Conflicts appear to have little effect on the ability to detect AFP cases and meet standard indicators, with similar results reported in countries such as Pakistan, Afghanistan, and Nigeria [39,41,42] The program's ability to detect and report the presence or absence of poliovirus is contingent upon the laboratory's ability to isolate and identify enteroviruses from AFP samples. These are affected by the reverse cold chain, with a 10% NPEV isolation rate serving as a reference point [43]. ...
Introduction:
in 1988 the World Health Assembly set an ambitious target to eradicate Wild Polio Virus (WPV) by 2000, following the successful eradication of the smallpox virus in 1980. South Sudan and the entire African region were certified WPV free on August 25, 2020. South Sudan has maintained its WPV free status since 2010, and this paper reviewed the country's progress, outlined lessons learned, and describes the remaining challenges in polio eradication.
Methods:
secondary data analysis was conducted using the Ministry of Health and WHO polio surveillance datasets, routine immunisation coverage, polio campaign data, and surveys from 2010 to 2020. Relevant technical documents and reports on polio immunisation and surveillance were also reviewed. Data analysis was conducted using EPI Info 7 software.
Results:
administrative routine immunisation coverage for bivalent Oral Polio Vaccine (OPV) 3rd dose declined from 77% in 2010 to 56% in 2020. In contrast, the administrative and post-campaign evaluation coverage recorded for the nationwide supplemental polio campaigns since 2011 was consistently above 85%; however, campaigns declined in number from four in 2011 to zero in 2020. Overall, 76% of notified cases of Acute Flaccid Paralysis (AFP) received three or more doses of the oral polio vaccine. The Annualized Non-AFP rate ranged between 4.0 to 5.4 per 100,000 under 15 years populations, and stool adequacy ranged from 83% to 94%.
Conclusion:
South Sudan's polio-free status documentation was accepted by the ARCC in 2020, thereby enabling the African Region to be certified WPV free on August 25, 2020. However, there are concerns as the country continues to report low routine immunisation coverage and a reduction in the number of polio campaigns conducted each year. It is recommended that the country conduct high-quality nationwide supplemental polio campaigns yearly to achieve and maintain the required herd immunity. It invests in its routine immunisation program while ensuring optimal AFP surveillance performance indicators.
... But, transmission was not sustained in Egypt, the West Bank and Gaza, where OPV was still part of vaccination programmes. This picture is somewhat complicated by the outbreak in Somalia [49], which had sustained transmission despite exclusive use of OPV, though the outbreak could also be explained by the low historical vaccine coverage there [50]. In this analysis, however, we recognize that the lack of evidence for spatial spread may instead be a lack of the right data. ...
Environmental pathogen surveillance is a sensitive tool that can detect early-stage outbreaks, and it is being used to track poliovirus and other pathogens. However, interpretation of longitudinal environmental surveillance signals is difficult because the relationship between infection incidence and viral load in wastewater depends on time-varying shedding intensity. We developed a mathematical model of time-varying poliovirus shedding intensity consistent with expert opinion across a range of immunization states. Incorporating this shedding model into an infectious disease transmission model, we analysed quantitative, polymerase chain reaction data from seven sites during the 2013 Israeli poliovirus outbreak. Compared to a constant shedding model, our time-varying shedding model estimated a slower peak (four weeks later), with more of the population reached by a vaccination campaign before infection and a lower cumulative incidence. We also estimated the population shed virus for an average of 29 days (95% CI 28–31), longer than expert opinion had suggested for a population that was purported to have received three or more inactivated polio vaccine (IPV) doses. One explanation is that IPV may not substantially affect shedding duration. Using realistic models of time-varying shedding coupled with longitudinal environmental surveillance may improve our understanding of outbreak dynamics of poliovirus, SARS-CoV-2, or other pathogens.
... A conceptual framework ( Fig. 1) was developed (as Yin recommends for case studies as noted above) encompassing the key factors that affect the AFP surveillance system in conflict-affected areas, and revised following data analysis. The framework was developed though a review of the literature, analysis of the current polio surveillance structure, and reflections on the unique challenges affecting surveillance in Borno [16][17][18][19][20][21][22][23][24][25][26][27][28][29]. It includes the systems, assumptions, barriers, theories, and opportunities regarding conducting high quality polio surveillance in conflict-affected areas. ...
This study examined the impact of armed conflict on public health surveillance systems, the limitations of traditional surveillance in this context, and innovative strategies to overcome these limitations. A qualitative case study was conducted to examine the factors affecting the functioning of poliovirus surveillance in conflict-affected areas of Borno state, Nigeria using semi-structured interviews of a purposeful sample of participants. The main inhibitors of surveillance were inaccessibility, the destroyed health infrastructure, and the destroyed communication network. These three challenges created a situation in which the traditional polio surveillance system could not function. Three strategies to overcome these challenges were viewed by respondents as the most impactful. First, local community informants were recruited to conduct surveillance for acute flaccid paralysis in children in the inaccessible areas. Second, the informants engaged in local-level negotiation with the insurgency groups to bring children with paralysis to accessible areas for investigation and sample collection. Third, GIS technology was used to track the places reached for surveillance and vaccination and to estimate the size and location of the inaccessible population. A modified monitoring system tracked tailored indicators including the number of places reached for surveillance and the number of acute flaccid paralysis cases detected and investigated, and utilized GIS technology to map the reach of the program. The surveillance strategies used in Borno were successful in increasing surveillance sensitivity in an area of protracted conflict and inaccessibility. This approach and some of the specific strategies may be useful in other areas of armed conflict.
... Somalia, a coastal country in eastern Africa, is a priority country for the GPEI owing to a longstanding humanitarian crisis and its vulnerability to recurrent polio outbreaks. Several years of political instability, occasioned by civil war and protracted armed conflict and insurgency, have led to fragmented political control and to a significant increase in vulnerable populations in the country [9]. By the end of 2017, it was estimated that 2.1 million persons were internally displaced in Somalia, and that 900,000 Somali refugees have A c c e p t e d M a n u s c r i p t 5 fled the country due to conflict [10]. ...
... WHO-UNICEF estimate that childhood immunization coverage with 3 doses of oral poliovirus vaccine (OPV; Sabin) has been consistently below 50% in Somalia during the last decade so that supplementary immunization campaigns with OPV have been needed to maintain population immunity against poliovirus [11]. Further complicating the situation, insurgency groups have restricted access for the delivery of immunization services in many districts in the south and central zones of the country, leaving about 1 million children under 10 years of age unvaccinated against polio [9]. ...
... Despite these challenges, the country successfully interrupted indigenous transmission of WPV in 2002 [9]. However, it experienced two outbreaks following importation of WPV during 2005-2007 and 2013-2014 [9,12,13]. ...
Background
Despite insecurity challenges in Somalia, key indicators for acute flaccid paralysis (AFP) surveillance have met recommended targets. However, recent outbreaks of vaccine-derived polioviruses have raised concerns about possible gaps. We analyzed non-polio enterovirus (NPEV) and Sabin poliovirus isolation rates, to investigate whether comparing these rates can inform about the integrity of stool specimens from inaccessible areas and the likelihood to detect circulating polioviruses.
Methods
Using logistic regression, we analyzed case-based AFP surveillance data for 1348 cases with onset during 2014—2017. We assessed the adjusted impacts of variables including age, accessibility, and Sabin-like virus isolation on NPEV detection.
Results
NPEVs were more likely to be isolated from AFP case-patients reported from inaccessible areas than accessible areas (23% vs. 15%, p=0.01). In a multivariable model, inaccessibility and detection of Sabin-like virus were positively associated with NPEV detection (adjusted odds ratio [AOR]=1.75, 95% confidence interval [CI]=1.14–2.65; and AOR=1.79, 95% CI=1.07–2.90, respectively), while being aged ±5 years was negatively associated (AOR=0.42, 95% CI=0.20–0.85).
Conclusions
Rates of NPEV and Sabin poliovirus detection in inaccessible areas suggest that the integrity of fecal specimens tested for AFP surveillance in Somalia can generate useful AFP data but uncertainties remain about surveillance system quality.
... Причина осложнения эпидемиологической обстановкиполитическая нестабильность и затяжной вооруженный конфликт, приведшие к значительному разрушению системы здравоохранения, и, следовательно, ограничению проведения вакцинации в труднодоступных районах юго-центральной части страны, находящихся под контролем антиправительственных элементов. Почти половина (44 %) заболевших никогда не были вакцинированы оральной полиомиелитной вакциной[148]. Для ликвидации вспышки была развернута кампания по дополнительной иммунизации против полиомиелита. ...
В справочнике разработаны, обобщены и систематизированы информационно-аналитические прогнозно-эпидемиологические материалы в странах мира по инфекционным болезням, учитываемым при осуществлении Международных медико-санитарных правил (2005 г.) и требующим проведения мероприятий по санитарной охране территории Российской Феде-рации, государств-участников СНГ, стран Евразийского экономического союза, других стран и международных объединений.
Справочник предназначен для специалистов органов и организаций Роспотребнадзора, Минздрава России, МЧС России, других заинтересованных в сохранении здоровья и санитарно-эпидемиологического благополучия населения ведомств, юридических и физических лиц, в том числе путешественников, осуществляющих международные поездки.
Эпидемиологические материалы в виде томов представлены по регионам Всемирной организации здравоохранения (ВОЗ): Восточно-Средиземноморскому, Африканскому, Американ-скому, Юго-Восточной Азии, Западно-Тихоокеанскому, Европейскому. Настоящий том посвящен Восточно-Средиземноморскому региону.
... Routine infant immunization coverage for all antigens is suboptimal and varies widely (40-60%) among the zones [3]; approximately 15% of the 2.9 million Somali children <5 years of age have been unreached for immunizations for several years [4]. The last detected evidence of indigenous wild poliovirus (WPV) transmission was in 2002, but two subsequent outbreaks occurred after WPV importations during 2005-2007 and 2013-2014 [5]; WPV cases were last detected in Somalia in early 2014 [6]. As an indication of very low population immunity, outbreaks of circulating vaccine-derived poliovirus (cVDPV) of both types 2 and 3 began in October 2017 and continue to date [7]. ...
One objective of the 2013-2018 Global Polio Eradication Initiative (GPEI) Strategic Plan was the transition of GPEI polio essential functions to other public health programs [1]. For many developing countries, in addition to polio essential functions, GPEI funding has been supporting integrated communicable disease surveillance and routine immunization programs. As GPEI progresses toward polio eradication, GPEI funding for some polio-free countries is being scaled back. The Somalia Polio Eradication Program, led by international organizations in collaboration with local authorities, is a critical source of immunizations for >2.5 million children. In addition, the polio program has been supporting a range of communicable disease surveillance, basic health services (e.g. routine immunizations) as well as emergency response activities (e.g. outbreak response). To assess current capacities in Somalia, interviews were conducted with representatives of relief organizations and ministries of health (MoHs) from Somaliland, Puntland, and South-Central political zones to elicit their opinions on their agency's capacity to assume public health activities currently supported by GPEI funds. Seventy percent of international and 62% of representatives of domestic relief agencies reported low capacity to conduct communicable disease surveillance without GPEI funds. Responses from MoH representatives for the three zones in Somalia ranged from "very weak" to "strong" regarding capacity to conduct both polio and non-polio related communicable disease surveillance and outbreak response activities. Zones programs are unprepared to provide communicable diseases services if GPEI funding were substantially reduced abruptly. Polio transition planning must strategically plan for shifting of GPEI staffing, operational assets and funding to support identified gaps in Somalia's public health infrastructure.
... 4 In Somalia, the first importation occurred during 2005-2007, resulting in more than 200 cases of paralytic polio. 5 Likewise, in Kenya, two cases in Garissa County were reported in 2006, 19 cases in Turkana County in 2009, and one case in Rongo district in 2011. Somalia experienced a polio-free period from 2007 to 2013. 5 This period of calm was upset when an outbreak of WPV type 1 (WPV1) rattled the Horn of Africa (HOA). ...
... Somalia experienced a polio-free period from 2007 to 2013. 5 This period of calm was upset when an outbreak of WPV type 1 (WPV1) rattled the Horn of Africa (HOA). 6 In May 2013, the Somalia Ministry of Health (MOH) and the WHO reported a confirmed WPV1 case in a child from Mogadishu (Banadir region). ...
In 2013, the outbreak of wild poliovirus (WPV) in the Horn of Africa (HOA) triggered an aggressive, coordinated national and regional response to interrupt continued transmission. Kenya, Somalia, Ethiopia, South Sudan, and other HOA countries share a range of complex factors that enabled the outbreak: porous and sparsely populated borders, insecurity due to armed conflicts, and weak health systems with persistently under-resourced health facilities resulting in low-quality care and low levels of immunization coverage in mobile populations. Consequently, the continued risk of WPV importation demanded cross-border and intersectoral collaboration. Assessing and addressing persistent communication gaps at the subnational levels were necessary to gain traction for improved immunization coverage and surveillance activities. This article describes a systematic approach to institutionalizing processes of dialogue and facilitation that can provide for a sustainable and effective joint cross-border health platform between Kenya and Somalia. It examines an operational model called the Cross-Border Health Initiative (CBHI) to support joint intercountry collaboration and coordination efforts. To evaluate progress of the CBHI, the authors used data from population coverage surveys for routine immunization and supplemental immunization activities (for polio), from acute flaccid paralysis (AFP) surveillance, and from plans developed by border districts and border health facilities. The project-trained community health volunteers have been a critical link between the hard-to-reach communities and the health facilities as well as an excellent resource to support understaffed health facilities. The authors conclude that the CBHI has been effective in bolstering immunization coverage, disease surveillance, and rapid outbreak response in border areas. The CBHI has the potential to address other public health threats that transcend borders.
... Somalia was therefore a fertile ground for the WPV outbreak in 2013. Response polio SIAs (SIAs carried out within 14 days of an outbreak declaration as opposed to regular SIAs also known as national immunisation days (NIDs) which are regularly scheduled) were hampered by vaccination bans put in place by non-government factions in several districts [15]. Due to armed conflicts, the DRC is one of the last countries in Africa to implement national immunisation days (NIDs). ...
Background: Supplementary immunisation activities (SIAs) play a central role in polio eradication efforts. Armed conflicts resulting in insecurity negatively affect SIAs. In the Southwest region of Cameroon, armed conflicts persisted in 2018. We present our experiences of conducting a polio SIA in an insecure region. Methods: The SIA took place from the 2nd to 4th of March 2018 and targeted 307,920 children aged 0–59 months. Bivalent polio vaccine was used. Before the SIA, extensive planning was done under the leadership of a Central Technical Group. Planning included security assessment, advocacy and social mobilisation. Results: Only 4 of the 18 health districts (HDs) of the Southwest region were considered safe. Regardless, vaccination teams worked in all HDs. The SIA achieved a coverage of 89.9%. Town criers and social mobilisers were the main sources of information about the SIA. Most (76%) children were vaccinated using the door to door strategy. There was no case of vaccine refusal. Conclusion: Community members were very receptive of the SIA and this may be due to the communication that was adopted. Strong dedication by vaccination teams, community members’ understanding and acceptance of polio SIAs are all key factors to the eradication of polio in conflict zones.
