Mass vaccination campaigns to eradicate poliomyelitis in Madagascar: oral poliovirus vaccine increased immunity of children who missed routine programme

Abstract

To assess the impact of mass vaccination campaigns using oral poliovirus vaccine (OPV) in Madagascar, serum neutralizing antibodies and geometrical mean titres (GMTs) to poliovirus were measured among 472 children aged up to 59 months, before and after the mass campaign, regardless of their previous history of routine vaccination. In this study, overall coverage with three routine and two mass campaign OPV doses was 69.9 and 93.4%, respectively. Seroprevalences to all poliovirus types were significantly higher after the mass campaign among the children who were not vaccinated through routine programme: 67.5% vs. 90.2% (P < 0.001) for type 1; 66.7% vs. 95.1% (P < 0.001) for type 2; and 55.3% vs. 82.9% (P < 0.001) for type 3. Geometrical mean titres to all poliovirus types also significantly increased after the mass campaign among the same study group: 34.5 vs. 238.9 (P < 0.001) for type 1; 35.1 vs. 402.6 (P < 0.001) for type 2; and 13.3 vs. 92.6 (P < 0.001) for type 3. Post-mass campaign seroprevalences and GMTs for poliovirus, especially types 1 and 3, among children who received up to two routine and two mass campaign OPV doses were significantly higher than pre-mass campaign seroprevalences among children who received three routine OPV doses. Reasons for lack of adherence to the vaccination programme and the mass campaign are discussed. The findings strongly support the WHO strategy of conducting mass campaign in all endemic countries. However, as the mass campaign strategy now has been discontinued, it is crucial to increase the routine coverage and to improve acute flaccid paralysis surveillance in order to fulfil the goal of poliomyelitis eradication.