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. 2014 Nov 1;210 Suppl 1(Suppl 1):S181-6.
doi: 10.1093/infdis/jiu453.

Polio outbreak investigation and response in Somalia, 2013

Raoul Kamadjeu  1 , Abdirahman Mahamud  2 , Jenna Webeck  2 , Marie Therese Baranyikwa  3 , Anirban Chatterjee  3 , Yassin Nur Bile  4 , Julianne Birungi  2 , Chukwuma Mbaeyi  2 , Abraham Mulugeta  1
Affiliations

Polio outbreak investigation and response in Somalia, 2013

Raoul Kamadjeu et al. J Infect Dis. .

Abstract

Background: For >2 decades, conflicts and recurrent natural disasters have maintained Somalia in a chronic humanitarian crisis. For nearly 5 years, 1 million children <10 years have not had access to lifesaving health services, including vaccination, resulting in the accumulation by 2012 of the largest geographically concentrated cohort of unvaccinated children in the world. This article reviews the epidemiology, risk, and program response to what is now known as the 2013 wild poliovirus (WPV) outbreak in Somalia and highlights the challenges that the program will face in making Somalia free of polio once again.

Methods: A case of acute flaccid paralysis (AFP) was defined as a child <15 years of age with sudden onset of fever and paralysis. Polio cases were defined as AFP cases with stool specimens positive for WPV.

Results: From 9 May to 31 December 2013, 189 cases of WPV type 1 (WPV1) were reported from 46 districts of Somalia; 42% were from Banadir region (Mogadishu), 60% were males, and 93% were <5 years of age. All Somalian polio cases belonged to cluster N5A, which is known to have been circulating in northern Nigeria since 2011. In response to the outbreak, 8 supplementary immunization activities were conducted with oral polio vaccine (OPV; trivalent OPV was used initially, followed subsequently by bivalent OPV) targeting various age groups, including children aged <5 years, children aged <10 years, and individuals of any age.

Conclusions: The current polio outbreak erupted after a polio-free period of >6 years (the last case was reported in March 2007). Somalia interrupted indigenous WPV transmission in 2002, was removed from the list of polio-endemic countries a year later, and has since demonstrated its ability to control polio outbreaks resulting from importation. This outbreak reiterates that the threat of large polio outbreaks resulting from WPV importation will remain constant unless polio transmission is interrupted in the remaining polio-endemic countries.

Keywords: Somalia; horn of Africa; outbreak; poliomyelitis eradication; wild poliovirus.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts.

Figures

Figure 1.
Figure 1.
Weekly incidence of wild poliovirus (WPV) infection in Somalia and Banadir (Mogadishu) during epidemiology weeks 1–52 in 2013. Abbreviations: AFP, acute flaccid paralysis; cVDPV, circulating vaccine-derived poliovirus.
Figure 2.
Figure 2.
Geographical distribution of wild poliovirus (WPV) infections and district accessibility status in Somalia during epidemiology weeks 1–52 in 2013.
See this image and copyright information in PMC

References

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    1. WHO. Polio eradication and endgame strategic plan 2013–2018. Geneva: The Polio Eradication Initiative, 2013. http://www.polioeradication.org/resourcelibrary/strategyandwork.aspx. Accessed 17 January 2014.
    1. United Nations Statistics Division. World statistics pocketbook—Somalia. New York: UN Statistics, 2013. http://data.un.org/CountryProfile.aspx?crName=Somalia. Accessed 17 January 2014.
    1. UNHCR. 2014 UNHCR country operations profile - Somalia. Geneva: UNHCR, 2014. http://www.unhcr.org/pages/49e483ad6.html. Accessed 3 September 2014.
    1. WHO. WHO vaccine-preventable diseases: monitoring system. 2013 global summary—Somalia, Geneva: WHO, 2013. http://apps.who.int/immunization_monitoring/globalsummary/countries?coun.... Accessed 17 January 2014.

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