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. 2014 Nov 1;210 Suppl 1(Suppl 1):S40-9.
doi: 10.1093/infdis/jiu318.

Progress toward poliomyelitis eradication in Nigeria

J Mohammed Ado  1 , Andrew Etsano  1 , Faisal Shuaib  2 , Eunice Damisa  1 , Pascal Mkanda  3 , Alex Gasasira  4 , Richard Banda  3 , Charles Korir  3 , Ticha Johnson  3 , Boubacar Dieng  5 , Melissa Corkum  5 , Ogu Enemaku  5 , Noah Mataruse  5 , Chima Ohuabunwo  6 , Shahzad Baig  7 , Michael Galway  7 , Vincent Seaman  7 , Eric Wiesen  8 , John Vertefeuille  8 , Ikechukwu U Ogbuanu  8 , Gregory Armstrong  8 , Frank J Mahoney  8
Affiliations

Progress toward poliomyelitis eradication in Nigeria

J Mohammed Ado et al. J Infect Dis. .

Abstract

Background: Transmission of wild poliovirus (WPV) has never been interrupted in Afghanistan, Pakistan, and Nigeria. Since 2003, infections with WPV of Nigerian origin have been detected in 25 polio-free countries. In 2012, the Nigerian government created an emergency operations center and implemented a national emergency action plan to eradicate polio. The 2013 revision of this plan prioritized (1) improving the quality of supplemental immunization activities (SIAs), (2) implementing strategies to reach underserved populations, (3) adopting special approaches in security-compromised areas, (4) improving outbreak response, (5) enhancing routine immunization and activities implemented between SIAs, and (6) strengthening surveillance. This report summarizes implementation of these activities during a period of unprecedented insecurity and violence, including the killing of health workers and the onset of a state of emergency in the northeast zone.

Methods: This report reviews management strategies, innovations, trends in case counts, vaccination and social mobilization activities, and surveillance and monitoring data to assess progress in polio eradication in Nigeria.

Results: Nigeria has made significant improvements in the management of polio eradication initiative (pei) activities with marked improvement in the quality of SIAs, as measured by lot quality assurance sampling (LQAS). Comparing results from February 2012 with results from December 2013, the proportion of local government areas (LGAs) conducting LQAS in the 11 high-risk states at the ≥90% pass/fail threshold increased from 7% to 42%, and the proportion at the 80%-89% threshold increased from 9% to 30%. During January-December 2013, 53 polio cases were reported from 26 LGAs in 9 states in Nigeria, compared with 122 cases reported from 13 states in 2012. No cases of WPV type 3 infection have been reported since November 2012. In 2013, no polio cases due to any poliovirus type were detected in the northwest sanctuaries of Nigeria. In the second half of 2013, WPV transmission was restricted to Kano, Borno, Bauchi, and Taraba states. Despite considerable progress, 24 LGAs in 2012 and 7 LGAs in 2013 reported ≥2 cases, and WPV continued to circulate in 8 LGAs that had cases in 2012. Campaign activities were negatively impacted by insecurity and violence in Borno and Kano states.

Conclusions: Efforts to interrupt transmission remain impeded by poor SIA implementation in localized areas, anti-polio vaccine sentiment, and limited access to vaccinate children because of insecurity. Sustained improvement in SIA quality, surveillance, and outbreak response and special strategies in security-compromised areas are needed to interrupt WPV transmission in 2014.

Keywords: Nigeria; OPV; oral polio vaccine; poliovirus.

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Conflict of interest statement

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

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Trends in results of lot quality assurance sampling in high-risk states, Kano, and Borno, October 2012–January 2014.
Figure 2.
Figure 2.
Trends in environmental surveillance data, by state, 2013–2014. Abbreviations: cVDPV, circulating vaccine-derived poliovirus; VDPV, vaccine-derived poliovirus; WPV, wild poliovirus.
Figure 3.
Figure 3.
Trends in case counts of wild poliovirus (WPV) infection, 2003–2013, Nigeria.
Figure 4.
Figure 4.
Geographic distribution of wild poliovirus and circulating vaccine-derived polio viruses, by type, 2012–2013.
See this image and copyright information in PMC

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