The reactive vaccination campaign against cholera emergency in camps for internally displaced persons, Borno, Nigeria, 2017: a two-stage cluster survey

Abstract

Introduction: In 2017, amidst insecurity and displacements posed by Boko Haram armed insurgency, cholera outbreak started in the Muna Garage camp for Internally Displaced Persons (IDPs) in Borno State, Nigeria. In response, the Borno Ministry of Health and partners determined to provide oral cholera vaccine (OCV) to about 1 million people in IDP camps and surrounding communities in six Local Government Areas (LGAs) including Maiduguri, Jere, Konduga, Mafa, Dikwa, and Monguno. As part of Monitoring and Evaluation, we described the coverage achieved, adverse events following immunisation (AEFI), non-vaccination reasons, vaccination decisions as well as campaign information sources.

Methods: We conducted two-stage probability cluster surveys with clusters selected without replacement according to probability-proportionate-to-population-size in the six LGAs targeted by the campaign. Individuals aged ≥1 years were the eligible study population. Data sources were household interviews with vaccine card verification and memory recall, if no card, as well as multiple choice questions with an open-ended option.

Results: Overall, 12 931 respondents participated in the survey. Overall, 90% (95% CI: 88 to 92) of the target population received at least one dose of OCV, range 87% (95% CI: 75 to 94) in Maiduguri to 94% (95% CI: 88 to 97) in Monguno. The weighted two-dose coverage was 73% (95% CI: 68 to 77) with a low of 68% (95% CI: 46 to 86) in Maiduguri to a high of 87% (95% CI: 74 to 95) in Dikwa. The coverage was lower during first round (76%, 95% CI: 71 to 80) than second round (87%, 95% CI: 84 to 89) and ranged from 72% (95% CI: 42 to 89) and 82% (95% CI: 82 to 91) in Maiduguri to 87% (95% CI: 75 to 95) and 94% (95% CI: 88 to 97) in Dikwa for the respective first and second rounds. Also, coverage was higher among females of age 5 to 14 and ≥15 years than males of same age groups. There were mild AEFI with the most common symptoms being fever, headache and diarrhoea occurring up to 48 hours after ingesting the vaccine. The most common actions taken after AEFI symptoms included 'did nothing' and 'self-medicated at home'. The top reason for taking vaccine was to protect from cholera while top reason for non-vaccination was travel/work. The main source of campaign information was a neighbour. An overwhelming majority (96%, 95% CI: 95% to 98%) felt the campaign team treated them with respect. While 43% (95% CI: 36% to 50%) asked no questions, 37% (95% CI: 31% to 44%) felt the team addressed all their concerns.

Conclusion: The campaign achieved high coverage using door-to-door and fixed sites strategies amidst insecurity posed by Boko Haram. Additional studies are needed to improve how to reduce non-vaccination, especially for the first round. While OCV provides protection for a few years, additional actions will be needed to make investments in water, sanitation and hygiene infrastructure.

Keywords: cholera; cross-sectional survey; public health; vaccines.

Figure 1

Vaccinated Local Government Areas (LGAs) in Borno, Nigeria - 2017. (A) Nigeria within the continent of Africa. (B) Neighbouring countries to Nigeria, Nigeria capital (Abuja) and Borno State where the first oral cholera vaccine in Nigeria were deployed in 2017. (C) LGA total and target population (pop) of the mass campaigns as well as number of wards and IDPs that were vaccinated. IDP, Internally Displaced Person.

Figure 2

Timeline of major activities of mass oral cholera vaccine campaigns in Borno, Nigeria 2017. (R1) and (R2) indicate rounds 1 and 2 campaigns, respectively. The red (planning activity), green (logistic activity) and blue (OCV deployment) dots on the timeline represents key milestones, while the colours represent the various phases leading up to the mass campaigns in Borno. The epidemic curve of the 2017 Borno outbreak is shown by the vertical bars above the timeline. Note that the decision to use OCV in Nigeria was not linked with the Borno outbreak; the latter only gave opportunity to implement decisions that were taken in May/June 2017. ICG, International Coordinating Group; MOH, Ministry of Health; NAFDAC, National Agency for Food and Drug Administration and Control; NCDC, Nigeria Centre for Disease Control; OCV, oral cholera vaccine.

Figure 3

Overall weighted OCV coverage by age and sex groups in the six LGAs combined. Excepting the ‘At least 1 dose’, coverage for the age group 1 to 4 years (yr) old female group was higher than for males of same age group. For children and adults of age 5 to 14 and 15+ years old, coverage was higher among the female than males, respectively. LGAs, Local Government Areas; OCV, oral cholera vaccine.