Response to Poliovirus Outbreaks in the Lake Chad Sub-Region: A GIS Mapping Approach.

The geographic information system (GIS) mapping was used to improve the efficiency of vaccination teams. This paper documents the process in the deployment of geographical information system in response to polio eradication in Chad. It started with a careful review of government official documents as well as review of literature and online resources on Chad, which confirmed that official boundaries existed at two levels, namely Regions and Districts. All settlement locations in the target Districts were identified by manual feature extraction of high-resolution, recent satellite imagery, and map layers created for the following categories: hamlets, hamlet areas, small settlements, and built-up areas (BUAs). This clearly improved microplanning and provided valuable feedback in identifying missed settlements, leading to increased coverage and fewer missed children.

Use of Call Centers in Polio Eradication Efforts in Island Settlement in Chad.

BACKGROUND: One of the four key strategies of the Global Polio Eradication Initiative (GPEI) is high immunization coverage, with oral polio vaccine as part of routine immunization schedules. However, given the weak routine immunization structures in the African Region, coverage is enhanced with supplemental immunization activities (SIAs), and mop-up immunizations. Unfortunately, anecdotal information show that vaccination teams sometimes omit some catchments areas without immunization. This paper thus describes the use of "Call Centers" in detecting missed populations and taking prompt corrective action. METHOD: The study was based on review of call records during polio supplemental immunization campaigns in Bol Districts in Chad from February to May 2018. The immunization coverage resulting from these campaigns was compared with that of February 2018. A compilation of data - details on communities, community leaders, and their phone numbers was performed. On the eve of the campaign, community leaders were alerted on the vaccinators' visitThe community leaders were called on the eve of the campaign to alert them on the visit of the vaccinators. At the end of each day, activities (visits as well) were reviewed at the coordination centres Vaccinators were asked to return to any community where community leaders did not confirm visits). RESULT: Telephone calls allowed the verification and confirmation of the vaccinators visits in 92% of cases. Villages where vaccination was planned but which were not reached were revisited. More than 1,011 children were caught up through this approach in 10 villages in the Bol district. CONCLUSION: In conclusion, call centers played significantly higher role in generating covering more children with immunization during immunization campaign.

Overview of Polio Outbreak Response in Kenya, 2013 to 2015.

BACKGROUND: Globally, tremendous improvement has been made in Polio eradication since its inception in 1988. For the third time in a decade, Kenya has experienced a Polio outbreak along the border with Somalia. The affected areas were in Garissa County, replete with previous occurrences in 2006 and 2012. This article, give an account of series of events and activities that were used to stop the transmission within 13 weeks, an interval between the first and the last case of the 2013 outbreak. METHODS: In an attempt to stop further transmission and time bound closure of the outbreak, many activities were brought to fore: the known traditional methods, innovative approaches, improved finances and surge capacity. These assisted in case detection, implementation, and coordination of activities. The external outbreak assessments and the six-monthly technical advisory group recommendations were also employed. RESULT: There were increased case detections of >=2/100,000, stool adequacy >=80%, due to enhanced surveillance, timely feedbacks from laboratory investigation and diagnosis. Sustained coverage in supplemental immunisation of > 90%, ensured that immune profile of >=3 polio vaccine doses was quickly attained to protect the targeted population, prevent further polio infection and eventual reduction of cases coming up with paralysis. CONCLUSION: Overall, the outbreak was stopped within the 120 days of the first case using 14 rounds of supplemental immunisation activities.

Establishment and Use of Polio Communication Network in Response to Polio in Outbreak Countries of the Horn of Africa: 2013-2014.

BACKGROUND: Between 2013 and 2014, the Horn of Africa countries experienced a severe and prolonged outbreak of polio viruses. It started in one district in Somalia but quickly became a national and even international disaster, crossing international boundaries into Kenya and Ethiopia. This paper documents experiences in the establishment and contributions of the Polio Communication Network (PCN) to the polio outbreak response in the outbreak countries of Somalia, Kenya and Ethiopia from 2013 to 2015. PROCESS: The establishment of the PCN network of partnerships and technical assistance was designed to implement a strategic communication response. Various strategies were used to establish the PCN. Some of these strategies included partnerships with faith-based organizations; involvement of local leaders in microplanning; social mobilization committees and research, monitoring, evaluation and documentation structures. MAJOR OUTCOMES: PCN contributions through sustained high levels of community awareness of polio rounds were demonstrated. The contributions of the context-sensitive approaches included significant gains in reaching traditionally missed, hard-to-reach, pastoral communities with polio information, improved communication capacity, and successful closure of the outbreak within the expected timeline. This PCN experience provides important communication lessons relevant to polio eradication and other public health programmes. The focus on building capacity in areas such as monitoring, and data collection generated social data that led to the communication approaches making a significant impact. PCN contributed to a better understanding of the behavioral and environmental factors affecting the demand for, and uptake of, health services in the HoA which can be extended to most of the countries in the HoA with the same demographic and epidemiological realities. CONCLUSION: The use of the PCN helped bring the 2013-2014 polio outbreak under control and illustrates how the PCN can help drive progress towards the realization of the agenda of the universal health coverage and vision 2030 agenda in the African Region and elsewhere.

A statistical model of the international spread of wild poliovirus in Africa used to predict and prevent outbreaks.

BACKGROUND: Outbreaks of poliomyelitis in African countries that were previously free of wild-type poliovirus cost the Global Polio Eradication Initiative US$850 million during 2003-2009, and have limited the ability of the program to focus on endemic countries. A quantitative understanding of the factors that predict the distribution and timing of outbreaks will enable their prevention and facilitate the completion of global eradication. METHODS AND FINDINGS: Children with poliomyelitis in Africa from 1 January 2003 to 31 December 2010 were identified through routine surveillance of cases of acute flaccid paralysis, and separate outbreaks associated with importation of wild-type poliovirus were defined using the genetic relatedness of these viruses in the VP1/2A region. Potential explanatory variables were examined for their association with the number, size, and duration of poliomyelitis outbreaks in 6-mo periods using multivariable regression analysis. The predictive ability of 6-mo-ahead forecasts of poliomyelitis outbreaks in each country based on the regression model was assessed. A total of 142 genetically distinct outbreaks of poliomyelitis were recorded in 25 African countries, resulting in 1-228 cases (median of two cases). The estimated number of people arriving from infected countries and <5-y childhood mortality were independently associated with the number of outbreaks. Immunisation coverage based on the reported vaccination history of children with non-polio acute flaccid paralysis was associated with the duration and size of each outbreak, as well as the number of outbreaks. Six-month-ahead forecasts of the number of outbreaks in a country or region changed over time and had a predictive ability of 82%. CONCLUSIONS: Outbreaks of poliomyelitis resulted primarily from continued transmission in Nigeria and the poor immunisation status of populations in neighbouring countries. From 1 January 2010 to 30 June 2011, reduced transmission in Nigeria and increased incidence in reinfected countries in west and central Africa have changed the geographical risk of polio outbreaks, and will require careful immunisation planning to limit onward spread. Please see later in the article for the Editors' Summary.