Bat and Lyssavirus Exposure among Humans in Area that Celebrates Bat Festival, Nigeria, 2010 and 2013.

Using questionnaires and serologic testing, we evaluated bat and lyssavirus exposure among persons in an area of Nigeria that celebrates a bat festival. Bats from festival caves underwent serologic testing for phylogroup II lyssaviruses (Lagos bat virus, Shimoni bat virus, Mokola virus). The enrolled households consisted of 2,112 persons, among whom 213 (10%) were reported to have ever had bat contact (having touched a bat, having been bitten by a bat, or having been scratched by a bat) and 52 (2%) to have ever been bitten by a bat. Of 203 participants with bat contact, 3 (1%) had received rabies vaccination. No participant had neutralizing antibodies to phylogroup II lyssaviruses, but >50% of bats had neutralizing antibodies to these lyssaviruses. Even though we found no evidence of phylogroup II lyssavirus exposure among humans, persons interacting with bats in the area could benefit from practicing bat-related health precautions.

Ornithodoros savignyi, the Tick Vector of "Candidatus Borrelia kalaharica" in Nigeria.

Endemic tick-borne relapsing fever (TBRF) has not been documented in Nigeria, yet clinically compatible cases have been described, and soft tick species are endemic in surrounding countries. Consequently, our aim was to investigate if TBRF-associated Borrelia is present in Nigeria. To address this, we examined 49 soft tick pools to identify the tick species and to screen for Borrelia The tick species was revealed by 16S rRNA gene amplification and Sanger sequencing to be Ornithodoros savignyi, an aggressive, multihost, rapidly feeding species with significant veterinary impact. We detected a Borrelia organism in 3 of 49 pooled samples (6%). Molecular analysis of amplified 16S rRNA and flagellin genes and intragenic spacer fragments disclosed that this Borrelia organism was synonymous with the recently described organism "Candidatus Borrelia kalaharica," identified in a tourist returning to Germany from South Africa. Given the widespread endemic range of this tick vector, TBRF should be considered part of the differential diagnosis for patients with fever returning from arid areas of Africa and further afield.

Assessing Inactivated Polio Vaccine Introduction and Utilization in Kano State, Nigeria, April-November 2015.

Background: Kano State, Nigeria, introduced inactivated polio vaccine (IPV) into its routine immunization (RI) schedule in March 2015 and was the pilot site for an RI data module for the National Health Management Information System (NHMIS). We determined factors impacting IPV introduction and the value of the RI module on monitoring new vaccine introduction. Methods: Two assessment approaches were used: (1) analysis of IPV vaccinations reported in NHMIS, and (2) survey of 20 local government areas (LGAs) and 60 associated health facilities (HF). Results: By April 2015, 66% of LGAs had at least 20% of HFs administering IPV, by June all LGAs had HFs administering IPV and by July, 91% of the HFs in Kano reported administering IPV. Among surveyed staff, most rated training and implementation as successful. Among HFs, 97% had updated RI reporting tools, although only 50% had updated microplans. Challenges among HFs included: IPV shortages (20%), hesitancy to administer 2 injectable vaccines (28%), lack of knowledge on multi-dose vial policy (30%) and age of IPV administration (8%). Conclusion: The introduction of IPV was largely successful in Kano and the RI module was effective in monitoring progress, although certain gaps were noted, which should be used to inform plans for future vaccine introductions.

Expanding polio surveillance reach beyond vaccination reach in Borno State, Nigeria: The contribution of community informants from insecure areas engaged to conduct polio surveillance in security compromised areas, 2018-2019.

INTRODUCTION: Borno state in north-eastern Nigeria is the epicentre of the >10 years' insurgency activities that have affected the region since 2009, resulting in the destruction of health facilities, killing of health workers, massive population displacement and lack of access to populations to provide health services. This article demonstrates how the involvement of community informants from insecure areas (CIIA) to conduct polio surveillance in security-challenged settlements of Borno state contributed to the expansion of polio surveillance reach beyond polio vaccination reach. METHOD: In each of the 19 security compromised Local Government areas (LGAs) with community informants from insecure areas, Android phones enabled with Vaccination Tracking System (VTS) technology and Open Data Kit (ODK) mobile application were provided to capture geo-coordinates as evidence (geo evidence) for polio surveillance activity conducted. These geo evidence captured were uploaded and mapped to show insecure settlements reached with polio surveillance and those yet to be reached. RESULTS: A total of 3183 security compromised settlements were reached for polio surveillance between March 2018 and October 2019 with valid geo evidence, 542 of these security-compromised settlements had not been previously reached by any other intervention for polio surveillance or polio vaccination. CONCLUSION: The capturing of geo-coordinates as a proxy indicator of polio surveillance activity conducted by informants provided significant evidence of settlements reached for sustained polio surveillance even when a case of Acute Flaccid Paralysis (AFP) had not been reported from these settlements. Using the geo evidence captured by CIIA in insecure settlements, we have demonstrated the expansion of polio surveillance reach beyond polio vaccination reach in Borno state.

Historical reconstruction of inaccessibility status in Local Government Areas (LGAs) of Borno and Yobe States, Nigeria, 2010-2020.

Introduction: ultimately detected in 2016, wild poliovirus (WPV) transmission continued undetected after 2011 in Northeast Nigeria Borno and Yobe States in security-compromised areas, inaccessible due to armed insurgency. Varying inaccessibility prevented children aged <5 years in these areas from polio vaccination interventions and surveillance, while massive population displacements occurred. We examined progress in access over time to provide data supporting a very low probability of undetected WPV circulation within remaining trapped populations after 2016. Methods: to assess the extent of inaccessibility in security-compromised areas, we obtained empirical historical data in 2020 on a quarterly and annual basis from relevant polio eradication staff for the period 2010-2020. The extent of access to areas for immunization by recall was compared to geospatial data from vaccinator tracking. Population estimates over time in security-compromised areas were extracted from satellite imagery. We compared the historical access data from staff with tracking and population esimates. Results: access varied during 2010-2020, with inaccessibility peaking during 2014-2016. We observed concurrent patterns between historical recalled data on inaccessibility and contemporaneous satellite imagery on population displacements, which increased confidence in the quality of recalled data. Conclusion: staff-recalled access was consistent with vaccinator tracking and satellite imagery of population displacments. Despite variability in inaccessibility over time, innovative immunization initiatives were implemented as access allowed and surveillance initiatives were initiated to search for poliovirus transmission. Along with escape and liberation of residents by the military in some geographic areas, these initiatives resulted in a massive reduction in the size of the unvaccinated population remaining resident.

Conducting public health surveillance in areas of armed conflict and restricted population access: a qualitative case study of polio surveillance in conflict-affected areas of Borno State, Nigeria.

This study examined the impact of armed conflict on public health surveillance systems, the limitations of traditional surveillance in this context, and innovative strategies to overcome these limitations. A qualitative case study was conducted to examine the factors affecting the functioning of poliovirus surveillance in conflict-affected areas of Borno state, Nigeria using semi-structured interviews of a purposeful sample of participants. The main inhibitors of surveillance were inaccessibility, the destroyed health infrastructure, and the destroyed communication network. These three challenges created a situation in which the traditional polio surveillance system could not function. Three strategies to overcome these challenges were viewed by respondents as the most impactful. First, local community informants were recruited to conduct surveillance for acute flaccid paralysis in children in the inaccessible areas. Second, the informants engaged in local-level negotiation with the insurgency groups to bring children with paralysis to accessible areas for investigation and sample collection. Third, GIS technology was used to track the places reached for surveillance and vaccination and to estimate the size and location of the inaccessible population. A modified monitoring system tracked tailored indicators including the number of places reached for surveillance and the number of acute flaccid paralysis cases detected and investigated, and utilized GIS technology to map the reach of the program. The surveillance strategies used in Borno were successful in increasing surveillance sensitivity in an area of protracted conflict and inaccessibility. This approach and some of the specific strategies may be useful in other areas of armed conflict.

National Stop Transmission of Polio Program support for polio supplemental immunization activities in Nigeria 2012-2016: deployment of management support team.

Introduction: to support polio eradication activities in Nigeria, in 2012 the National Polio Emergency Operation Center (NEOC) created the Management Support Teams (MST) to address gaps in the quality of supervision of polio vaccination teams. The National Stop Transmission of Polio (NSTOP) Program supported the polio eradication activities by deploying trained supervisors as part of the MST for polio and non-polio immunization campaigns. Methods: trained MST members were deployed approximately 4 days before the start of the campaign to participate in pre-implementation activities and supervise vaccination teams during campaigns. Terms of reference (TOR) developed by NEOC was provided to MST members to guide their activities. Qualified MSTs that met pre-determined criteria were selected and deployed to the field to support pre, intra and post campaigns activities. Results: a pool of over 400 MST personnel have been identified, trained, and repeatedly deployed from 2012 till 2016. The number of deployed MST personnel rose from 40 per campaign in October 2012 to 342 in May 2016. Of these, 270 (79%) MST personnel were deployed to 11 polio high-risk states of northern Nigeria, where campaigns are conducted between eight and ten times yearly as planned by NEOC. For measles campaigns, about 300 (75%) MST personnel were deployed for the one-off northern and southern campaigns in 2016. The results of clustered Lot Quality Assurance Sampling (LQAS) post-campaign vaccination coverage surveys, a measure of campaign quality, of which introduction into the polio program coincided with deployment of MSTs, showed improvement over time, from 10% (very poor quality) in February 2012 to about 90% (good quality) in December 2016. Conclusion: the deployment of MST personnel increased the number of trained supervisors in the field, frequency of supervisory visits and had a positive impact on the quality of polio campaigns.

Enhancing acute flaccid paralysis surveillance through the use of pictorial surveillance reminder cards during supplementary immunization activities, December 2014: a survey in Jigawa State, Nigeria.

Introduction: Acute flaccid paralysis (AFP) pictorial surveillance reminder cards (AFP cards) could aid AFP case identification during supplementary immunization activities (SIAs). We assessed the availability and utilization of AFP cards among vaccination teams during the December 2014 polio SIAs in Jigawa State, Nigeria. Methods: We conducted a cross-sectional survey of a convenience sample of 95 vaccination team supervisors. We used a semi-structured interviewer-administered questionnaire to collect information on socio-demographics, knowledge of AFP cases, availability and utilization of the AFP cards for case identification and investigation and non-compliance resolution by vaccination teams. Univariate and bivariate analyses were performed using Epi Info version 3.5.1. Results: Of the 95 supervisors interviewed, 86 (91%) reported that vaccinators properly displayed the AFP cards, 90 (95%) reported use of cards for AFP case identification, 88 (93%) reported use of cards to resolve non-compliance with polio vaccination and 77 (81%) reported use of cards to ask caregivers six key questions to prevent missed children. Fifty-eight (61%) supervisors knew the AFP case definition. A total of 21 possible AFP cases were identified by vaccination team members with the aid of the cards, of which 17 (81%) were referred to the nearest health facility. Conclusion: The survey demonstrated usefulness of reminder cards for identification and follow-up of AFP cases. Based on these findings, use of AFP cards was implemented in all Nigerian States and similar cards were developed and implemented for measles surveillance during SIAs.

Prevalence of Needlestick Injury and Its Potential Risk among Veterinarians in Nigeria.

A cross sectional study using multistage sampling method by means of structured interviewer administered questionnaire was designed to estimate the rate of occurrence of needlestick injuries among veterinarians involved in clinical practice and to evaluate needle handling practices and risk factors. The study was carried out during the months of August-November 2015. Out of the 215 veterinarians that participated in the survey, 171 (79.5%) reported to have suffered needlestick injuries (NSIs). In the multivariable model, only male sex (OR 2.8, 95% CI 1.4-6.0, and P = 0.006) and working with poultry daily (OR 2.4, 95% CI 1.1-6.2, and P = 0.036) were significantly associated with NSI. Most (111, 64.9%) veterinarians had discomfort including pain, headache, fever, worry, and local numbness from NSIs; however, none was hospitalised. Only 1 (0.6%) had lost time at work. The approach to needlestick injury avoidance was poor and most (98.8%) NSIs were not reported. The findings of this research call for comprehensive health and injection safety programs for veterinarians involved in clinical practice.