Persistent Transmission of Circulating Vaccine-Derived Poliovirus - Somalia, January 2017-March 2024.

Since the launch of the Global Polio Eradication Initiative in 1988, substantial progress has been made in the interruption of wild poliovirus (WPV) transmission worldwide: global eradication of WPV types 2 and 3 were certified in 2015 and 2019, respectively, and endemic transmission of WPV type 1 continues only in Afghanistan and Pakistan. After the synchronized global withdrawal of all serotype 2 oral poliovirus vaccines (OPVs) in 2016, widespread outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2) have occurred, which are linked to areas with low population immunity to poliovirus. Officials in Somalia have detected ongoing cVDPV2 transmission since 2017. Polio vaccination coverage and surveillance data for Somalia were reviewed to assess this persistent transmission. During January 2017-March 2024, officials in Somalia detected 39 cVDPV2 cases in 14 of 20 regions, and transmission has spread to neighboring Ethiopia and Kenya. Since January 2021, 28 supplementary immunization activities (SIAs) targeting cVDPV2 were conducted in Somalia. Some parts of the country are security-compromised and inaccessible for vaccination campaigns. Among 1,921 children with nonpolio acute flaccid paralysis, 231 (12%) had not received OPV doses through routine immunization or SIAs, 95% of whom were from the South-Central region, and 60% of whom lived in inaccessible districts. Enhancing humanitarian negotiation measures in Somalia to enable vaccination of children in security-compromised areas and strengthening campaign quality in accessible areas will help interrupt cVDPV2 transmission.

Combined use of inactivated and oral poliovirus vaccines in refugee camps and surrounding communities - Kenya, December 2013.

Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, circulation of indigenous wild poliovirus (WPV) has continued without interruption in only three countries: Afghanistan, Nigeria, and Pakistan. During April-December 2013, a polio outbreak caused by WPV type 1 (WPV1) of Nigerian origin resulted in 217 cases in or near the Horn of Africa, including 194 cases in Somalia, 14 cases in Kenya, and nine cases in Ethiopia (all cases were reported as of March 10, 2014). During December 14-18, 2013, Kenya conducted the first-ever campaign providing inactivated poliovirus vaccine (IPV) together with oral poliovirus vaccine (OPV) as part of its outbreak response. The campaign targeted 126,000 children aged ≤59 months who resided in Somali refugee camps and surrounding communities near the Kenya-Somalia border, where most WPV1 cases had been reported, with the aim of increasing population immunity levels to ensure interruption of any residual WPV transmission and prevent spread from potential new importations. A campaign evaluation and vaccination coverage survey demonstrated that combined administration of IPV and OPV in a mass campaign is feasible and can achieve coverage >90%, although combined IPV and OPV campaigns come at a higher cost than OPV-only campaigns and require particular attention to vaccinator training and supervision. Future operational studies could assess the impact on population immunity and the cost-effectiveness of combined IPV and OPV campaigns to accelerate interruption of poliovirus transmission during polio outbreaks and in certain areas in which WPV circulation is endemic.

Magnetic resonance imaging findings of intracranial tuberculoma patients in a tertiary hospital in Mogadishu, Somalia: A retrospective study.

Introduction: Tuberculosis (TB) is a fatal disease caused by Mycobacterium tuberculosis (M.TB) with over eight million annual mortality reported worldwide attributed to the disease's direct or indirect effects. Among the most severe form of M. TB is an infection of the Central nervous system (CNS-TB). This infection is characterized by meningitis, tuberculoma, and tuberculous brain abscess. Tuberculomas are the most common variety of intracranial parenchymal tuberculosis. They occur because of conglomeration and conjugation of tubercular microgranulomas, which tend to occur at the grey-white matter junction due to the arrest of the hematogenous disseminating microbes caused by a decrease in the caliber of vessels in that region. Intracranial tuberculoma shows central hypointensity compared to grey matter, seeing this centrally on T2W images is helpful, as it is not seen in most other ring-enhancing lesions. Objectives: The purpose of this study was to evaluate the findings of the magnetic resonance imaging (MRI) scan of patients with intracranial tuberculoma using retrospective hospital records. Methodology: We conducted a retrospective data analysis of 73 patients with an age range of 3-70 years between 2018 and 2021 who were diagnosed with intracranial tuberculoma using MRI features at the Radiology Department, Somali-Turkey Recep Tayyip Erdogan Hospital. All the patients' MRI were evaluated, including conventional and contrast sequences and as well as MR diffusion. Results: This study revealed that most tuberculoma patients were female with 43 (58.9%) and 30 (41.1%) male. According to age group, the majority of patients 30 (41.1%) were 18-30 years of age. Based on the distribution of the conglomerates' tubercles, 39 (53.4%) were located in the supratentorial region, while 24 (32.9%) were found in both the supra-tentorial and infra-tentorial regions, with 10 (13.7%) residing in the infratentorial region. Interestingly, this study also discovered that the majority of the tuberculoma patients 43 (58.9%) had multifocal lesions, with 30 (41.1%) having single lesions. Also, associated abnormalities were detected in 28 (38.4%) of the patients with meningitis, while 7 (9.6%) had both hydrocephalus and meningitis, 2 (2.7%) had hydrocephalus, and one patient had cerebral infarction. Conclusion: The outcome of this investigation shows MRI as a suitable diagnostic tool for the diagnosis of intracranial tuberculoma and associated abnormalities in geographic areas where tuberculosis is endemic.

Strategies to Reach Nomadic Children During Polio SIAs: Experience in Dadaab and Fafi Sub-Counties of Kenya after the 2013-2014 Polio Outbreak.

BACKGROUND: Poliomyelitis, often called polio is a viral paralytic disease caused by Polioviruses. Although all susceptible individuals are at risk of getting infected, only about 1% become paralyzed. During the 2013 Polio Outbreak in Garissa County in Kenya, 50% of the confirmed cases were from the nomadic population although it comprises of only less than 20% of the total population in the county. Following concerns from the Horn of Africa Polio Technical Advisory Group (TAG) regarding inadequate vaccine coverage of nomadic population, several strategies were put in place to improve coverage and Acute Flaccid Paralysis case reporting among nomads in the rest of the planned 2014 polio vaccination campaigns. We describe strategies initiated from April 2014 by the Ministry of Health and partners to reach children in nomadic settlement in the two sub-counties of Dadaab and Fafi of Garissa County. METHODS: The strategies involved improving the mapping and tracking of the nomadic population by establishing lists of nomadic settlements obtained from local clan leaders and government administrators, their <5-year-old populations and focal persons. Focal persons were used to mobilise residents in their respective settlements and guide vaccination teams during campaigns. Settlement leaders were sensitised to report cases of Acute Flaccid Paralysis. In remote hamlets, trained community health volunteers were used as vaccinators. In such places drugs for common illness were also provided during the campaigns. A tracking tool to monitor nomadic population movement and special tally sheets to capture data were created. Training of vaccination personnel and intense social mobilisation activities was done. RESULTS AND CONCLUSION: About 2,000 additional children, from both nomadic and non-nomadic areas were reached when the new initiatives were started. For the first time, an actual number of nomadic children accessed was documented. Suspected AFP cases continued to be reported from nomadic settlements, and the number of zero dose children among the nonpolio AFP cases dropped. With modification and improvement, these strategies may be used to take health services such as routine immunisation to nomadic communities and reduce their vulnerability to vaccine preventable disease outbreaks.

Evaluation of Borama tuberculosis control program in Somaliland, Somalia.

INTRODUCTION: The Borama TB program in Somalia lost resources for TB operations in 2003. We evaluated the impact of the loss on the program. METHODOLOGY: Pre-event (2002-2003) and post-event (2007) design were used. All TB patients registered in Borama and a sample of four months from Hargeisa (comparison) TB patients in both periods were abstracted. The following TB treatment outcomes were estimated: treatment success, treatment failure, case fatality, treatment interruption and transfer rates, along with percentage of patients with sputum specimen prior to treatment, percentage of patients from neighboring countries, and monthly average patients enrolled in treatment. The pre-event to post-event outcomes and measures were compared using descriptive and multivariate analyses. RESULTS: In total, 3,367 TB cases were abstracted. In Borama, the TB treatment success rate increased 6% in the post-event. The treatment failure and interruption rates both declined 75%. Monthly average TB patients declined 55%. Percentage of patients smear tested prior to the initiation of the treatment declined 9%. Percentage of TB patients from neighboring countries and other parts of Somalia declined 51%. Treatment interruption/transfer rates declined significantly in the post-event, compared to the pre-event period. Treatment failure/death rate did not change in the post-event period. In Hargeisa, the treatment success, failure/death, and interruption/transfer rates were similar in both periods. The RR did not change in these measures after adjusting for age and gender. CONCLUSIONS: This study indicates a significant setback to the Borama TB control program in the majority of measures evaluated, except the TB success rate.

Etiology and Incidence of Viral Acute Respiratory Infections Among Refugees Aged 5 Years and Older in Hagadera Camp, Dadaab, Kenya.

We used the Centers for Disease Control and Prevention-Kenya Medical Research Institute Acute Respiratory Infection (ARI) Surveillance System data to estimate severe acute respiratory infection (SARI) hospitalization rates, viral etiology, and associated complaints of influenza-like illnesses (ILI) and SARI conditions among those aged 5 years and older in Hagadera, Dadaab refugee camp, Kenya, for 2010-2012. A total of 471 patients aged ≥ 5 years met the case definition for ILI or SARI. SARI hospitalization rates per 10,000 person-years were 14.7 (95% confidence interval [CI] = 9.1, 22.2) for those aged 5-14 years; 3.4 (95% CI = 1.6, 7.2) for those aged 15-24 year; and 3.8 (95% CI = 1.6, 7.2) for those aged ≥ 25 years. Persons between the ages of 5 and 14 years had 3.5 greater odds to have been hospitalized as a result of SARI than those aged ≥ 25 years (odds ratio [OR] = 3.5, P < 0.001). Among the 419 samples tested, 169 (40.3%) were positive for one or more virus. Of those samples having viruses, 36.9% had influenza A; 29.9% had adenovirus; 20.2% had influenza B; and 14.4% had parainfluenza 1, 2, or 3. Muscle/joint pain was associated with influenza A (P = 0.002), whereas headache was associated with influenza B (P = 0.019). ARIs were responsible for a substantial disease burden in Hagadera camp.

Competence of maternal and child health clinic workers in detecting malnutrition in Somalia.

BACKGROUND: The MCH clinic workers in Somalia receive formal and in-service training to perform their professional duties. Their competence in the field was never examined. This study assessed their competencies in detecting malnourished children 5 years and below in Beledweyne. OBJECTIVE: To assess the competence of MCH clinic workers in detecting malnourished children. DESIGN: Cross-sectional study. METHODS: The study was conducted in 1989. We obtained data on children five years and below from the MCH clinic in Beledweyne, Somalia. We analyzed two months data. We used CASP program to calculate the Weight-for-Age index (WFA). The nutritional status determined by the MCH clinic workers and the WFA index were used to estimate the positive and negative predicted values of the MCH clinic workers' competence in detecting malnourished children. RESULTS: We studied 487 children 5 years old and below. The health workers determined that 13.5% were malnourished. The positive and negative predicted values of the MCH clinic workers' nutritional measure were 76% and 92% respectively. CONCLUSION: The MCH clinic workers showed deficiency in their competence to detect malnourished children. They misclassified 10% of the children, which was worse among the malnourished, due to incorrect plotting of the child's current weight on the growth chart.