Djibouti launches polio vaccination campaign to raise immunity nationwide
Djibouti, 12 October 2022 – The national polio vaccination campaign, initiated by the Government of Djibouti and carried out by the Ministry of Health, in collaboration with WHO and UNICEF, started on Monday 10 October 2022. It will run for five days, until Friday 14 October 2022.
More than 150 000 children under the age of 5 in Djibouti will receive an additional dose of the polio vaccine in this campaign, which follows 2 earlier vaccination rounds, in February and March 2022. The Ministry of Health, through this campaign, aims to protect all children throughout the country against poliovirus.
Djibouti was declared polio-free in 2002, but there are currently outbreaks of circulating variant polioviruses in the Horn of Africa, which increases the risk for all children in the Region.
This campaign, like the first 2 rounds, is a supplementary vaccination campaign offering children under 5 years of age an additional dose of oral polio vaccine to protect them from poliovirus, on top of their regular childhood vaccinations.
“It is our duty to protect Djibouti by ensuring that our children under 5 receive the polio vaccine whenever it is offered. I encourage all parents to make the vaccination of their children a priority – for them and for Djibouti,” said His Excellency the Minister of Health Dr Ahmed Robleh Abdilleh.
The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) are supporting the campaign by providing novel oral polio vaccine type 2 (nOPV2), a next-generation polio vaccine. The 2 UN agencies also provide technical support to teams and staff working in the health system, including in disease surveillance.
“WHO provided technical support to the Ministry of Health for the planning and execution of this campaign. With the number and severity of polio outbreaks in the region on the rise, coupled with Djibouti’s geographic location and historical role as a crossroads, its children are increasingly vulnerable to polio. For this reason, it is essential that we vaccinate all children under age five, even if these children are up to date with their regular vaccinations,” said Dr Reinhilde Van De Weert, WHO Representative in Djibouti.
During this campaign, 378 vaccination teams will crisscross every neighbourhood for 5 days and go door-to-door in Djibouti’s towns and even the most remote localities to vaccinate every child.
“Despite the extraordinary progress that has been made in the polio eradication effort over the past 3 decades, new cases of polio are emerging around the world, and this is not acceptable. It is vital that we do everything we can to protect children, once and for all,” said Ms Beate Dastel, UNICEF Representative in Djibouti.
Poliovirus mainly affects children under the age of 5 and can lead to lifelong paralysis. It can easily be prevented by vaccination. Parents are urged to accept polio vaccines whenever offered.
The vaccination campaign in Djibouti is also supported by Gavi, the vaccine alliance, CDC (Centers for Disease Control) and AFENET (African Field Epidemiology Network). It is part of the global poliovirus eradication effort, led by the Global Polio Eradication Initiative (GPEI).
What it took to close a polio outbreak in Sudan
25 September 2022 – It takes more than a town crier reading off a scroll to close a polio outbreak in any country. Rather, it takes multi-disciplinary teams of experts wading through country-level data from polio eradication programmes – often more than once. They scrutinize evidence, crunch numbers to analyse information, and interview health workers, polio teams and high-level authorities, among other activities, before arriving at a conclusion.
The recent poliovirus outbreak in Sudan
Sudan’s circulating vaccine-derived poliovirus (cVDPV) type 2 outbreak began with the importation of the virus from neighbouring Chad. Confirmed in August 2020, the outbreak affected and paralyzed 58 children in 42 districts of 15 states. Additionally, 14 sewage samples in Khartoum tested positive for cVDPV2, indicating circulation there.
In mounting a robust response to the outbreak, Sudan conducted 2 high-quality nationwide campaigns delivering monovalent oral polio vaccine type 2 (mOPV2) to children in all 18 states and 184 localities in November 2020 and January 2021. Each round, supported by the World Health Organization (WHO), UNICEF and other partners, vaccinated more than 8 million children aged under 5.
Who makes the decisions
On 7 October 2021, a virtual technical assessment mission kicked off the process of analysing the absence of polioviruses across Sudan. Members of the assessment group shared recommendations with Sudan’s polio eradication team to ramp up their efforts across the country.
Then, from 24 July to 1 August 2022, an official outbreak response assessment team undertook a second phase of this detailed task, visiting Khartoum and 6 of Sudan’s 18 states as part of its work.
Both review teams comprised experts from WHO and the United Nations Children’s Fund (UNICEF) with skills and experience in global public health, epidemiology and biostatistics, surveillance, vaccine management and communication. They worked closely with the Federal Ministry of Health of Sudan, with state-level ministry staff and with health workers at ground level.
Spotlight on polio surveillance
In particular, a review of the surveillance system is important to close any disease outbreak. In line with this, the assessment team analysed the functionality and sensitivity of the polio surveillance system in Sudan to ensure no polio cases have been missed. They noted that Sudan’s acute flaccid paralysis (AFP) surveillance indicators are meeting the necessary indicators, and that the 14 environmental surveillance sites across Sudan are collecting and testing samples regularly and in line with international protocols.
As per standard protocols, the team in Sudan collects stool samples from both children who are healthy and those with AFP. A review of data showed that all samples collected since 18 December 2020 – the date of onset of paralysis of the last child affected in the outbreak – were processed like clockwork in the laboratory in Sudan, reported as poliovirus negative and recorded.
Speaking to the role of surveillance in this process, Dr Hamid Jafari, WHO Director for Polio Eradication in the Eastern Mediterranean Region said, "The programme has to be extremely diligent and careful before it declares an outbreak to have ended. The most important element that drives that decision is the quality of surveillance; the ability of the country to detect any remaining circulating poliovirus."
Holistic overview of all technical work
The technical mission also reviewed the core functions of Sudan’s laboratories, the country’s preparation mechanisms for poliovirus events or outbreaks, data on population immunity and childhood immunization, and vaccine management protocol.
Following this extensive work, the outbreak team concluded that the spread of cVDPV2 has indeed stopped, and that the outbreak is over.
“Credits go to the Public Health Officers and immunization staff on the ground. A fast and well-planned response enhanced immunity among children and contained this outbreak in early months after the declaration. Despite the fact that this outbreak is over, we have received sufficient recommendations to maintain sensitive AFP surveillance, ensure better preparedness and response, enhance coverage of essential immunization, and strengthen cross-border coordination,” said Dr Ni’ma Saeed Abid, WHO Representative to Sudan.
While debriefing with the Government of Sudan and partners, the mission reiterated that Sudan remains at high risk of poliovirus, and that the current robust level of functionality and preparedness must be maintained in order to promptly detect and respond to any future emergence or importation of poliovirus.
Polio outbreak in Sudan successfully stopped and declared closed
Khartoum, 18 September 2022 – Sudan’s outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) has been successfully stopped, according to experts from WHO, UNICEF and the United States Centers for Disease Control and Prevention.
Declared in 15 out of 18 states, the outbreak was caused by a circulating vaccine-derived poliovirus (cVDPV2) strain imported from Chad, paralyzing 58 children.
Today’s announcement comes after virtual and in-country reviews of Sudan’s response to the outbreak and its surveillance system by a team of experts in polio eradication, global public health, epidemiology, and vaccine management. The final Outbreak Response Assessment, held between 24 July and 1 August 2022, included interviews and reviews of reports and records with surveillance and immunization staff at state, locality, and health facility levels. The findings of the Outbreak Response Assessment, coupled with the absence of the cVDPV2 virus for more than 18 months in the presence of sustained high-quality poliovirus surveillance, make it possible to conclude that the cVDPV2 outbreak can now be declared closed.
Nomina Akhtar continues to work for polio eradication while battling stage-3 breast cancer
A story of determination, friendship and support
19 August 2022 – In 2021, when the news of cancer hit, Nomina Akhtar felt her world collapsing. It was discovered too late. By the time she knew, it was already stage-3 breast cancer.
Since 2015, Akhtar has been part of Pakistan’s polio programme as a community health worker. During these 6 years, she has found friends and well-wishers among her team members who have given her the support to carry on.
Akhtar, 43 and a mother of 3 continues to work for polio eradication as she undergoes treatment for cancer. “I gathered my courage and promised that I will fight till the end and live for my children. All my family, colleagues and seniors were with me whenever I needed support. That gave me courage and made me believe that I could, in fact, beat cancer.”
Based in Peshawar, Nomina’s husband and her 3 children, aged 6, 7 and 18, rely solely on her income. The lockdowns due to the pandemic caused her husband, a motorcycle mechanic, to close down his shop that has yet to reopen.
A life with cancer has been both physically and emotionally exhausting. She is undergoing both radiation and chemotherapy in Peshawar. This means a commute of almost 20 kilometers after a whole day of work.
“When I have to go for chemotherapy after work, it becomes very draining. I have to take public transport and wait at the hospital for hours. There are times when I have to return without treatment because either the machine is faulty or something else comes up. This treatment regime along with the medicine will continue for at least 5 years. It’s excruciatingly painful,” she says.
Polio programme: a great source of strength for Akhtar
“My colleagues are like my extended family, and I am like a sister to them. When I found out about my cancer, they wept with me. They have stood by my children and myself every step of the way.”
The supervisor of her area, Uzma Mansoor, says that when they first heard the news, they were devastated. “But it’s great to see that she has not lost hope and is fighting the disease like a champion,” she said.
The community she works in has also been incredibly supportive. “Some of the people in my work area came to know about my illness and they appreciated the fact that despite fighting cancer, I come to their doorstep during every polio campaign. Irrespective of extreme temperatures and illness, I am there to vaccinate their children and protect them from this life-threatening disease. Their support has increased manifold after this.”
Sahibullah, the Union Council Polio Officer of her area, says not only does Nomina continue to vaccinate children, but she is a role model for all other polio workers.
“It was God’s will, and we will face it with courage,” says her husband Aurangzeb Akhtar. “Despite being ill, Nomina is the one who keeps us going. She is working and earning for our family as well as motivating us to not lose hope. My children and I are so proud of her. Inshallah she will get well very soon.”
Nomina has strong conviction. She is fighting cancer and polio simultaneously, and is determined that she will defeat both very soon. “At least cancer has treatment,” she says. “Polio is incurable and the sooner we end this disease forever, the better.”
