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Polio surveillance improves in Nigeria
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Strategies implemented in the security-challenged Nigerian states of Adamawa, Borno and Yobe, which have weathered the brunt of the Boko Haram insurgency, improved the quality of polio surveillance from 2009 to 2014, according to a study published in The Journal of Infectious Diseases.
“The compromised security has resulted in the killing of health workers, the destruction of health facilities and the displacement of large numbers of individuals, all of which have negatively affected polio eradication activities, including surveillance,” Ado J.G. Muhammed, MBBS, MPH, executive director of the National Primary Health Care Development Agency, Abuja, Nigeria, and colleagues wrote. “These states are also at high risk for polio transmission, because even in the absence of security challenges, vaccine noncompliance was rampant in these areas, leading to widespread outbreaks of wild polio virus infection.”
Using data from WHO’s representative office in Nigeria, the researchers conducted a retrospective review of acute flaccid paralysis surveillance and examined reports of surveillance activities in Adamawa, Borno and Yobe to identify the strategies that were implemented to increase polio surveillance. They found that officials in Borno implemented environmental surveillance and began testing sewage samples for the presence of poliovirus in 2013, a move that was mirrored in Yobe in 2014. The proportion of disease surveillance and notification officers trained in the three states increased from less than 90% in 2013 to 100% in 2014, and the number of community informants substantially increased. In addition, messages educating the public on the importance of immunization and the need to report new cases were broadcast on radio and television during prime times, and concerns about immunization were addressed during phone-in programs.
Acute flaccid paralysis surveillance sensitivity, gauged by the rate of nonpolio-associated cases, was met in all three states. Officials in Borno and Yobe collected stool samples from three contacts of every individual with acute flaccid paralysis in 2014. Of the 792 contact samples that were expected to be assessed, 46% were collected and sent for analysis.
“We … found that traditional strategies of improving polio surveillance can be effective even in times of conflict,” Muhammed and colleagues wrote. “One of the key public health implications of our findings is that compromised security by itself is not an absolute barrier to achieving quality surveillance. We found that political commitment, adequate resources and determined and persistent efforts are required for optimal surveillance in the face of security challenges.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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