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Conflict in Central African Republic interrupts anti-poliovirus activities
Researchers are calling for more efforts to improve poliovirus vaccination and surveillance activities in the Central African Republic, which have been sidelined in the region during the height of a military and political crisis, according to recent study findings.
The last case of wild poliovirus in the Central African Republic (CAR) was identified in November 2011, Alain Farra, of the Enteric Viruses and Measles Laboratory at the Institut Pasteur de Bangui in CAR, and colleagues reported in Open Forum Infectious Diseases. With active surveillance of acute flaccid paralysis (AFP), the country would be on track to receive certification for poliomyelitis eradication. However, a severe military and political crisis that intensified in December 2012 has disrupted health care activities, including AFP surveillance.
“Surveillance in Africa is strongly affected in zones of insecurity, such as certain cities in Nigeria and in North Kivu in the Democratic People’s Republic of the Congo, where there are armed militias that make it difficult to conduct active case finding for AFP,” Farra and colleagues wrote. “The CAR should be moving towards certification as poliomyelitis-free; however, the low national vaccination rates … might compromise the strategy for eradication in the country.”
Farra and colleagues compared laboratory data collected prior to the start of the crisis in 2007 with data obtained during the most severe period of the conflict in 2013 and 2014 to determine the extent of its impact on anti-poliovirus interventions. Most fecal samples sent to the laboratory in 2013 (52.5%) and 2014 (68.4%) for AFP surveillance were obtained from children aged 5 years or younger. The mean number of samples collected annually before 2013 was 274 — well above the 150 samples requested by WHO, the researchers wrote. However, only 118 samples were registered at the laboratory in 2013, representing a 57% decline in active surveillance. In response, members of the country’s ministry of health and WHO strengthened surveillance activities despite security issues, increasing the number of samples registered in 2014 to 177 — a 50% increase from 2013, but still a 36% decrease from previous years.
Among children with AFP, only 37.3% in 2013 and 49.7% in 2014 were vaccinated against poliovirus; however, no wild-type or vaccine-derived poliovirus cases were reported. Laboratory performance for timeliness of viral isolation and intratypic differentiation results reached only 65.5% and 66.7% of the targets in 2013, but were met in 2014.
“From 2014, all the performance indicators for both surveillance and laboratory work began to improve consistently,” Farra and colleagues concluded. “Many children still live in internal displaced camps, and some regions of the country remain inaccessible because of the presence of armed militias. Peace and security are essential to allow health workers to resume their activities and become operational again in order to restore health services throughout the country.” – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.