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AFP Surveillance Quality and Wild Poliovirus Epidemiology

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Expert Review Committee (ERC) Meeting on Polio Eradication in Nigeria

Summary

This presentation was part of the 12th meeting of the Expert Review Committee on polio eradication in Nigeria, the first to be held in the country following the global Urgent Stakeholder Consultation on Polio Eradication in Geneva in February 2007. The meeting reviewed progress made on recommendations since the previous 11th ERC meeting, held in December 2006, in all major areas of Nigeria's polio eradication and routine immunisation programmes. In attendance were members from the National Primary Health Care Development Agency (NPHCDA), the World Health Organization (WHO), the Government of Nigeria, and members from the "Very High Risk" (VHR) states of Kano, Katsina and Jigawa.


This presentation reviews acute flaccid paralysis (AFP) surveillance quality and wild poliovirus (WPV)pepidemiology in Nigeria. In particular, it outlines surveillance and laboratory performance, the current WPV burden, and assesses whether Nigeria is in fact making any progress towards eradication. The challenges remaining for the programme in the latter half of 2007 are also addressed.



The national non-polio AFP rate in Nigeria has increased from 5.1 in 2006 to 8.0 in 2007. The stool adequacy rate has also improved, reaching 90% across the country in 2007 as compared to 82% in 2006. The two major polio laboratories in Nigeria, Ibadan and Maiduguri, were rated against performance on four main indicators between 2006 and 2007. The Maiduguri laboratory is currently only provisionally accredited, subject to further review.

According to the presenters, Nigeria continues to maintain certification-level AFP surveillance performance indicators, and an improvement in these indicators has been demonstrated in the first quarter of 2007 as compared to the same period in 2006. Orphan virus strains have been identified most often in state-bordering legal government areas (LGAs), which could be attributed to expansion of AFP surveillance to underserved areas. The team proposes maintaining and improving on current levels of AFP surveillance indicators through: consolidating plans for capacity building and supportive supervision to underperforming areas; monitoring laboratory performance and providing necessary support to the laboratories; strengthening documentation, reporting and feedback at all levels; and conducting peer reviews and implementing recommendations based on findings.



The epidemiology of WPV in Nigeria reflects a concentration of cases in the north of the country, with southern Nigeria remaining polio free over the last year. As of March 2007, 63 cases were observed in 15 states. Over 38% of these cases occurred in children who had received at least three doses of oral polio vaccine (OPV). Currently, the majority of infected LGAs are on state borders or riverine areas, and are hard to reach during standard vaccination rounds.

The following four key points regarding the epidemiology of WPV in Nigeria were offered:

  1. There has been a significant decline in WPV burden in early 2007 (approximately of the total number of
    WPV cases).
  2. A significant reduction (approximately 95%) of WPV Type 1 has been observed.
  3. Unlike previous years, WPV Type 3 is currently the largest burdent of WPV in Nigeria.
  4. Specific areas and children, particularly in hard-to-reach locales, are still being missed by Immunisation Plus Days (IPDs).



Proposed ways forward suggested by the team include:

  • Continue Improving Quality of IPDs - in order to reach missed areas and children, through microplanning, more rigorous team selection, increased supervision and social mobilisation activities.
  • Introduction of Additional Innovations - to control and interrupt surge in WPV Type 3 cases, through conducting in-between round activities and expediting the licensing and use of monovalent oral polio vaccine 3 (mOPV3).
  • Continue Strengthening Routine Immunisation - by accelerating the Reach Every Ward (REW) strategy implementation.



In conclusion, the team asked the following question of the ERC:


Are there additional innovations that we should be doing to interrupt wild poliovirus in Nigeria in 2007 or early 2008?