Despite new cases of circulating vaccine-derived poliovirus type 2, Nigeria may get a polio eradication certificate since the country has gone over 24 months with very strong surveillance without a case of wild polio virus

By Anayo Ezugwu

WITH reported new cases of circulating vaccine-derived poliovirus type 2, cVDPV2, outbreaks in Baruten local government area of Kwara state, Nigeria is at risk of not attaining polio free status this year. So far this year, the country has reported four cVDPV2 cases with a total number 34 cVDPV2 cases in 2018.

According to the Global Polio Eradication Initiative, the case in Kwara State was the first to be reported in Nigeria and globally in 2019. Since then, the country has recorded two cVDPV2-positive environmental samples in Damaturu local government area of Yobe State and Maiduguri local government area of Borno State. The samples were collected between on February 20, and March 5, respectively.

But the Global Polio Eradication Initiative confirmed that no case of wild poliovirus type 1, WPV1, has been reported in the country since the one detected in Borno State on August 21, 2016. It stated that the country has continued to be affected by two separate cVDPV2 outbreaks – the first centred in Jigawa State with subsequent spread to other states as well as to neighbouring Republic of Niger, and the second in Sokoto State.

The Global Polio Eradication Initiative in their latest report published on March 6, stated that recent confirmation of spread of one of the cVDPV2 outbreaks, both within Nigeria and internationally, underscores the urgent need to fill remaining vaccination gaps in the ongoing outbreak response, and to optimise the geographic extent and operational quality of mOPV2 response. At the same time, it said outbreak response to WPV1 continues, including efforts to address surveillance and immunity gaps in parts of Borno State.

Nigeria is one of only three countries in the world endemic to wild poliovirus, alongside Afghanistan and Pakistan. The country is also affected by cVDPV2 outbreaks. With the latest cases found in the country, the window period for Nigeria to attain polio free status certification might be extended to 2022.

It should be recalled that Nigeria was declared polio free in 2014, but two years later, it experienced a major setback as four new cases of WPV was detected in Borno State. However, the country has been free from WPV since 2016. While this development has begun to create concerns, World Health Organisation, WHO, has said it is not a setback even though it is also a perquisite.

Matshidiso Moeti, regional director for Africa, WHO, said since the launch of the Global Polio Eradication Initiative, GPEI, nearly 30 years ago, new cases of polio have dropped by more than 99.9 percent – from 350,000 cases every year in more than 125 affected countries, to 22 wild polio cases in 2017 in two affected countries.

She said African region has now reached an important milestone towards eradication. “It has been more than two years since the last case of wild poliovirus. I applaud the excellent efforts of governments, polio eradication partners, communities, parents and health workers in achieving this magnificent milestone.

“However, this is no time to be complacent. Until polio is eradicated, all countries remain at risk of outbreaks. As a Region, Africa can only be certified to have eradicated polio if three years have passed without any confirmed wild poliovirus, and if polio surveillance has been maintained at the level required for certification. If no new case is confirmed, and surveillance is quickly strengthened, the African region can be certified to have eradicated polio by the end of 2019 or early 2020,” she said.

Likewise, Oyewale Tomori, chairman, Expert Review Committee on Polio and Routine Immunisation in Nigeria, is optimistic that Nigeria will end polio and strengthen routine immunisation programmes in the country. He said Nigeria should not relent on its routine immunisation programmes even after securing certificate of a polio-free status.

On his part, Faisal Shuaib, executive director, National Primary Health Care Development Agency, NPHCDA, said the country may be certified polio-free in August 2019, if access to insecure areas in Borno State and some parts of the North-East, improves. He said Nigeria was very close to obtaining a polio eradication certificate, adding that the country had gone over 24 months with very strong surveillance without a case of wild polio virus.

He said the surveillance showed clearly that government was not missing any wild polio in the country. “If this positive trajectory continues, then it is very likely that certification institutions will review the progress that Nigeria has made and the lack of wild polio virus transmission. Very likely, in the next few months, we will be certified a polio-free nation. It will be an unprecedented declaration in the life of Nigerians; a situation where no single child is paralysed due to wild polio virus,’’ he said.

Shuaib reiterated the agency’s commitment to sustain the population’s immunity against wild polio virus and other vaccine-preventable diseases through strengthened routine immunisation programmes. “One of the greatest challenges we still face is around mothers and care givers bringing their kids to health facilities to access routine immunisation, even in the urban centres where places are accessible.

“We still have that challenge largely because folks have not realised the need for kids to take the full complement of routine immunisation vaccines let alone in the hard-to-reach areas,’’ the executive director said.

Tunji Funsho, consultant physician and chairman, Polio plus Committee, Rotary International, said the race to be polio free is not against time, but against polio. “The race is not against time, but against polio. If the WHO certifies Nigeria polio-free, and two months later we find polio in Nigeria that will not be the idea. We want every child in Nigeria to be polio-free that is the goal.

“No matter how long it will take us to eradicate polio in Nigeria, we will be patient. It is not a thing of ego but that Nigeria is actually polio-free. The new cases in the North-East, will not discourage us, rather it is a call for action,” he said.

In May 2012, the World Health Assembly, WHA, declared polio eradication as a global public health emergency. To put an end to the crippling disease, the director-general of the World Health Organization, WHO, established the Polio Eradication and Endgame Strategic Plan, PEESP, 2013–2018.

– Apr. 12, 2019 @ 17:42 GMT |