Efforts Towards Polio Eradication in Madagascar: 1997 to 2017

Abstract

Background: In 1988, the World Health Assembly launched the Global Polio Eradication Initiative. WHO AFRO is close to achieve this goal with the last wild poliovirus detected in 2014 in Borno States in Nigeria. The certification of the WHO African Region requires that all the 47 member states meet the critical indicators for a polio free status. Madagascar started implementing polio eradication activities in 1996 and was declared polio free in June 2018 in Abuja. This study describes the progress achieved towards polio eradication activities in Madagascar from 1977- 2017 and highlights the remaining challenges to be addressed. Methods: Data were collected from the national routine immunization services, Country Acute Flaccid surveillance databases and national reports of SIAS and Mop Up campaign. Country complete polio and immunization related documentation provided detailed historical information’s. Results: From 1997 to 2017, Madagascar reported one wild poliovirus (WPV) outbreak and four circulating Vaccine Derived Polio Virus (cVDPV) oubreaks with a total of 21 polioviruses (1 WPV and 21 cVDPV). The last WPV and cVDPV were notified in 1997 in Antananarivo and 2015 in Sakaraha health districts respectively. Madagascar met the main polio surveillance indicators over the last ten years and made significant progress following the last cVDPV2 outbreak in 2014 -2015. In addition, the country successfully implemented the switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio vaccine (bOPV) and containment activities. Environmental Surveillance established since 2015 did not reveal any poliovirus. The administrative coverage of the 3rd dose of oral polio vaccine (OPV3) varied across the years from 55% in 1991 to a maximum of 95% in 2007 before a progressive decrease to 86% in 2017. The percentage of AFP cases with more than 3 doses of oral polio vaccines increased from 56% in 2014 to 88% in 2017. A total of 19 supplementary immunization activities (SIA) were conducted in Madagascar from 1997 to 2017, among which 3 were subnational immunization days (sNID) and 16 were national immunization days (NIDs). Poor routine coverage contributed to the occurrence of cVDPC outbreaks in the country; addressing this should remain a key priority for the country to maintain the polio free status. From 2015 to June 2017, Madagascar achieved the required criteria leading to the acceptance of the country’s polio-free documentation in June 2018 by ARCC. However, continuous efforts will be needed to maintain a highly sensitive polio surveillance system with emphasis on security compromised areas. Finally strengthening the health system and governance at all levels will be necessary if these achievements are to be sustained. Conclusions: High national political commitment and support of the Global Polio Eradication Partnership were critical for Madagascar to achieve polio free status. Socio-political instability, weakness of the health system, sub-optimal routine immunization performance, insufficient SIA quality and existing security compromised areas remain critical program challenges to address in order to maintaining the polio free status. Continuous high-level advocacy should be kept in order to ensure that new government authorities maintain polio eradication among the top priorities of the country.

Vaccination Coverage and Risk Factors Associated With Incomplete Vaccination Among Children in Cambodia, Madagascar, and Senegal

“…In Madagascar, coverage of the pentavalent vaccine was lower than that of OPV. This may be explained by possible mass vaccinations targeting polio vaccine, in which all children in a given age group, regardless of disease or vaccination history, are vaccinated [ 18 ]. Modifiable logistical or care organization issues such as stock-outs in distribution channels or possibly freezer breakdowns would need to be explored to better understand insufficient and asymmetric immunization coverage.…”

Innovative strategies developed to mitigate the impact of COVID-19 pandemic on polio surveillance in Nigeria, 2020

“…The Global Polio Eradication Initiative (GPEI) was inititated by World Health Assembly resolution in 1988 [ 1 , 2 ]. Global strategies for polio eradication include high levels of routine immunization, supplementary immunization activities, robust acute flaccid paralysis (AFP) surveillance and mop-up campaigns targeted to local areas with suspected or proven poliovirus transmission [ 3 - 5 ]. Acute flaccid paralysis (AFP) surveillance focuses activities where poliovirus transmission is found, allows for prompt detection in the case of an outbreak, and provides evidence of the lack of transmission.…”

“…For any World Health Organization (WHO) region to be certified as polio-free, there must be no detection of poliovirus for 3 consecutive years, with high quality surveillance systems meeting performance indicators to detect poliovirus [ 1 , 6 , 7 ]. Therefore, poliovirus surveillance remains the backbone for GPEI and the primary means is AFP surveillance [ 5 , 8 , 9 ]. Systematic sampling of sewage water and testing for poiiovirus (envitonmental surveillance) can supplement AFP surveillance.…”