The global switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV): facts, experiences and lessons learned from the south-south zone; Nigeria, April 2016

Abstract

BackgroundThe globally synchronized switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio Vaccine (bOPV) took place in Nigeria on April 18th 2016. The country is divided into six geopolitical zones. This study reports the experiences and lessons learned from the switch process in the six states that make up Nigeria’s south-south geopolitical zone.MethodsThis was a descriptive retrospective review of Nigeria’s switch plan and structures used for implementing the tOPV-bOPV switch in the south-south zone. Nigeria’s National Polio Emergency Operation Centre (NPEOC) protocols, global guidelines and reports from switch supervisors during the switch were used to provide background information for this study. Quantitative data were derived from reviewing switch monitoring and validation documents as submitted to the NPEOCResultsThe switch process took place in all 3078 Health Facilities (HFs) and 123 Local Government Areas (LGAs) that make up the six states in the zone. A total of $139,430 was used for this process. The ‘healthcare personnel’ component received the highest budgetary allocation (59%) followed by the ‘logistics’ component (18%).Akwa Ibom state was allocated the highest number of healthcare personnel and hence received the most budgetary allocation compared to the six states (total healthcare personnel = 458, total budgetary allocation = $17,428).Validation of the switch process revealed that eight HFs in Bayelsa, Cross-River, Edo and Rivers states still possessed tOPV in cold-chain while six HFs in Cross-River and Rivers states had tOPV out of cold-chain but without the ‘do not use’ sticker.Akwa-Ibom was the only state in the zone to have bOPV and Inactivated Polio Vaccine (IPV) available in all its HFs monitored.ConclusionThe Nigerian tOPV-bOPV switch was successful. For future Oral Polio Vaccine (OPV) withdrawals, implementation of the switch plan would be more feasible with an earlier dissemination of funds from global donor organizations, which would greatly aid timely planning and preparations. Increased budgetary allocation to the ‘logistics’ component to accommodate unexpected hikes in transportation prices and the general inefficiencies with power supply in the country is also advised.

Polio and Its Epidemiology

“…It also potentially provides a longer window for industry to increase production, integrate information from current fractional vaccine dosage and alternative routes of administration trials, and overcome problems of biocontainment and antigenicity associated with optional use of sIPV (using classic OPVor newly developed nOPVs) as a substitute for the wild strains used in IPV production. One of the problems observed during the switch from tOPV to bOPV was a recommendation to add a single dose of IPV before or at the time of switch to bOPV [379] was that there was not enough vaccine (IPV and/or bOPV) on hand and production delays led to under-vaccination of some birth cohorts in some countries or introduction of a single IPV dose rather than multiple IPV doses [380][381][382].…”

“…Eradication, which is tantalizingly close, will require substantial changes in vaccination policy and practice [160]. We have witnessed the disruptions that were caused in routine vaccination programs and in all facilities in every country including PEFs and non-PEFs within the global polio laboratory network when WPV2 was declared eradicated and phase 2 of GAP III put into operation for containment of material containing or potentially containing PV2 [381,[383][384][385][386][387][388][389][390][391][392][393][394][395][396]. Eradication of WPV3 will be declared in the very near future.…”

Poliovirus Immunity among Children Aged 6–11 and 36–48 Months in 14 Polio High-Risk Provinces of Afghanistan: A Health-Facility-Based Study

“…Serological surveys of antipoliovirus neutralizing antibodies have been carried out in many countries as a tool to evaluate program performance, assess population immunity gaps, and identify areas of high risk for poliovirus transmission [ 19 , 20 , 21 , 22 ]. The poliovirus immunity profiles of young children in China, Egypt, Indonesia, Madagascar, and India [ 23 ] have provided country-specific results that have led to programmatic actions and an immunity benchmark for the eradication initiative.…”

AFP Case Detection Along International Border Communities in Oyo State: Challenges, Opportunities and Threats

“…Four of the six World Health Organization regions have been certified as polio free nearly 3 decades after the World Health Assembly launched the Global Polio Eradication Initiative (GPEI) in 1988. [1,2] Nigeria, Afghanistan and Pakistan remain the only countries without a polio free certification. [3,4] Nigeria was readmitted to the list of polio endemic countries following the August 2016 incident where four WPV1 was discovered in Borno state.…”

“…[3,4] Nigeria was readmitted to the list of polio endemic countries following the August 2016 incident where four WPV1 was discovered in Borno state. [1] Though no new cases of WPV have been reported, Nigeria continues to implement prompt response strategies to ensure that the August 2016 scenario does not repeat itself.…”