Trends in measles incidence and measles vaccination coverage in Nigeria, 2008-2018

INTRODUCTION: All WHO regions have set measles elimination objective for 2020. To address the specific needs of achieving measles elimination, Nigeria is using a strategy focusing on improving vaccination coverage with the first routine dose of (monovalent) measles (MCV1) at 9 months, providing measles vaccine through supplemental immunization activities (children 9-59 months), and intensified measles case-based surveillance system. METHODS: We reviewed measles immunization coverage from population-based surveys conducted in 2010, 2013 and 2017-18. Additionally, we analyzed measles case-based surveillance reports from 2008-2018 to determine annual, regional and age-specific incidence rates. FINDINGS: Survey results indicated low MCV1 coverage (54.0% in 2018); with lower coverage in the North (mean 45.5%). Of the 153,097 confirmed cases reported over the studied period, 85.5% (130,871) were from the North. Moreover, 70.8% (108,310) of the confirmed cases were unvaccinated. Annual measles incidence varied from a high of 320.39 per 1,000,000 population in 2013 to a low of 9.80 per 1,000,000 in 2009. The incidence rate is higher among the 9-11 months (524.0 per million) and 12-59 months (376.0 per million). Between 2008 and 2018, the incidence rate had showed geographical variation, with higher incidence in the North (70.6 per million) compare to the South (17.8 per million). CONCLUSION: The aim of this study was to provide a descriptive analysis of measles vaccine coverage and incidence in Nigeria from 2008 to 2018 to assess country progress towards measles elimination. Although the total numbers of confirmed measles cases had decreased over the time period, measles routine coverage remains sub-optimal, and the incidence rates are critically high. The high burden of measles in the North highlight the need for region-specific interventions. The measles program relies heavily on polio resources. As the polio program winds down, strong commitments will be required to achieve elimination goals

The cost of implementing measles campaign in Nigeria:comparing the stand-alone and the integrated strategy

Background: Effective integration, one of the seven strategic priorities of the Immunization Agenda 2030, can contribute to increasing vaccination coverage and efficiency. The objective of the study is to measure and compare input costs of “non-selective” measles vaccination campaign as a stand-alone strategy and when integrated with another vaccination campaign.Methods: We conducted a cost-minimization study using a matched design and data from five states of Nigeria. We carried-out our analysis in 3 states that integrated measles vaccination with Meningitis A and the 2 states that implemented a stand-alone measles campaign. The operational costs (e.g., costs of personnel, training, supervision etc.) were extracted from the budgeted costs, the financial and technical reports. We further used the results of the coverage surveys to demonstrate that the strategies have similar health outputs.Results: The analysis of the impact on campaign budget (currency year: 2019) estimated that savings were up to 420,000 United States Dollar (USD) with the integrated strategies; Over 200 USD per 1,000 children in the target population for measles vaccination (0.2 USD per children) was saved in the studied states. The savings on the coverage survey components were accrued by lower costs in the integration of trainings, and through reduced field work and quality assurance measures costs.Conclusions: Integration translated to greater value in improving access and efficiency, as through sharing of costs, more life-saving interventions are made accessible to the communities. Important considerations for integration are resource needs, micro-planning adjustments, and health systems delivery platforms.</p

COVID-19 vaccine hesitancy amongst healthcare workers: An assessment of its magnitude and determinants during the initial phase of national vaccine deployment in Nigeria.

Background: While vaccination plays a critical role in the global response to the COVID-19 pandemic, vaccine rollout remains suboptimal in Nigeria and other Low- and Middle-income countries (LMICs). This study documents the level of hesitancy among health workers (HWs) during the initial COVID-19 vaccine deployment phase in Nigeria and assesses the magnitude and determinants of hesitancy across Nigeria. Methods: A cross sectional study across all States in Nigeria was conducted with over 10,000 HWs interviewed between March and April 2021. Data were cleaned and analyzed with proportions and confidence intervals of hesitancy documented and stratification by HW category. We compared the level of confidence/acceptance to be vaccinated across Nigeria and documented the sources of negative information amongst HWs who refused the vaccine. Findings: Among the 10 184 HWs interviewed, 9 369 [92% (95% CI= 91, 92)] were confident of the COVID-19 vaccines and were already vaccinated at the time of this survey. Compared to HWs who were less than 20 years old, those aged 50 - 59 years were significantly more confident of the COVID-19 vaccines and had been vaccinated (OR=3.8, 95% CI=2.3 - 6.4, p<0.001). Only 858 (8%) of the HWs interviewed reported being hesitant with 57% (479/858) having received negative information, with the commonest source of information from social media (43.4%.). Interpretation: A vast majority of HWs who were offered COVID-19 vaccines as part of the first phase of national vaccine roll out were vaccinated and reported being confident of the COVID-19 vaccines. The reported hesitancy was due mainly to safety issues, and negative information about vaccines from social media. The issues identified remain a significant risk to the success of subsequent phases of the vaccine rollout in Nigeria. Funding: None

Institutionalizing documentation for WHO Nigeria country office visibility and improved donor relations, 2013–2016

Abstract Background The mandate and unique experience of the World Health Organization (WHO) globally, enables over 190 countries, Nigeria inclusive, to depend on the technical support provided by the organization to define and mitigate the threats to public health. With other emerging health actors competing for scarce donors’ resources, the demand for visibility has invariably equaled expectations on WHO’s expertise and technical support. However, the inability to systematically document activities conducted by WHO personnel before 2013 overshadowed most of its invaluable contributions due to poor publicity. The inauguration of the Communications Group in December 2013 with a visibility plan necessitated a paradigm shift towards building a culture of documentation to engender visibility. Methods We used a pre-post design of activities to evaluate the effectiveness of specific interventions implemented to improve visibility from 2013 to 2016. The paper highlights how incorporating communication strategies into the accountability framework of staff contributed in changing the landscape as well as showcasing the activities of WHO in Nigeria for improved donor relations. Results With the specific interventions implemented to improve WHO’s visibility in Nigeria, we found that donor relations improved between 2013 and 2015. It is not a mere coincidence that the period corresponds with the era of incorporation of documentation into the accountability framework of technical staff for visibility as locally mobilized resources increased to record 112% in 2013 and 2014. The intervention assisted in the positive projection of WHO and its donors by the Nigeria media. Conclusion Despite several interventions, which worked, made WHO ubiquitous and added awareness and visibility for donors who funded various projects, other factors could have contributed towards achieving results. Notwithstanding, incorporating documentation component into the accountability framework of field staff and clusters has significantly improved communication of WHO’s work and promoted healthy competition for increased visibility

Measles outbreak in complex emergency: estimating vaccine effectiveness and evaluation of the vaccination campaign in Borno State, Nigeria, 2019.

Background: From January to May 2019, large measles outbreaks affected Nigeria. Borno state was the most affected, recording 15,237 suspected cases with the state capital of Maiduguri having 1125 cases investigated and line-listed by March 2019. In Borno state, 22 of the 27 Local Government Areas (LGAs or Districts), including 37 internally displaced persons (IDPs) camps were affected. In response to the situation, an outbreak response immunization (ORI) campaign was conducted in the 13 most affected LGAs. In addition to conventional vaccination teams, special teams were deployed in security compromised areas, areas with migrants, and for nomadic and IDPs. Here we describe the outbreak and the ORI campaign. We also assess the measles-containing vaccine (MCV) coverage and vaccine effectiveness (VE) in order to quantify the population-level impact. Methods: We reviewed the ORI activities, and conducted an analysis of the surveillance and the outbreak investigation reports. We assessed VE of MCV by applying the screening-method. Sensitivity analyses were also conducted to assess the effect of final classification of cases on the VE of MCV. The MCV coverage was assessed by a post-campaign coverage survey after completion of the ORI through a quantitative survey in the 12 LGAs that were accessible. Results: Of the total 15,237 reported measles cases, 2002 cases were line-listed and investigated, and 737 were confirmed for measles by week 9 of 2019. Of the investigated cases 67.3% (n = 1348) were between 9 and 59 months of age. Among the 737 confirmed cases, only 9% (n = 64) stated being vaccinated with at least 1 dose of MCV. The overall VE for MCV was 98.4% (95%CI: 97.8–98.8). No significant differences were observed in the VE estimates of lab-confirmed and epi-linked cases when compared to the original estimates. The aggregated weighted vaccination coverage was 85.7% (95% CI: 79.6–90.1). Conclusion: The experience in Borno demonstrates that adequate VE can be obtained in conflict-affected areas. In complex emergencies affected by measles outbreaks, health authorities may consider integration with other health strategies and the engagement of security personnel as part of the ORI activities

Measurements of ammonia in ambient air and over a controlled artificial source during the AMICA field campaign at a rural site in the Ile-de-France region

International audienceAmmonia is an atmospheric pollutant precursor of inorganic fine particles (sulphate and ammonium nitrate particles) that are particularly harmful to human health. Ammonia and particulate matter (PM) are responsible for severe pollution outbreaks over Europe (LCSQA, LCSQA 2019), during springtime of 2012 (Kutzner et al., 2021), 2014 (Fortems-Cheiney et al., 2016), 2015 (Petit et al., 2017), 2016 (Tournadre et al., 2020: Viatte et al., 2020) and 2020 (Viatte et al., 2021). Despite this major societal and scientific interest, there is a crucial lack of routine ammonia and aerosol speciation observations. One of the scientific reasons comes from the difficulty to measure atmospheric ammonia due to its sticky, volatile, and reactive nature (von Bobrutzki et al., 2010).The objective of the Multi-Instrumental Analysis of Ammonia Concentrations (AMICA) project is to compare the response of different available systems for measuring atmospheric ammonia at a rural site in the &#206;le-de-France region. The 14 instruments based on different NH3 measurement techniques are compared over a wide range of ammonia concentrations from ambient atmospheric to boosted concentrations (10 to 600 ppbv) using an innovative 400 m2 ammonia emission system. They are all synchronized with a cross-correlation function based on the median value. At elevated concentrations all inlet-based instruments sampling to the same manifold performed very well on precision, even at high temporal resolution monitoring (1 min) that highlights a great progress for current in situ NH3 analysers. By comparing with the data from a mini Differential Optical Absorption Spectrometer (miniDOAS) and a sequential acid trap-IC (ROSAA), we demonstrated that inlet design perturbs the response time of the instruments connected to the manifold, which was already mentioned in literature. This measurement campaign is part of a series of ammonia projects that have recently taken place in France.ReferencesFortems-Cheiney, A., et al., Geophys. Res. Lett., 43, 5475&#8211;5482, https://doi.org/10.1002/2016GL069361, 2016.Kutzner, R. D., et al., Atmos. Chem. Phys., 21, 12091&#8211;12111, https://doi.org/10.5194/acp-21-12091-2021, 2021.LCSQA, Le Laboratoire Central de Surveillance de la Qualit&#233; de l'Air, Bilan des travaux 2018-2019 du programme CARA, Ref. INERIS : DRC-19-181155-02828A, 2019.Petit, J.-E. , et al., T, Atmospheric Environment, Volume 155, 2017, Pages 68-84, ISSN 1352-2310, https://doi.org/10.1016/j.atmosenv.2017.02.012.Tournadre, B., et al., Atmos. Meas. Tech., 13, 3923&#8211;3937, https://doi.org/10.5194/amt-13-3923-2020, 2020.Viatte, C., et al., Atmos. Chem. Phys., 20, 577&#8211;596, https://doi.org/10.5194/acp-20-577-2020, 2020.Viatte C., et al., Atmosphere, 2021, 12, 160, https://doi.org/10.3390/atmos12020160.von Bobrutzki, et al., Atmos. Meas. Tech., 3, 91&#8211;112, https://doi.org/10.5194/amt-3-91-2010, 2010.&#160;&#160