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

Lessons learnt from implementing community engagement interventions in mobile hard-to-reach (HTR) projects in Nigeria, 2014–2015

Abstract Background The year 2014 was a turning point for polio eradication in Nigeria. Confronted with the challenges of increased numbers of polio cases detected in rural, hard-to-reach (HTR), and security-compromised areas of northern Nigeria, the Nigeria polio program introduced the HTR project in four northern states to provide immunization and maternal and child health services in these communities. The project was set up to improve population immunity, increase oral polio vaccine (OPV) and other immunization uptake, and to support Nigeria’s efforts to interrupt polio transmission by 2015. Furthermore, the project also aimed to create demand for these services which were often unavailable in the HTR areas. To this end, the program developed a community engagement (CE) strategy to create awareness about the services being provided by the project. The term HTR is operationally defined as geographically difficult terrain, with any of the following criteria: having inter-ward/inter-Local Government Area/interstate borders, scattered households, nomadic population, or waterlogged/riverine area, with no easy to access to healthcare facilities and insecurity. Methods We evaluated the outcome of CE activities in Kano, Bauchi, Borno, and Yobe states to examine the methods and processes that helped to increase OPV and third pentavalent (penta3) immunization coverage in areas of implementation. We also assessed the number of community engagers who mobilized caregivers to vaccination posts and the service satisfaction for the performance of the community engagers. Results Penta3 coverage was at 22% in the first quarter of project implementation and increased to 62% by the fourth quarter of project implementation. OPV coverage also increased from 54% in the first quarter to 76% in the last quarter of the 1-year project implementation. Conclusions The systematic implementation of a CE strategy that focused on planning and working with community structures and community engagers in immunization activities assisted in increasing OPV and penta3 immunization coverage

Conduct of vaccination in hard-to-reach areas to address potential polio reservoir areas, 2014–2015

Abstract Background The Global Vaccine Action Plan (GVAP) seeks to achieve the total realization of its vision through equitable access to immunization as well as utilizing the immunization systems for delivery of other primary healthcare programs. The inequities in accessing hard-to-reach areas have very serious implications for the prevention and control of vaccine-preventable diseases, especially the polio eradication initiative. The Government of Nigeria implemented vaccination in hard-to-reach communities with support from the World Health Organization (WHO) to address the issues of health inequities in the hard-to-reach communities. This paper documents the process of conducting integrated mobile vaccination in these hard-to-reach areas and the impact on immunization outcomes. Methods We conducted vaccination using mobile health teams in 2311 hard-to-reach settlements in four states at risk of sustaining polio transmission in Nigeria from July 2014 to September 2015. Results The oral polio vaccine (OPV)3 coverage among children under 1 year of age improved from 23% at baseline to 61% and OPV coverage among children aged 1–5 years increased from 60 to 90%, while pentavalent vaccine (penta3) coverage increased from 22 to 55%. Vitamin A was administered to 78% of the target population and 9% of children that attended the session were provided with treatment for malaria. Conclusions The hard-to-reach project has improved population immunity against polio, as well as other routine vaccinations and delivery of child health survival interventions in the hard-to-reach and underserved communities

Enhanced surveillance for covid-19 response in Lagos State, Nigeria: lessons learnt, 2020

Background The SARS-CoV-2, the novel virus which causes the coronavirus disease (COVID-19), has changed the world. No aspect of humanity is untouched from health, aviation, service industry, politics, economy, education, and entertainment to social and personal lives, since the outbreak of influenza-like illness in Wuhan, China, in December 2019. The Lagos State COVID-19 response team deployed enhanced surveillance through Active Case Search (ACS) for Acute Respiratory Infections (ARI) at health facilities and communities in the 20 Local Government Areas (LGAs) of Lagos State. Lagos State was the first state in Nigeria to deploy this specific surveillance strategy for Nigeria’s COVID-19 response. Methods We utilized descriptive and quantitative approaches to describe and assess the impact of the Active Case Search (ACS) for Acute Respiratory Infections (ARI) in health facilities and communities in 20 LGAs of Lagos State between 1st April and 15th May 2020. Results We found a significant difference in mean scores of suspected COVID-19 cases (M=60, SD=109, before ACS for ARI compared to M=568, SD=732, after ACS for ARI, P=0.0039), confirmed cases (M=10, SD=19, before ACS for ARI compared to M=144, SD=187, after ACS for ARI, P=0.0028) and contacts (M=56, SD=116, before ACS for ARI compared to M=152, SD=177, after ACS for ARI, P=0.044) before and after ACS for ARI in 20 LGAs of Lagos State, between 1st April and 15th May 2020. Conclusion The deployment of the Lagos State government’s polio-eradication structure for the COVID-19 response is both innovative and effective. The response to COVID-19 requires robust surveillance, credible and timely communication, collaboration, coordination among government, inter-governmental organizations (e.g., WHO), non-governmental organizations, and citizens to succeed and limit the medical, economic, social, and personal losses to the COVID-19 pandemic