AVADAR (Auto-Visual AFP Detection and Reporting): demonstration of a novel SMS-based smartphone application to improve acute flaccid paralysis (AFP) surveillance in Nigeria

Abstract Background Eradication of polio requires that the acute flaccid paralysis (AFP) surveillance system is sensitive enough to detect all cases of AFP, and that such cases are promptly reported and investigated by disease surveillance personnel. When individuals, particularly community informants, are unaware of how to properly detect AFP cases or of the appropriate reporting process, they are unable to provide important feedback to the surveillance network within a country. Methods We tested a new SMS-based smartphone application (App) that enhances the detection and reporting of AFP cases to improve the quality of AFP surveillance. Nicknamed Auto-Visual AFP Detection and Reporting (AVADAR), the App creates a scenario where the AFP surveillance network is not dependent on a limited number of priority reporting sites. Being installed on the smartphones of multiple health workers (HWs) and community health informants (CHIs) makes the App an integral part of the detection and reporting system. Results Results from two phases of tests conducted in Nigeria point to the effectiveness of the App in the surveillance of AFP. Conclusion We posit that appropriate use of the App can soon bring about a worldwide eradication of poliomyelitis

Stopping circulatory vaccine-derived poliovirus in Kaduna state by scaling up special interventions in local government areas along rivers of interest- kamacha basin experience, 2013–2015

Abstract Background The Kamacha river is one of the five polio environmental surveillance sites in Kaduna State where 13 circulating vaccine-derived polioviruses (cVDPDs) were isolated between 2014 and 2015. Kamacha river accounted for 5 of all reported cVDPVs in Kaduna State between 2014 and 2015. Poor quality Supplemental Immunization Activities (SIAs) and low population immunity have been reported in the 10 LGAs with tributaries that flow into the river. We described the processes of implementing the various health interventions in these targeted LGAs along the Kamacha River and assessed the effectiveness of the interventions in stopping cVDPV in Kaduna, state, Nigeria. Methods Special interventions that had been proven to be functional and effective in reaching unreached children with potent vaccines in the state were scaled up in these targeted 10 LGAs along the Kamacha River. These interventions included revision of house based microplans, scaling up of transit vaccination, scaling up of youth engagement, intensified supportive supervision, scaling up of Directly Observed Polio Vaccination (DOPV) and in-between rounds vaccination activities. We analyzed immunization plus days (IPDs) administrative tally sheet and monitoring data from 10 rounds before and 10 rounds after the special interventions. Results The number of children immunized increased from 1,862,958 in December 2014 before the intervention to 1,922,940 in March 2016 after the intervention. Lot Quality Assurance Sampling (LQAS) results showed an increase in the proportion of LGAs accepted at coverage > 90% after the interventions, from 67% before intervention to 84% after intervention. The proportion of non-polio AFP children with > 4 doses of oral polio vaccine increased from 2 to 8% before to 93–98% after the interventions.. No new environmental cVDPV has been isolated since the introduction of the interventions in April 2015 until July 2016. Conclusion Scaling up known working interventions in the 10 LGAs with tributaries that drain to Kamacha River environmental sample site may have contributed to improved immunity and interruption of cVDPV in Kaduna state. These interventions should be replicated in LGAs and states with persistent poliovirus isolation

Towards an effective poliovirus laboratory containment strategy in Nigeria

Abstract Background The Global Commission for the Certification of the Eradication of Poliomyelitis will declare the world free of wild poliovirus transmission when no wild virus has been found in at least 3 consecutive years, and all laboratories possessing wild poliovirus materials have adopted appropriate measures of containment. Nigeria has made progress towards poliomyelitis eradication with the latest reported WPV type 1 on 21 Aug 2016 after 2 years without any case. This milestone achievement was followed by an inventory of biomedical laboratories completed in November 2015 with the destruction of all identified infectious materials. This paper seeks to describe the poliovirus laboratory containment process in Nigeria on which an effective containment system has been built to minimize the risk of virus re-introduction into the population from the laboratories. Methods A national survey of all biomedical facilities, as well as an inventory of laboratories from various sectors, was conducted from June–November 2015. National Task Force (NTF) members and staff working on polio administered an on-site questionnaire in each facility. Laboratory personnel were sensitized with all un-needed materials destroyed by autoclaving and incineration. All stakeholders were also sensitized to continue the destruction of such materials as a requirement for phase one activities. Results A total of 20,638 biomedical facilities were surveyed with 9575 having laboratories. Thirty laboratories were found to contain poliovirus or potentially infectious materials. The 30 laboratories belonged to the ministries of health, education, defence and private organizations. Conclusions This article is amongst the first in Africa that relates poliovirus laboratory containment in the context of the tOPV-bOPV switch in alignment with the Global Action Plan III. All identified infectious materials were destroyed and personnel trained to continue to destroy subsequent materials, a process that needs meticulous monitoring to mitigate the risk of poliovirus re-introduction to the population