Adebisi, Yusuff Adebayo

Boyiga, Bodinga Nuga

Eliseo-Lucero Prisno III, Don

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Public Health in Practice 1 (2020) 100043Contents lists available at ScienceDirectPublic Health in Practicejournal homepage: www.journals.elsevier.com/public-health-in-practiceLetter to the EditorLast fight of wild polio in Africa: Nigeria’s battleA R T I C L E I N F OKeywordsPolioWild polioEradicationNigeriaAfricahttps://doi.org/10.1016/j.puhip.2020.100043Received 19 September 2020; Accepted 25 SeptemAvailable online 1 October 20202666-5352/© 2020 The Author(s). Published by Elslicense (http://creativecommons.org/licenses/by-nc-nd/4.0/).11 56202355782 830112228679638821 6312253 6 0 4 0 0 0 0020040060080010001200Number of Wild Polio Cases in Nigeria, 2000 to 2020Number of Wild Polio CasesFig. 1. Wild polio cases in Nigeria, 2000 to 2020; Source: Federal ministry ofhealth of Nigeria.Dear EditorPolio is an incurable deadly disease caused by a virus which consti-tutes major public health threat in Africa for many years. The virususually afflicts children under-five and can cause paralysis or even deathif the breathing muscles are affected [1]. The poliovirus is frequentlytransmitted by person-to-person spread through the faecal-oral route,common vehicle such as contaminated food or water and virus multipliesin the intestine [1]. In August 2019, the African Region became eligibleto be declared free of wild poliovirus, after Nigeria, being the last countryto be certified polio free, recorded no new cases in three years (therequisite period) [2]. The Africa Regional Certification Commission, anindependent body, had already accepted the documentation of the othercountries in the WHO African region [2]. By 2020, all the three strains ofthe wild poliovirus (type 1, type 2, and type 3) have been eradicated inAfrica.In Nigeria, there has been steady progress toward controlling thetransmission of the virus [Fig. 1]. In 2009, there were 388 cases of wildpoliovirus, with only 21 cases in 2010. However, there was a new surgein the number of cases in 2011 with 63 cases. In 2012, there were 122cases of wild poliovirus in 60 districts and 53 cases in 30 districts in 2013[3]. A turning point towards eradicating wild poliovirus in Nigeria was in2013 and this progress was maintained in 2014 with a significantdecrease in the case count of wild poliovirus cases. Since 3 September2013, indigenous wild poliovirus circulation has been restricted toNorthern part of Nigeria [3]. On 25 August 2020, Nigeria became lastcountry in Africa to be certified free from wild polio, after the continent’slast case was reported in Borno, north-eastern Nigeria four years ago [4].This implies that only Afghanistan and Pakistan remain endemic withpolio and thus make the African continent to be free of wild polio [5].Human resources, capacity built, knowledge, skills and experiencegained in the fight against polio epidemic will leave behind a legacy inpublic health response to diseases outbreak on the continent and thatwith solidarity, resilience and commitment, reaching the marginalizedpopulation with healthcare services is a possibility.The Global Polio Eradication Initiative, spearheaded by nationalgovernments, the World Health Organization, Rotary International, theUnited States Centers for Disease Control, the Global Alliance forber 2020evier Ltd on behalf of The RoyalVaccines and Immunizations and Prevention, the Gates Foundation andUnited Nations Children’s Fund, played a key role in putting an end to thewild poliovirus epidemic in Africa. The hard-won achievement ofimmunizing more than 95% of Africa’s population is an importantmilestone and comes with many lessons for Africa’s public health sys-tems, importantly the benefits vaccination, public-private partnerships,cooperation and collaboration and increase in political will and effectiveleaderships can reap for diseases prevention and control. However, thismajor achievement has not come without challenges in Nigeria. Thecountry has overcome several unique challenges over the past severaldecades to finally eliminate polio. Insecurity caused by Islamist militantgroup Boko Haram in Northern Nigeria, myths about negative effects ofimmunization, parent vaccine refusal and other health issues, like ma-laria, tuberculosis, Lassa fever and HIV taking priority in an alreadystressed health environment are some of the challenges that faced polioresponse in Nigeria [3,6].Even though the continent is certified free of wild poliovirus, effortsneed to be intensified to prevent future outbreak. The virus is stillendemic in Pakistan and Afghanistan and due to international travel,wild poliovirus can easily be imported into countries that are polio freeand can spread among under-immunised populations. In addition, thereis a form of vaccine-derived polio, a mutated form of the attenuated livevirus contained in the oral polio vaccine, that is yet to be eradicated inSociety for Public Health. This is an open access article under the CC BY-NC-NDLetter to the Editor Public Health in Practice 1 (2020) 100043many African countries including Nigeria. There are 18 vaccine-derivedpoliovirus cases reported in 2019 and two cases as of 19 August 2020 inNigeria [7]. Surge in polio cases happened in Angola in 2005, after poliowas defeated in the country in 2001 [4]. It was thought that the virus wasbrought in from outside the country. With the emergence of COVID-19, itis therefore important that African countries including Nigeria remainvigilant and ensure vaccination and effective surveillance for a strongvigil towards early detection and effective response to any re-emergenceof the virus. It is also important that Nigeria and other African countriestake the lessons learned and best practices from eradicating wild poliovirus to put an end to other vaccine-preventable diseases like measles,hepatitis, pneumonia, and rotavirus diarrhoea on the continent. Thelessons learned should also be leveraged to improve public health sys-tems on the continent and importantly in the fight against COVID-19pandemic.FundingNone.Authors contributionYusuff Adebisi Adebayo conceptualized and wrote the first draft ofthe manuscript with an important contribution from Don Eliseo-LuceroPrisno III and Boyiga Bodinga Nuga. All the authors read and approvedthe final manuscript.Declaration of competing interestNone.References[1] World Health Organization, Poliomyelitis. https://www.who.int/health-topics/poliomyelitis. (Accessed 27 August 2020).2[2] World Health Organization African Region, Africa’s wild polio-free status to bedetermined in August. https://www.afro.who.int/news/africas-wild-polio-free-status-be-determined-august. (Accessed 27 August 2020).[3] U.N. Nasir, A.S. Bandyopadhyay, F. Montagnani, J.E. Akite, E.B. Mungu, I.V. Uche,A.M. Ismaila, Polio elimination in Nigeria: a review, Hum. Vaccines Immunother. 12(3) (2016 Mar 3) 658–663, https://doi.org/10.1080/21645515.2015.1088617.PMID: 26383769; PMCID: PMC4964709.[4] BBC. Africa declared free of wild polio in ’milestone. https://www.bbc.com/news/world-africa-53887947. (Accessed 27 August 2020).[5] A. Ahmadi, M.Y. Essar, Lin Xu, Y.A. Adebisi, D.E. Lucero-Prisno III, Polio inAfghanistan: the current situation amid COVID-19, Am. J. Trop. Med. Hyg. (2020)1–3.[6] T.D. Mangal, R.B. Aylward, M. Mwanza, A. Gasasira, E. Abanida, M.A. Pate,N.C. Grassly, Key issues in the persistence of poliomyelitis in Nigeria: a case-controlstudy, Lancet Glob. Health 2 (2) (2014 Feb) e90–e97, https://doi.org/10.1016/S2214-109X(13)70168-2. Epub 2014 Jan 23. PMID: 25104665.[7] The Global Polio Eradication Initiative, Nigeria. http://polioeradication.org/where-we-work/nigeria/. (Accessed 27 August 2020).Yusuff Adebayo Adebisi*Director for Research, Global Health Focus, London, UKFaculty of Pharmacy, University of Ibadan, Ibadan, NigeriaDon Eliseo-Lucero Prisno IIIFounder, Global Health Focus, London, UKDepartment of Global Health and Development, London School of Hygieneand Tropical Medicine, UKE-mail address: don-eliseo.lucero-prisno@lshtm.ac.uk.Boyiga Bodinga NugaProgram Manager, International Organization for Migration, United NationsMigration Agency, Abuja, NigeriaAB Global Health Initiative, Ogun State, NigeriaE-mail address: bboyiga@iom.int.* Corresponding author. Director for Research, Global Health Focus,London, UK.E-mail address: adebisi.adebayo@ghfocus.org (Y.A. Adebisi).

Last fight of wild polio in Africa: Nigeria’s battle

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Last fight of wild polio in Africa: Nigeria’s battle

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