Polio Transmission Stopped in Equatorial Guinea
With a polio-free future back in its grasp, Equatorial Guinea must now use gains against polio to build more sustainable protection for the future health of its children.
The immunity of children in Equatorial Guinea against polio has been strengthened through the outbreak response, enabling transmission of the virus to be stopped.
Eight children were paralyzed by polio in Equatorial Guinea in an outbreak of the disease between January and May 2014. This June, the final independent assessment took place for the response to this outbreak. The assessment examined two things in detail: is surveillance sensitive enough to find the virus if it is present and are people immunized well enough to protect them from polio?
Although the assessment found that both disease surveillance and vaccination campaigns to prevent it had improved, it also recommended further improvements in mapping communities to ensure that children are not missed. Noting that the outbreak happened due to poor immunity, the assessment concluded that strengthening routine immunization is the single most important step to ensuring that another polio outbreak does not take place.
The assessment concluded that the outbreak response had succeeded in interrupting the transmission of wild poliovirus. The commitment from the highest level of government has been essential for this success, including the personal involvement of the President and the cross ministerial response.
The assessment gathered information from the Ministry of Health, partners of the Global Polio Eradication Initiative such as WHO and UNICEF, surveillance and immunization officers, health workers, traditional healers and other stakeholders, making field visits to directly observe health facilities, cold stores, communities and border vaccination points, enabling a full review of the outbreak response.
Over the course of the outbreak, surveillance has improved with non-polio acute flaccid paralysis rate of 4.6 reported per 100,000 under 15 year olds. Active surveillance has been introduced, ensuring that hospital registers are double checked for symptoms that could be polio. In August 2014, training was carried out to build the capacity of selected health workers at all levels to act as focal points for regular reporting.
The quality of supplementary immunization activities has also improved, with increased engagement from the national authorities in planning and implementing the eight national campaigns which have taken place in response to the outbreak. However, the assessment determined that micro-planning still needed strengthening to reduce the number of missed children, particularly in the cities of Malabo and Bata.
Since 2010, national oral polio vaccine (OPV) coverage had dropped below 40 %, and only 66 % of public health facilities provide routine immunization services, despite high demand. This enabled the outbreak to take place, as immunity was not being maintained at a high enough level. Campaigns have strengthened population immunity against types 1 and 3 wild poliovirus, which has enabled transmission to be stopped. To maintain these gains, it is crucial that routine immunization must be strengthened to prevent this immunity slipping. A plan has been put in place for the introduction of inactivated polio vaccine in Equatorial Guinea in 2015 as part of the biggest synchronised global introduction of any vaccine, an essential part of the bivalent to trivalent OPV switch, which is planned for April 2016. The assessment concluded that strengthening routine immunization is the single most important step to ensuring that another polio outbreak does not take place, requiring the securing of vaccines, a functional cold chain, training of healthcare personnel, the use of micro-planning for the routine immunization programme, and better tracking of dropout rates by health care centres.
The assessment concluded that while transmission has been interrupted and the surveillance system is adequate to detect transmissions, it is crucial that momentum is maintained to address the remaining challenges and to continue to keep children protected. The national leadership that has been so crucial in halting transmission will become even more essential in the coming months to secure funds for routine immunization and surveillance, to review the performance of the programme and to put in place a strong plan for any future outbreak response, supported by WHO and UNICEF country offices.
Long term, it is the commitment of the Government supported by its Partners that will protect the gains of the outbreak response and ensure routine immunization is strengthened, giving more children lifelong protection against vaccine preventable diseases like polio.