Andrew Etsano
Federal Ministry of Health
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Morbidity and Mortality Weekly Report | 2016
Andrew Etsano; Eunice Damisa; Faisal Shuaib; Gatei wa Nganda; Ogu Enemaku; Samuel Usman; Adekunle Adeniji; Jaume Jorba; Jane Iber; Chima Ohuabunwo; Chimeremma Nnadi; Eric Wiesen
In September 2015, more than 1 year after reporting its last wild poliovirus (WPV) case in July 2014 (1), Nigeria was removed from the list of countries with endemic poliovirus transmission,* leaving Afghanistan and Pakistan as the only remaining countries with endemic WPV. However, on April 29, 2016, a laboratory-confirmed, circulating vaccine-derived poliovirus type 2 (cVDPV2) isolate was reported from an environmental sample collected in March from a sewage effluent site in Maiduguri Municipal Council, Borno State, a security-compromised area in northeastern Nigeria. VDPVs are genetic variants of the vaccine viruses with the potential to cause paralysis and can circulate in areas with low population immunity. The Nigeria National Polio Emergency Operations Center initiated emergency response activities, including administration of at least 2 doses of oral poliovirus vaccine (OPV) to all children aged <5 years through mass campaigns; retroactive searches for missed cases of acute flaccid paralysis (AFP), and enhanced environmental surveillance. Approximately 1 million children were vaccinated in the first OPV round. Thirteen previously unreported AFP cases were identified. Enhanced environmental surveillance has not resulted in detection of additional VDPV isolates. The detection of persistent circulation of VDPV2 in Borno State highlights the low population immunity, surveillance limitations, and risk for international spread of cVDPVs associated with insurgency-related insecurity. Increasing vaccination coverage with additional targeted supplemental immunization activities and reestablishment of effective routine immunization activities in newly secured and difficult-to-reach areas in Borno is urgently needed.
Morbidity and Mortality Weekly Report | 2015
Andrew Etsano; Rajni Gunnala; Faisal Shuaib; Eunice Damisa; Pascal Mkanda; Johnson Ticha; Richard Banda; Charles Korir; Ana Chevez; Ogu Enemaku; Melissa Corkum; Lora Davis; Gatei-wa Nganda; Cara C. Burns; Steven G. F. Wassilak; John Vertefeuille
Since the 1988 launch of global poliomyelitis eradication efforts, four of the six World Health Organization (WHO) regions have been certified polio-free. Nigeria is one of only three countries, along with Afghanistan and Pakistan, where transmission of wild poliovirus (WPV) has never been interrupted. During 2003-2013, northern Nigeria served as a reservoir for WPV reintroduction into 26 previously polio-free countries. In 2012, the Nigerian government launched a national polio eradication emergency plan to intensify efforts to interrupt WPV transmission. This report describes polio eradication activities and progress in Nigeria during January 2014-July 2015 and updates previous reports. No WPV cases have been reported to date in 2015, compared with a total of six cases reported during 2014. Onset of paralysis in the latest reported WPV type 1 (WPV1) case was July 24, 2014. Only one case of circulating vaccine-derived poliovirus type 2 (cVDPV2) has been reported to date in 2015, compared with 20 cVDPV2 cases during the same period in 2014. Pending final laboratory testing of 218 remaining specimens of 16,617 specimens collected since January 2015, Nigeria could be removed from the WHO list of polio-endemic countries in September 2015. Major remaining challenges to the national polio eradication program include sustaining political support and program funding in the absence of active WPV transmission, maintaining high levels of population immunity in hard-to-reach areas, and accessing children in security-compromised areas of the northeastern states.
The Journal of Infectious Diseases | 2014
J. Mohammed Ado; Andrew Etsano; Faisal Shuaib; Eunice Damisa; Pascal Mkanda; Alex Gasasira; Richard Banda; Charles Korir; Ticha Johnson; Boubacar Dieng; Melissa Corkum; Ogu Enemaku; Noah Mataruse; Chima Ohuabunwo; Shahzad Baig; Michael Galway; Vincent Y. Seaman; Eric Wiesen; John Vertefeuille; Ikechukwu U. Ogbuanu; Gregory L. Armstrong; Frank Mahoney
BACKGROUND Transmission of wild poliovirus (WPV) has never been interrupted in Afghanistan, Pakistan, and Nigeria. Since 2003, infections with WPV of Nigerian origin have been detected in 25 polio-free countries. In 2012, the Nigerian government created an emergency operations center and implemented a national emergency action plan to eradicate polio. The 2013 revision of this plan prioritized (1) improving the quality of supplemental immunization activities (SIAs), (2) implementing strategies to reach underserved populations, (3) adopting special approaches in security-compromised areas, (4) improving outbreak response, (5) enhancing routine immunization and activities implemented between SIAs, and (6) strengthening surveillance. This report summarizes implementation of these activities during a period of unprecedented insecurity and violence, including the killing of health workers and the onset of a state of emergency in the northeast zone. METHODS This report reviews management strategies, innovations, trends in case counts, vaccination and social mobilization activities, and surveillance and monitoring data to assess progress in polio eradication in Nigeria. RESULTS Nigeria has made significant improvements in the management of polio eradication initiative (pei) activities with marked improvement in the quality of SIAs, as measured by lot quality assurance sampling (LQAS). Comparing results from February 2012 with results from December 2013, the proportion of local government areas (LGAs) conducting LQAS in the 11 high-risk states at the ≥90% pass/fail threshold increased from 7% to 42%, and the proportion at the 80%-89% threshold increased from 9% to 30%. During January-December 2013, 53 polio cases were reported from 26 LGAs in 9 states in Nigeria, compared with 122 cases reported from 13 states in 2012. No cases of WPV type 3 infection have been reported since November 2012. In 2013, no polio cases due to any poliovirus type were detected in the northwest sanctuaries of Nigeria. In the second half of 2013, WPV transmission was restricted to Kano, Borno, Bauchi, and Taraba states. Despite considerable progress, 24 LGAs in 2012 and 7 LGAs in 2013 reported ≥2 cases, and WPV continued to circulate in 8 LGAs that had cases in 2012. Campaign activities were negatively impacted by insecurity and violence in Borno and Kano states. CONCLUSIONS Efforts to interrupt transmission remain impeded by poor SIA implementation in localized areas, anti-polio vaccine sentiment, and limited access to vaccinate children because of insecurity. Sustained improvement in SIA quality, surveillance, and outbreak response and special strategies in security-compromised areas are needed to interrupt WPV transmission in 2014.
The Journal of Infectious Diseases | 2016
Kebba Touray; Pascal Mkanda; Sisay G. Tegegn; Peter Nsubuga; Tesfaye B. Erbeto; Richard Banda; Andrew Etsano; Faisal Shuaib; Rui G. Vaz
Introduction. Nigeria is among the 3 countries in which polio remains endemic. The country made significant efforts to reduce polio transmission but remains challenged by poor-quality campaigns and poor team performance in some areas. This article demonstrates the application of geographic information system technology to track vaccination teams to monitor settlement coverage, reduce the number of missed settlements, and improve team performance. Methods. In each local government area where tracking was conducted, global positioning system–enabled Android phones were given to each team on a daily basis and were used to record team tracks. These tracks were uploaded to a dashboard to show the level of coverage and identify areas missed by the teams. Results. From 2012 to June 2015, tracking covered 119 immunization days. A total of 1149 tracking activities were conducted. Of these, 681 (59%) were implemented in Kano state. There was an improvement in the geographic coverage of settlements and an overall reduction in the number of missed settlements. Conclusions. The tracking of vaccination teams provided significant feedback during polio campaigns and enabled supervisors to evaluate performance of vaccination teams. The reports supported other polio program activities, such as review of microplans and the deployment of other interventions, for increasing population immunity in northern Nigeria.
PLOS Medicine | 2016
Margarita Pons-Salort; Natalie A. Molodecky; Kathleen M. O’Reilly; Mufti Zubair Wadood; Rana M. Safdar; Andrew Etsano; Rui G. Vaz; Hamid Jafari; Nicholas C. Grassly; Isobel M. Blake
Background Global withdrawal of serotype-2 oral poliovirus vaccine (OPV2) took place in April 2016. This marked a milestone in global polio eradication and was a public health intervention of unprecedented scale, affecting 155 countries. Achieving high levels of serotype-2 population immunity before OPV2 withdrawal was critical to avoid subsequent outbreaks of serotype-2 vaccine-derived polioviruses (VDPV2s). Methods and Findings In August 2015, we estimated vaccine-induced population immunity against serotype-2 poliomyelitis for 1 January 2004–30 June 2015 and produced forecasts for April 2016 by district in Nigeria and Pakistan. Population immunity was estimated from the vaccination histories of children <36 mo old identified with non-polio acute flaccid paralysis (AFP) reported through polio surveillance, information on immunisation activities with different oral poliovirus vaccine (OPV) formulations, and serotype-specific estimates of the efficacy of these OPVs against poliomyelitis. District immunity estimates were spatio-temporally smoothed using a Bayesian hierarchical framework. Coverage estimates for immunisation activities were also obtained, allowing for heterogeneity within and among districts. Forward projections of immunity, based on these estimates and planned immunisation activities, were produced through to April 2016 using a cohort model. Estimated population immunity was negatively correlated with the probability of VDPV2 poliomyelitis being reported in a district. In Nigeria and Pakistan, declines in immunity during 2008–2009 and 2012–2013, respectively, were associated with outbreaks of VDPV2. Immunity has since improved in both countries as a result of increased use of trivalent OPV, and projections generally indicated sustained or improved immunity in April 2016, such that the majority of districts (99% [95% uncertainty interval 97%–100%] in Nigeria and 84% [95% uncertainty interval 77%–91%] in Pakistan) had >70% population immunity among children <36 mo old. Districts with lower immunity were clustered in northeastern Nigeria and northwestern Pakistan. The accuracy of immunity estimates was limited by the small numbers of non-polio AFP cases in some districts, which was reflected by large uncertainty intervals. Forecasted improvements in immunity for April 2016 were robust to the uncertainty in estimates of baseline immunity (January–June 2015), vaccine coverage, and vaccine efficacy. Conclusions Immunity against serotype-2 poliomyelitis was forecasted to improve in April 2016 compared to the first half of 2015 in Nigeria and Pakistan. These analyses informed the endorsement of OPV2 withdrawal in April 2016 by the WHO Strategic Advisory Group of Experts on Immunization.
The Journal of Infectious Diseases | 2017
Chimeremma Nnadi; Andrew Etsano; Belinda Uba; Chima Ohuabunwo; Musa Melton; Gatei wa Nganda; Lisa Esapa; Omotayo Bolu; Frank Mahoney; John Vertefeuille; Eric Wiesen; Elias Durry
Vaccination is an important and cost-effective disease prevention and control strategy. Despite progress in vaccine development and immunization delivery systems worldwide, populations in areas of conflict (hereafter, “conflict settings”) often have limited or no access to lifesaving vaccines, leaving them at increased risk for morbidity and mortality related to vaccine-preventable disease. Without developing and refining approaches to reach and vaccinate children and other vulnerable populations in conflict settings, outbreaks of vaccine-preventable disease in these settings may persist and spread across subnational and international borders. Understanding and refining current approaches to vaccinating populations in conflict and humanitarian emergency settings may save lives. Despite major setbacks, the Global Polio Eradication Initiative has made substantial progress in vaccinating millions of children worldwide, including those living in communities affected by conflicts and other humanitarian emergencies. In this article, we examine key strategic and operational tactics that have led to increased polio vaccination coverage among populations living in diverse conflict settings, including Nigeria, Somalia, and Pakistan, and how these could be applied to reach and vaccinate populations in other settings across the world.
The Journal of Infectious Diseases | 2016
Rui G. Vaz; Pascal Mkanda; Peter Nsubuga; Muhammad Ado; Andrew Etsano
The polio eradication journey in Nigeria has been long, with a mix of good and not so good news over the years. Nigeria was very close to interrupting transmission of polio and then experienced an upsurge of transmission, owing to an interaction of several factors. At one point, Nigeria became a net exporter of poliovirus to polio-free countries, but at the end of 2013 there was clear evidence that the hard work and numerous innovations that the government and its partners had implemented were beginning to pay off: the number of cases of wild poliovirus (WPV) type 1 infection had decreased by 58%, compared with 2012; there had not been any cases of WPV type 3 infection detected since November 2012; and there had also been a reduction in the genetic diversity (clusters) of WPV1, from 8 in 2012 to 2 in 2013. In 2014, there were 6 cases of WPV1 infection, compared with 53 in 2013, and the number of genetic clusters had decreased to 1. Poliovirus transmission in Nigeria has been driven by reservoirs in northern Nigeria, where several states are considered to be at very high risk of poliovirus transmission. Additionally, 3 states in the northeast region have suffered from insecurity, and this added another facet to the struggle to control polio; several health workers gave the ultimate sacrifice to polio eradication, when they were killed as they conducted their work. All public health programs rely on effective surveillance and prompt response guided by the best information available. Polio eradication, like other infectious diseases surveillance and response programs, relies on prompt detection, registration, and laboratory and epidemiologic confirmation of suspected polio cases; reporting, analysis, use, and feedback of data; and preparedness and response (eg, outbreak investigations, contact tracing, and public health interventions). Like other programs, polio eradication needs managerial and support functions, which include coordination, supervision or performance evaluation, training, and resource provision for infrastructure, including communication. In Nigeria, each of these core activities and support functions were needed for the polio eradication program to produce the remarkable results that it has achieved, given the situation that it is in. New innovations also had to be tried and perfected to solve complex problems that revolved around the community accepting incessant rounds of oral polio vaccination. This supplement presents some of the public health programmatic innovations that the Nigerian government and its polio partners, with the support of the World Health Organization, tried and implemented to interrupt the transmission of polio. The programmatic interventions that are described here include efforts to create demand for polio vaccination; strategies to detect every case of suspected WPV, including those in the environment; methods to determine the underlying population immunity; strategies to effectively plan for, implement, and track vaccination activities, using the latest technologies; and approaches to widen the polio partnership in noncompliant and security-compromised communities. These interventions were enabled by a focused effort to obtain the necessary resources, use them effectively and transparently, provide the needed public health workforce, and ensure accountability for results. In 2014, Nigeria was one of the countries that was affected by the Ebola virus disease outbreak in West Africa. This supplement reviews how the polio partnership demonstrated remarkable flexibility by addressing and quickly overcoming this major public health challenge, using lessons and experiences obtained from polio eradication without compromising the gains that had been won for polio eradication. At the time this supplement was prepared, Nigeria had gone 12 months with no report of WPV and had started using inactivated polio vaccine. We believe that these public health interventions and other activities will help Nigeria enter a poliovirus-free environment. We also believe that these lessons can be adapted to improve routine immunization in Nigeria. We hope you will enjoy learning about these interventions.
The Journal of Infectious Diseases | 2016
Charity Warigon; Pascal Mkanda; Ado Muhammed; Andrew Etsano; Charles Korir; Samuel Bawa; Emmanuel Gali; Peter Nsubuga; Tesfaya B. Erbeto; George Gerlong; Richard Banda; Yared G. Yehualashet; Rui G. Vaz
Introduction. Poliomyelitis remains a global threat despite availability of oral polio vaccine (OPV), proven to reduce the burden of the paralyzing disease. In Nigeria, children continue to miss the opportunity to be fully vaccinated, owing to factors such as unmet health needs and low uptake in security-compromised and underserved communities. We describe the implementation and evaluation of several activities to create demand for polio vaccination in persistently poor-performing local government areas (LGAs). Methods. We assessed the impact of various polio-related interventions, to measure the contribution of demand creation activities in 77 LGAs at very high risk for polio, located across 10 states in northern Nigeria. Interventions included provision of commodities along with the polio vaccine. Results. There was an increasing trend in the number of children reached by different demand creation interventions. A total of 4 819 847 children were vaccinated at health camps alone. There was a reduction in the number of wards in which >10% of children were missed by supplementary immunization activities due to noncompliance with vaccination recommendations, a rise in the proportion of children who received ≥4 OPV doses, and a decrease in the proportion of children who were underimmunized or unimmunized. Conclusions. Demand creation interventions increased the uptake of polio vaccines in persistently poor-performing high-risk communities in northern Nigeria during September 2013–November 2014.
The Journal of Infectious Diseases | 2016
Emmanuel Gali; Pascal Mkanda; Richard Banda; Charles Korir; Samuel Bawa; Charity Warigon; Suleiman Abdullahi; Bashir Abba; Ayodeji Isiaka; Yared G. Yahualashet; Kebba Touray; Ana Chevez; Sisay G. Tegegne; Peter Nsubuga; Andrew Etsano; Faisal Shuaib; Rui G. Vaz
Background. Remarkable progress had been made since the launch of the Global Polio Eradication Initiative in 1988. However endemic wild poliovirus transmission in Nigeria, Pakistan, and Afghanistan remains an issue of international concern. Poor microplanning has been identified as a major contributor to the high numbers of chronically missed children. Methods. We assessed the contribution of the revised household-based microplanning process implemented in Kano State from September 2013 to April 2014 to the outcomes of subsequent polio supplemental immunization activities using used preselected planning and outcome indicators. Results. There was a 38% increase in the number of settlements enumerated, a 30% reduction in the number of target households, and a 54% reduction in target children. The reported number of children vaccinated and the doses of oral polio vaccine used during subsequent polio supplemental immunization activities showed a decline. Postvaccination lot quality assurance sampling and chronically missed settlement reports also showed a progressive reduction in the number of children and settlements missed. Conclusions. We observed improvement in Kano States performance based on the selected postcampaign performance evaluation indicators and reliability of baseline demographic estimates after the revised household-based microplanning exercise.
Vaccine | 2016
Audu Musa; Bashir Abba; Adamu Ibrahim Ningi; Emanuel Gali; Samuel Bawa; Fadninding Manneh; Pascal Mkanda; Richard Banda; Yared G. Yehuluashet; Sisay G. Tegegne; Gregory Umeh; Peter Nsubuga; Andrew Etsano; Faisal Shuaib; Ado Mohammed; Rui G. Vaz
INTRODUCTION In Kaduna State of Nigeria, the high influx of people from neighboring states with eligible children for polio vaccination represents a significant proportion of the target population. Many of these children are often missed by the vaccination team. The purpose of the study was to determine the contribution of targeted stakeholders in transit polio vaccination. METHODS We used the trends of vaccinated children at transit points, motor parks and markets, well as total children vaccinated by transit teams in Chikun, Igabi and Sabon Gari Local Government Areas (LGAs) of Kaduna State, Nigeria, four rounds before and after the introduction of transit polio vaccination with targeted stakeholders in Kaduna State. RESULTS A total of 87,502 under-5 children were vaccinated by the various transit teams in the three LGAs, which accounted for 3.2% of the total 2,781,162 children vaccinated by the three LGAs. For transit point vaccination, the number of vaccinated children increased from 1026 to 19,289 (302%), while motor park vaccination increased from 1289 to 4106 (318%) and market vaccination increased from 10,488 to 14,511 (138%), four rounds after the introduction of transit polio vaccination with targeted stakeholders. CONCLUSION Engagement of targeted stakeholders significantly enhanced transit polio vaccination in Kaduna State, Nigeria.