Sélectionnez votre langue
What it took to close a polio outbreak in Sudan
25 September 2022 – It takes more than a town crier reading off a scroll to close a polio outbreak in any country. Rather, it takes multi-disciplinary teams of experts wading through country-level data from polio eradication programmes – often more than once. They scrutinize evidence, crunch numbers to analyse information, and interview health workers, polio teams and high-level authorities, among other activities, before arriving at a conclusion.
The recent poliovirus outbreak in Sudan
Sudan’s circulating vaccine-derived poliovirus (cVDPV) type 2 outbreak began with the importation of the virus from neighbouring Chad. Confirmed in August 2020, the outbreak affected and paralyzed 58 children in 42 districts of 15 states. Additionally, 14 sewage samples in Khartoum tested positive for cVDPV2, indicating circulation there.
In mounting a robust response to the outbreak, Sudan conducted 2 high-quality nationwide campaigns delivering monovalent oral polio vaccine type 2 (mOPV2) to children in all 18 states and 184 localities in November 2020 and January 2021. Each round, supported by the World Health Organization (WHO), UNICEF and other partners, vaccinated more than 8 million children aged under 5.
Who makes the decisions
On 7 October 2021, a virtual technical assessment mission kicked off the process of analysing the absence of polioviruses across Sudan. Members of the assessment group shared recommendations with Sudan’s polio eradication team to ramp up their efforts across the country.
Then, from 24 July to 1 August 2022, an official outbreak response assessment team undertook a second phase of this detailed task, visiting Khartoum and 6 of Sudan’s 18 states as part of its work.
Both review teams comprised experts from WHO and the United Nations Children’s Fund (UNICEF) with skills and experience in global public health, epidemiology and biostatistics, surveillance, vaccine management and communication. They worked closely with the Federal Ministry of Health of Sudan, with state-level ministry staff and with health workers at ground level.
Spotlight on polio surveillance
In particular, a review of the surveillance system is important to close any disease outbreak. In line with this, the assessment team analysed the functionality and sensitivity of the polio surveillance system in Sudan to ensure no polio cases have been missed. They noted that Sudan’s acute flaccid paralysis (AFP) surveillance indicators are meeting the necessary indicators, and that the 14 environmental surveillance sites across Sudan are collecting and testing samples regularly and in line with international protocols.
As per standard protocols, the team in Sudan collects stool samples from both children who are healthy and those with AFP. A review of data showed that all samples collected since 18 December 2020 – the date of onset of paralysis of the last child affected in the outbreak – were processed like clockwork in the laboratory in Sudan, reported as poliovirus negative and recorded.
Speaking to the role of surveillance in this process, Dr Hamid Jafari, WHO Director for Polio Eradication in the Eastern Mediterranean Region said, "The programme has to be extremely diligent and careful before it declares an outbreak to have ended. The most important element that drives that decision is the quality of surveillance; the ability of the country to detect any remaining circulating poliovirus."
Holistic overview of all technical work
The technical mission also reviewed the core functions of Sudan’s laboratories, the country’s preparation mechanisms for poliovirus events or outbreaks, data on population immunity and childhood immunization, and vaccine management protocol.
Following this extensive work, the outbreak team concluded that the spread of cVDPV2 has indeed stopped, and that the outbreak is over.
“Credits go to the Public Health Officers and immunization staff on the ground. A fast and well-planned response enhanced immunity among children and contained this outbreak in early months after the declaration. Despite the fact that this outbreak is over, we have received sufficient recommendations to maintain sensitive AFP surveillance, ensure better preparedness and response, enhance coverage of essential immunization, and strengthen cross-border coordination,” said Dr Ni’ma Saeed Abid, WHO Representative to Sudan.
While debriefing with the Government of Sudan and partners, the mission reiterated that Sudan remains at high risk of poliovirus, and that the current robust level of functionality and preparedness must be maintained in order to promptly detect and respond to any future emergence or importation of poliovirus.
Polio outbreak in Sudan successfully stopped and declared closed
Khartoum, 18 September 2022 – Sudan’s outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) has been successfully stopped, according to experts from WHO, UNICEF and the United States Centers for Disease Control and Prevention.
Declared in 15 out of 18 states, the outbreak was caused by a circulating vaccine-derived poliovirus (cVDPV2) strain imported from Chad, paralyzing 58 children.
Today’s announcement comes after virtual and in-country reviews of Sudan’s response to the outbreak and its surveillance system by a team of experts in polio eradication, global public health, epidemiology, and vaccine management. The final Outbreak Response Assessment, held between 24 July and 1 August 2022, included interviews and reviews of reports and records with surveillance and immunization staff at state, locality, and health facility levels. The findings of the Outbreak Response Assessment, coupled with the absence of the cVDPV2 virus for more than 18 months in the presence of sustained high-quality poliovirus surveillance, make it possible to conclude that the cVDPV2 outbreak can now be declared closed.
Nomina Akhtar continues to work for polio eradication while battling stage-3 breast cancer
A story of determination, friendship and support
19 August 2022 – In 2021, when the news of cancer hit, Nomina Akhtar felt her world collapsing. It was discovered too late. By the time she knew, it was already stage-3 breast cancer.
Since 2015, Akhtar has been part of Pakistan’s polio programme as a community health worker. During these 6 years, she has found friends and well-wishers among her team members who have given her the support to carry on.
Akhtar, 43 and a mother of 3 continues to work for polio eradication as she undergoes treatment for cancer. “I gathered my courage and promised that I will fight till the end and live for my children. All my family, colleagues and seniors were with me whenever I needed support. That gave me courage and made me believe that I could, in fact, beat cancer.”
Based in Peshawar, Nomina’s husband and her 3 children, aged 6, 7 and 18, rely solely on her income. The lockdowns due to the pandemic caused her husband, a motorcycle mechanic, to close down his shop that has yet to reopen.
A life with cancer has been both physically and emotionally exhausting. She is undergoing both radiation and chemotherapy in Peshawar. This means a commute of almost 20 kilometers after a whole day of work.
“When I have to go for chemotherapy after work, it becomes very draining. I have to take public transport and wait at the hospital for hours. There are times when I have to return without treatment because either the machine is faulty or something else comes up. This treatment regime along with the medicine will continue for at least 5 years. It’s excruciatingly painful,” she says.
Polio programme: a great source of strength for Akhtar
“My colleagues are like my extended family, and I am like a sister to them. When I found out about my cancer, they wept with me. They have stood by my children and myself every step of the way.”
The supervisor of her area, Uzma Mansoor, says that when they first heard the news, they were devastated. “But it’s great to see that she has not lost hope and is fighting the disease like a champion,” she said.
The community she works in has also been incredibly supportive. “Some of the people in my work area came to know about my illness and they appreciated the fact that despite fighting cancer, I come to their doorstep during every polio campaign. Irrespective of extreme temperatures and illness, I am there to vaccinate their children and protect them from this life-threatening disease. Their support has increased manifold after this.”
Sahibullah, the Union Council Polio Officer of her area, says not only does Nomina continue to vaccinate children, but she is a role model for all other polio workers.
“It was God’s will, and we will face it with courage,” says her husband Aurangzeb Akhtar. “Despite being ill, Nomina is the one who keeps us going. She is working and earning for our family as well as motivating us to not lose hope. My children and I are so proud of her. Inshallah she will get well very soon.”
Nomina has strong conviction. She is fighting cancer and polio simultaneously, and is determined that she will defeat both very soon. “At least cancer has treatment,” she says. “Polio is incurable and the sooner we end this disease forever, the better.”
Electronic reporting system digitizes reporting for polio certification
36th meeting of the Regional Commission of Certification endorses submission of reports for 2021
14 August 2022 – One of the key markers on the global journey towards eradication of poliovirus is certification, the formal verification of a region as polio-free. Last month, that marker got a digital upgrade.
Following the resolution passed at the World Health Assembly in 1988 to eradicate polio, the Global Certification Commission was established to lead the formal process for certifying regions as polio-free.
In 1995, WHO’s Eastern Mediterranean Region established the Regional Commission of Certification (RCC). The RCC comprises public health and scientific experts who independently review and assess country data and documentation of activities and reports submitted by the national committees on polio eradication for all countries in the Region.
The RCC serves an important purpose: it reviews the annual certification reports submitted by countries in the Region to identify gaps in polio-free countries and recommends appropriate risk mitigation measures. It also works closely with the National Certification Committees (NCCs) and other groups, and reviews progress towards certification of polio eradication and to containment of laboratory stocks of poliovirus.
Each year, the RCC meets with members of the NCC from countries in the Region, stakeholders from the Global Polio Eradication Initiative and ministries of health to review the epidemiological situation, progress and submits recommendations to countries.
In May, the RCC met for its 36th meeting in Dubai. Speaking at the event, WHO Regional Director for the Eastern Mediterranean Dr Al-Mandhari expressed appreciation for the efforts of the RCC to support polio eradication in the Region. “I am pleased to inform you that as a result of your efforts, 20 out of the 22 countries in our Region had achieved the required standards for poliomyelitis certification. With significant gains in the last 2 endemic countries of our Region, we are closer than ever to eradicating polio.”
This year, The RCC had reviewed reports from Bahrain, Djibouti, Egypt, Islamic Republic of Iran, Iraq, Jordan, Kuwait, Libya, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen. The reports had been provisionally accepted pending revision based on RCC comments. For Afghanistan and Pakistan, their progress reports were reviewed and noted by the RCC.
During the meeting, the RCC endorsed the new Electronic Annual Certification Reporting (e-ACR) system, effectively taking the system out of beta status and moving it into established practice and agreed for certification reports to be submitted through this system prior to the 37th RCC meeting in 2023.
The e-ACR, as a recommendation from the RCC during the 33rd meeting in 2019, was developed as a web-based system to mimic the offline workflow, including submission, review, approval and archiving of reported data within the annual certification reports. It allows for customized and structured data entry that will help users to easily retrieve data for comparison and analysis with reports from previous years – a process that previously was reliant on records kept in multiple separate systems, or even paper records.
Following the software development, 65 participants representing the RCC, NCCs and ministry of health focal persons from 13 countries were trained in 2 separate sessions in May and June 2022. Feedback and recommendations from these trainings are being incorporated into the e-ACR system. A third training is scheduled for September 2022 for representatives from the 9 remaining countries in the Region.
The introduction of the innovative e-ACR system makes the Region to be one of the leading among other WHO regions in digital archive of all certification reports. This system not only facilitates easy retrieval of data but also allows for the next generation of disease eradicators to learn from the experience of certification and the process of polio eradication.
