<< Back To Home

Polio Eradication Initiative: Contribution to improved communicable diseases surveillance in WHO African region

Friday, 7th of October 2016

Vaccine, Volume 34, Issue 43, 10 October 2016, Pages 5170–5174

Polio Eradication Initiative Best Practices in the WHO African Region

Polio Eradication Initiative: Contribution to improved communicable diseases surveillance in WHO African region

http://dx.doi.org/10.1016/j.vaccine.2016.05.060

Get rights and content

Under a Creative Commons license

Open Access

Highlights

•PEI supported implementation of surveillance for other priority communicable diseases.

•PEI resources orologi replica and infrastructure can be used as one strategy to build IDSR in Africa.

•Other disease-specific programs with eradication goals might consider investing IDSR.

Excerpts below; full text is at http://www.sciencedirect.com/science/article/pii/S0264410X16303863

Abstract

Introduction

Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, there has been a tremendous progress in the reduction of cases of poliomyelitis. The world is on the verge of achieving global polio eradication and in May 2013, the 66th World Health Assembly endorsed the Polio Eradication and Endgame Strategic Plan (PEESP) 2013–2018. The plan provides a timeline for the completion of the GPEI by eliminating all paralytic polio due to both wild and vaccine-related polioviruses.

Methods

We reviewed how GPEI supported communicable disease surveillance in seven of the eight countries that were documented as part of World Health Organization African Region best practices documentation. Data from WHO African region was also reviewed to analyze the performance of measles cases based surveillance.

Results

All 7 countries (100%) which responded had integrated communicable diseases surveillance core functions with AFP surveillance. The difference is on the number of diseases included based on epidemiology of diseases in a particular country. The results showed that the polio eradication infrastructure has supported and improved the implementation of surveillance of other priority communicable diseases under integrated diseases surveillance and response strategy.

Conclusion

As we approach polio eradication, polio-eradication initiative staff, financial resources, and infrastructure can be used as one strategy to build IDSR in Africa. As we are now focusing on measles and rubella elimination by the year 2020, other disease-specific programs having similar goals of eradicating and eliminating diseases like malaria, might consider investing in general infectious disease surveillance following the polio example.

1. Introduction

Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, governments and partners mobilized a lot of resources to achieve the target by the year 2000 [1]. Countries stated implementing National Immunization days (NIDs) and intensified surveillance of Acute Flaccid Paralysis (AFP) at all levels of the health care delivery system in order to achieve the target. GPEI has shown tremendous progress as evidenced by the reduction of cases of poliomyelitis by >99% and the eradication of type 2 wild poliovirus which disappeared since it was last isolated in 1999 [2].

The World Health Organization African Region (WHO AFR) adopted the global goal of eradicating poliomyelitis in 1989. In 1995 Member States initiated specific polio-eradication strategies including AFP surveillance [3]. This was followed by increased investment in human, financial and material resources such as vehicles, cold chain equipment, computer hardware and software. Case based surveillance of AFP cases together with laboratory confirmation of cases changed the mode of reporting of cases from aggregate clinically confirmed cases to virological diagnosis of individual cases. This approach promoted a clear link between epidemiologic, clinical, and virological surveillance of polio.

In 1998, the WHO Regional committee for Africa adopted the Integrated Diseases Surveillance (IDS) strategy with the aim of performing communicable disease surveillance in an integrated manner thereby providing a rational basis for decision-making and implementing public health interventions that are efficacious in responding to priority communicable diseases [4]. The core and support functions of IDSR were the same as the ones applied in AFP surveillance and both approaches were applied at all levels of health system from the community, district and peripheral levels, to the national, and the WHO levels. Core activities include identification of cases using standardized case definitions, timely, reporting and regular notification, investigation and confirmation; analysis, use, and feedback of data; and public health action for decision making. Support functions include communication, training, supervision resource mobilization, and management.

By 2015 the world was on the verge of achieving global polio eradication [5]. In May 2013, the 66th World Health Assembly endorsed the Polio Eradication and Endgame Strategic Plan (PEESP) 2013–2018 [6]. The plan provides a timeline for the completion of the GPEI by eliminating all paralytic polio due to both wild and vaccine-related polioviruses. The PEESP has four main objectives: (1) to detect and interrupt all poliovirus transmission; (2) to strengthen immunization systems and withdraw all oral polio vaccine from use; (3) to contain poliovirus and certify interruption of transmission, and (4) to plan the GPEIs legacy.

In the context of these objectives, particularly the GPEI legacy, it is important to document the lessons learned from polio eradication, because it is one of the largest global health initiatives ever with clear strategies and interventions on core activities and support functions for surveillance and response to priority diseases [5]. The public health community has an obligation to ensure that these lessons and the knowledge generated are shared and contribute to real sustained changes in our approach to global health including improvement of global health security [6]. As the initiative draws to an end, the GPEIs primary goals of legacy planning are both to protect a polio-free world and to ensure that the investments made, designed to eradicate polio, contribute to broader health goals taking into account the stakeholders needs to attain the highest possible level of health for all people. This entails documentation of lessons learnt from polio eradication.

We report best practices regarding the effect of the polio-eradication initiative on the surveillance for other infectious diseases in Africa in line with IDSR and the International Health Regulations (IHR) frameworks, citing the experiences of eight countries that were documented by WHO-AFR Office (WHO-AFRO) as part of GPEI legacy planning.