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Topv) to Bivalent Oral Polio Vaccine (Bopv

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Topv) to Bivalent Oral Polio Vaccine (Bopv Bassey et al. BMC Infectious Diseases (2018) 18:57 DOI 10.1186/s12879-018-2963-6 RESEARCH ARTICLE Open Access The global switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV): facts, experiences and lessons learned from the south-south zone; Nigeria, April 2016 Bassey Enya Bassey*, Fiona Braka, Rui Gama Vaz, William Komakech, Sylvester Toritseju Maleghemi, Richard Koko, Thompson Igbu, Faith Ireye, Sylvester Agwai, Godwin Ubong Akpan, Sisay Gashu Tegegne, Abdul-Aziz Garba Mohammed and Angela Okocha-Ejeko Abstract Background: The globally synchronized switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio Vaccine (bOPV) took place in Nigeria on April 18th 2016. The country is divided into six geopolitical zones. This study reports the experiences and lessons learned from the switch process in the six states that make up Nigeria’s south-south geopolitical zone. Methods: This was a descriptive retrospective review of Nigeria’s switch plan and structures used for implementing the tOPV-bOPV switch in the south-south zone. Nigeria’s National Polio Emergency Operation Centre (NPEOC) protocols, global guidelines and reports from switch supervisors during the switch were used to provide background information for this study. Quantitative data were derived from reviewing switch monitoring and validation documents as submitted to the NPEOC Results: The switch process took place in all 3078 Health Facilities (HFs) and 123 Local Government Areas (LGAs) that make up the six states in the zone. A total of $139,430 was used for this process. The ‘healthcare personnel’ component received the highest budgetary allocation (59%) followed by the ‘logistics’ component (18%). Akwa Ibom state was allocated the highest number of healthcare personnel and hence received the most budgetary allocation compared to the six states (total healthcare personnel = 458, total budgetary allocation = $17,428). Validation of the switch process revealed that eight HFs in Bayelsa, Cross-River, Edo and Rivers states still possessed tOPV in cold-chain while six HFs in Cross-River and Rivers states had tOPV out of cold-chain but without the ‘do not use’ sticker. Akwa-Ibom was the only state in the zone to have bOPV and Inactivated Polio Vaccine (IPV) available in all its HFs monitored. (Continued on next page) * Correspondence: [email protected]; [email protected] World Health organization (WHO) Nigeria Country office, UN House, plot 617/618, Diplomatic Drive, Central Business District, Abuja, Garki PMB 2861, Nigeria © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Bassey et al. BMC Infectious Diseases (2018) 18:57 Page 2 of 9 (Continued from previous page) Conclusion: The Nigerian tOPV-bOPV switch was successful. For future Oral Polio Vaccine (OPV) withdrawals, implementation of the switch plan would be more feasible with an earlier dissemination of funds from global donor organizations, which would greatly aid timely planning and preparations. Increased budgetary allocation to the ‘logistics’ component to accommodate unexpected hikes in transportation prices and the general inefficiencies with power supply in the country is also advised. Keywords: tOPV, bOPV, Switch, Background 2018 [15, 16]. Endorsed in 2013 by the 66th WHA, this The launch of the Global Polio Eradication Initiative plan consists of four principal objectives that address the (GPEI) by the World Health Assembly (WHA) in 1988 eradication of all polio diseases whether caused by set the stage for global polio eradication [1]. This led to WPVs or cVDPVs [17]. the dramatic decline in the number of poliomyelitis Since the eradication of WPV2, cVDPV2s due to cases due to wild poliovirus (WPV) from an estimated OPV2 have for accounted for 94% of the 721 poliomyel- 350,000 cases in 1988 to about 37 cases in 2016 [2–4]. itis cases caused by cVDPVs detected between January The transmission of WPV has been limited to just three 2006 and May 2016 [14]. To stop further risks of countries, Afghanistan, Pakistan and Nigeria [5]. Reports cVDPV2s, SAGE reaffirmed the need for the switch from 2016 showed that Pakistan and Afghanistan re- from tOPV to bivalent Oral Polio Vaccine (bOPV), ported 20 and 13 WPV type1 (WPV1) cases respectively which contains Sabin serotypes 1 and 3 strains (i.e. OPV [5–7].Nigeria was readmitted to the list of polio endemic 1and 3) [18, 19] This decision was reached after review- countries following the detection of four WPV1 cases ing the epidemiology of cVDPV2s and all criteria neces- and a single case of circulating vaccine-derived polio- sary for the switch in line with the objectives of the virus type 2 (cVDPV2) in August 2016 [8]. No new cases PEESP in October 2015 [18–20]. But, one country can- of WPV have been reported as Nigeria continues to not just stop tOPV use if other countries that may implement emergency outbreak response in response to export OPV2-related viruses continue to use tOPV. This the detected WPV1 strain and cVDPV2 strains affecting is because, as its population becomes more susceptible, the country [6]. imported OPV2-related viruses can easily establish sus- Despite polio eradication setbacks in Nigeria, the GPEI tained circulation and develop into cVDPV2s [21, 22]. has made significant efforts towards polio eradication As a result, the switch was carried out in a globally syn- through the use of Oral Polio Vaccine (OPV) i.e. triva- chronized manner between 17th April and 1st May to lent Oral Polio Vaccine (tOPV), which contains Sabin prevent the risk of exporting OPV2-related viruses (i.e. strains of all three poliovirus serotypes (i.e. OPV 1,2 and polioviruses related to the serotype 2 strain in tOPV) 3) [9]. The use of this vaccine has led to the eradication from the countries using tOPV to other neighbouring of WPV type 2 (WPV2) [10]. The last known case of areas that have stopped tOPV use [14, 21, 22]. WPV2 dates back to 1999 in northern India and WPV2 However, the cessation of tOPV use also carries some was declared eradicated by the Global Certification risk for facilitating the spread of undetected or newly Commission (GCC) in 2015 [10, 11]. The last case of emergent cVDPV2s among persons without immunity to WPV type 3 (WPV3) dates back to 2012 in Nigeria [12]. serotype 2 polioviruses after the switch. [12] To stop the Four of the six World Health Organization (WHO) spread of existing cVDPV2s before the switch and to regions have also been certified as polio-free [13]. prevent post switch outbreaks, population immunity to However, attenuated polioviruses in OPV can undergo serotype 2 polioviruses at the time of the switch were to genetic changes during replication, and in communities be boosted with Supplementary Immunization Activities with low vaccination coverage, can result in vaccine- (SIAs) using tOPV along with the introduction of at least derived polioviruses (VDPVs) [14]. These can cause one dose of Inactivated Polio Vaccine (IPV) to the paralytic polio indistinguishable from the disease caused Routine Immunization (RI) system [14]. The introduc- by WPVs [12]. These VDPVs can further acquire trans- tion of IPV will provide vaccinated children born after missibility and become circulating VDPVs (cVDPVs) [3]. the switch with individual protection from poliomyelitis In response to the risk associated with tOPV use, caused by serotype 2 polioviruses [17]. WHO Strategic Advisory Group of Experts on Nigeria complied with these requirements when she car- immunization (SAGE), together with the GPEI devel- ried out SIAs across the country using tOPV for 3 weeks oped a comprehensive long-term plan called the Polio before the switch to boost immunity against serotype 2 po- Eradication & Endgame Strategic Plan (PEESP), 2013– lioviruses. This was coupled with the phased introduction Bassey et al. BMC Infectious Diseases (2018) 18:57 Page 3 of 9 of IPV into the country’s RI schedule well over 6 months this study. Quantitative data were derived from review- before the April/May 2016 global switch period. ing switch monitoring and validation documents as The tOPV-bOPV switch took place in Nigeria on the submitted to the NPEOC. 18th of April 2016. This study reports the experiences The switch was conducted in such a way that most ac- and lessons learned from the tOPV-bOPV switch tivities occurred at the Health Facility (HF) level. Switch process in south-south zone of Nigeria. activities were coordinated at different levels (LGAs, state) but final coordination was done at the national Methods level. Clear timelines were given for the implementation Study location of each switch activity and these were monitored using Nigeria is divided into six geopolitical zones namely: standardized dashboards. The key activities conducted north-east, north-west, north-central, south-south, were: establishment of switch committees, training of south-east and south-west. This study documents the health workers, sensitization of stakeholders, data man- switch from tOPV to bOPV in the south-south zone of agement and inventory, production and distribution of Nigeria. This zone comprises of six states and 123 Local data tools and bOPV vials to HFs, switch implementa- Government Areas (LGAs) namely: Akwa Ibom (31), tion, switch monitoring and validation, the ‘sweep Bayelsa (8), Cross-River (18), Edo (18), Delta (25) and process’ and tOPV destruction. The ‘sweep process’ was Rivers (23). The zone is commonly referred to as the a systematic search conducted in all HFs in an LGA Niger Delta region of the country because it is located where tOPV vials were found to ensure the complete (in the southern part of Nigeria) at the point where the withdrawal of residual vaccines in that LGA.
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