Regional experts confirm the polio outbreak is successfully interrupted in Ethiopia and Kenya

Vigilance in Somalia and region still needed before the region is declared polio-free once more.

By Shalini Rozario

Dr. Jean-Marc Olive, Horn of Africa (HOA) Polio Technical Advisory Group (TAG) Chair, chairs proceedings of the HOA Polio Outbreak Final Assessment
Dr. Jean-Marc Olive, Horn of Africa (HOA) Polio Technical Advisory Group (TAG) Chair, chairs proceedings of the HOA Polio Outbreak Final Assessment, and is seated with representatives from the Kenyan Government, WHO, UNICEF and partners such as Rotary International, The Gates Foundation, CDC among others. ©UNICEF Ethiopia/2015/Rozario

17 June 2015, Nairobi, Kenya. Government representatives, technical experts, donors, and polio partners gathered on Wednesday, 17 June 2015 to review the polio outbreak status in the Horn of Africa (HOA) Region. The final assessment concluded the following:

  • The assessment team commends the overall robust outbreak response in the HOA with strong vaccination, communication strategy and strengthened surveillance.
  • The assessment team believes that transmission in Kenya and Ethiopia has been interrupted; however, continued undetected low level transmission cannot be ruled out in Somalia

Overall progress in the region was reviewed since onset of the outbreak in April 2013, which resulted in a total of 223 WPV cases across the region (10 in Ethiopia), and remaining challenges ahead were identified. Chaired by the Horn of Africa polio Technical Advisory Group (TAG) Chair, Dr. Jean-Marc Olive, the meeting gave opportunity to strategically reflect on the current outbreak status and required next steps for all three countries. Dr. Ephrem Tekle, Director of the Maternal and Child Health Directorate, Ethiopia Federal Ministry of Health responded positively to the wild poliovirus (WPV) interruption in Ethiopia, and also acknowledged the work ahead to further improve routine immunisation. “Successes achieved in the polio response are due to the political commitment and the support of partners,” said Dr. Ephrem. “We have been successful on SIAs (supplementary immunisation activities) and NIDs (National Immunisation Days). However, I don’t think we are yet fully successful on routine immunisation; there is a lot to do on routine immunisation even though WPV transmission is interrupted.” Dr. Ephrem acknowledged the strong focus on the involvement of religious and clan leaders in the Somali Region, and mobilisation of the community which have been instrumental to some of the immense achievements in the polio legacy process. He cited an example of community leaders asking for a generator so they could continue routine immunisation services. In moving ahead, Dr. Ephrem stressed the importance of sustaining the polio gains made, using the momentum to improve routine immunisation in the country, and also emphasised the importance to intensify the same efforts in regions bordering South Sudan, such as Benshangul Gumuz and Gambella, in light of the immense population migration. The HOA TAG Chair congratulated Dr. Ephrem and the Ethiopia team on their efforts and wished the country success for strengthening routine immunisation in the country, a challenging task. Closing remarks were provided by governments and partners such as Rotary International, CDC, The Gates Foundation, Red Cross, Core Group, USAID, Communication Initiative, UNICEF, WHO and the HOA TAG Chairman. Next steps for countries include working towards the polio legacy transition plan and using polio assets and achievement to further strengthen routine immunisation and beyond. Countries will continue to implement specific recommendations from the external assessment team, and the outbreak response in Somalia will be assessed again after three months. Following the Somalia assessment, the next HOA TAG meeting in August, and continual monitoring of regional progress, it is hoped that soon, the entire HOA region will be declared “polio-free.”

Through the generous support of polio donors and partners such as the Centres for Disease Control and Prevention; Crown Prince Court, Abu Dhabi, UAE; European Union; the Bill and Melinda Gates Foundation; National Philanthropic Trust; Slim Foundation; Rotary International; Swedish International Development Cooperation; and others, successful interruption of the outbreak in Ethiopia has been achieved. Continued collaboration is critical to sustain gains for polio and routine immunisation for healthy children and families in Ethiopia.

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Polio transmission deemed interrupted in Ethiopia

Polio transmission deemed interrupted in Ethiopia by 4th polio external assessment; final decision awaited by Horn of Africa Final Assessment on 17 June.

Assessment recommendations include sustaining polio achievements for “polio legacy” in Ethiopia.

By Shalini Rozario 

12 June 2015

Health Extension Worker administers Polio Vaccination
National Polio Vaccination Campaign. ©UNICEF Ethiopia/2005/Heger

Addis Ababa. From 8-12 June 2015, the 4th Polio External Assessment took place in Addis Ababa, to review the progress to date of the polio outbreak response, and determine the quality and status of the outbreak in the country. The assessment team was led by WHO and included members from CDC, Core Group, the Gates Foundation, UNICEF and others. The assessment team looked in detail at key elements of the polio programme including surveillance, campaign quality, communication, vaccine supply and logistics and other factors contributing to the interruption of the polio virus transmission.

4th external polio assessment debriefing
His Excellency Dr. Kebede Worku, State Minister to the Federal Ministry of Health of Ethiopia along with Dr. Pierre Mpele-Kilebou, WHO Representative to Ethiopia; and Gillian Mellsop, Country Representative to UNICEF Ethiopia during the 4th external polio assessment debriefing on 12 June 2015. ©UNICEF Ethiopia/2015/Rozario

On Friday afternoon, 12 June, the external assessment team debriefed His Excellency Dr. Kebede Worku, State Minister to the Federal Ministry of Health of Ethiopia along with Dr. Pierre Mpele-Kilebou, WHO Representative to Ethiopia; Gillian Mellsop, Country Representative to UNICEF Ethiopia along with key polio partners, and reviewed findings of the week-long assessment.

The overall conclusion was that the assessment believes that transmission in Ethiopia has been interrupted and called for sustained government support to ensure sustained gains.

Since the onset of the Horn of Africa (HOA) polio outbreak in May 2013, Ethiopia responded intensively. Following confirmation of cases in Somalia and Kenya, the first confirmed WPV case in Ethiopia was in August 2013 in the Somali Region resulting in a total of 10 WPV type-1 (wild poliovirus type 1) cases in the Doolo Zone of Somali Region. The last WPV case was confirmed in January 2014 — nearly 17 months ago – an indicator of interruption of transmission due to the intensive vaccination response, which includes 14 vaccination campaigns reaching children in all corners of the country with OPV (oral polio vaccine), including 4 rounds of National Immunization Days (NIDs), targeting between 12 to over 14 million children. All campaigns were supported with intensified communication and social mobilization activities, and engaged partnerships for solid community awareness, knowledge and acceptance of OPV.

H.E. Dr. Kebede responded enthusiastically to the assessment outcome, and stated, “The outbreak was closed due to the frontline teams and practioners on the ground.” He expressed support and said to value the recommendations to strengthen routine immunization, surveillance and quality SIAs (campaigns), which will benefit children and the health system in general. H.E. Dr. Kebede expressed gratitude to the leadership of the regional governments, particularly in the Somali Region. He appreciated efforts of community leaders, including religious leaders of the Islamic Affairs Supreme Council, who played a key role in the outbreak response. Dr. Kebede thanked Dr. Pierre Mpele-Kilebou, for his commitment, and for his frequent visits to the outbreak epicenter, Doolo Zone of the Somali Region. He also welcomed Gillian Mellsop, as the new Country Representative to UNICEF Ethiopia and appreciated both partners for their contributions along with the other Polio Eradication Initiative partners such as CDC, Core Group, the Gates Foundation and Rotary International.

4th external polio assessment debriefing
Dr. Pierre Mpele-Kilebou, WHO Representative to Ethiopia; Gillian Mellsop, Country Representative to UNICEF Ethiopia and Macoura Oulare, Chief of Health, UNICEF Ethiopia catch up during the 4th external polio assessment debriefing on 12 June 2015. ©UNICEF Ethiopia/2015/Rozario

Dr. Pierre Mpele-Kilebou and Gillian Mellsop, congratulated the Ministry of Health on their achievements, expressed their support for the polio programme, and acknowledged the importance of drawing on the successes and lessons learned for the “polio legacy” in Ethiopia.

Final recommendations will be delivered to the Horn of Africa countries, government representatives and partners on 17 June 2015 in Nairobi at the Horn of Africa Outbreak Final Assessment Debriefing.

Rotarians visit to Ethiopia – a true demonstration of commitment

By Shalini Rozario

Rotary International advocacy visit to Ethiopia to support the polio eradication efforts and participate in the National Polio Immunization campaign
Rotary International advocacy visit to Ethiopia to support the polio eradication efforts and participate in the National Polio Immunization campaign ©UNICEF Ethiopia/2014/Tsegaye

36 Rotarians from Ethiopia, Canada and the United States visited East Shewa zone in the Oromia region of Ethiopia to deliver polio vaccinations to more than 600 children under the age of five.

The visit marked the launch of the first round of polio National Immunisation Days in the country and the group also visited the country office of UNICEF Ethiopia, which is a partner in the global polio eradication initiative.

The visit coincided with an intensified immunisation campaign in Ethiopia, in response to the polio outbreak which began in August 2013, triggered by the Horn of Africa outbreak in Somalia and Kenya.

As of November 2014, 10 cases of Wild Poliovirus Type 1 (WPV1) had been confirmed in the Somali region of Ethiopia.

At the UNICEF Ethiopia offices, members of the Rotary Polio Advocacy Group were shown a video and presentation on polio eradication efforts in the country, followed by a discussion.

Patrizia DiGiovanni, Acting Representative to UNICEF Ethiopia, welcomed the Rotarians and thanked them for their continued support in efforts to eradicate polio, which included a recent grant.

The grant is part of a larger announcement by Rotary International marking World Polio Day of a pledge of $44.7 million to fight polio in Africa, Asia and the Middle East.

To date, Rotary has donated more than $1.3 billion to global eradication efforts, allowing the mobilisation of resources at the grass-roots level through volunteer leaders.

Rotary International advocacy visit to Ethiopia to support the polio eradication efforts and participate in the National Polio Immunization campaign
Rotary International advocacy visit to Ethiopia to support the polio eradication efforts and participate in the National Polio Immunisation campaign ©UNICEF Ethiopia/2014/Tsegaye

During their visit to the Oromia region, the Rotarians attended a colourful ceremony at a primary school, alongside Dr Kebede Worku, State Minister at the Federal Ministry of Health and Dr Taye Tolera, Special Adviser to the State Minister of Health.

They were joined by the Federal Ministry of Health Expanded Programme on Immunisation (EPI) team, staff from the East Shewa Zone Health Office, UNICEF, WHO and other partners.

The group visited several kebeles within East Shewa Zone to visit people’s homes and carry out vaccinations, accompanied by kebele Health Extension Workers and Health Workers.

The Lume district health office and Shara Didandiba Health Post organised a kebele launching ceremony to mark the Rotarians’ visit. The Rotarians handed out t-shirts and caps to children and parents at the event.

The visiting Rotarians have a range of backgrounds, but share a common interest in supporting polio immunsation, child health and development programmes in Ethiopia. Some members of the group have visited Ethiopia several times.

The visit was intended to inform and promote polio advocacy work in Canada and the US through advocacy and fundraising, as well as engagement with US Congressional leaders.

Rotary International is spearheading the Global Polio Eradication Initiative, alongside the World Health Organisation, Bill & Melinda Gates Foundation, US Centers for Disease Control & Prevention and UNICEF. It has been at the forefront of the global fight against polio for the last three decades.

Drop by drop closer to polio-free Ethiopia

Polio vaccination a response of a recent polio outbreak in the Horn of Africa
Polio vaccination a response of a recent polio outbreak in the Horn of Africa ©UNICEF Ethiopia/2013/Sewunet

 

Jigjiga/Wardher, 9 February 2015: A pledge of commitment for a polio-free Ethiopia was made on 8 February 2015 in Jigjiga and Warher to launch the polio national immunization days (NIDs) in Somali Regional State. Ethiopia has been polio free since 5 January 2014, but the risk of polio cases in Horn of Africa prevails. The campaign running until 11 February 2015 aims to reach over one million children under the age of five in the region.

“Despite the progress, Ethiopia is in a fragile position and the risks for outbreaks remain. We invite all stakeholders to make the goal of a polio-free Africa in 2015 a reality,” said Dr Pierre M’Pele-Kilebou, WHO Representative to Ethiopia at the launch event in Jigjiga.

The pledge signatories – the State Ministers of Health, the Vice President of the Somali Regional State, the Head of the Somali Regional Health Bureau, Doollo Zonal Administration, religious and clan leaders, WHO, UNICEF, Rotary International and Ethiopian Pharmaceuticals Fund and Supply Agency among others, – pledged to do their part to ensure that all children are provided with an equal chance for health and success in life through immunization.

The State Ministers of Health are supervising the work of almost 3000 vaccination teams in Somali Region. H.E. Dr Amir Amin, State Minister of Health, said at the launch in Wardher, the epicentre of the Ethiopian polio outbreak, that the Government, partners, communities and families need to share responsibility to ensure immunization of children and “to save children from sickness, disability and death.”  H.E. Dr Kebede Worku, State Minister of Health, stressed in Jigjiga that parents should get their children vaccinated even if they had been vaccinated in the previous round. 

“Ethiopia is working to find hard-to-reach communities and settlements, to bring vaccination to those areas. So, when polio eradication is achieved, we will end polio everywhere for everyone and leave a legacy of healthy families and communities, rooted in equality for all,” – Ms Anupama Rao Singh, Country Representative a.i. to UNICEF Ethiopia.

The national polio campaigns conducted in all regions of Ethiopia between 6 to 9 February 2015 reached over 13 million children under 5 years of age. Since August 2013, when the outbreak began, 12 rounds of polio immunization campaigns have been conducted in addition to vaccination of children along Ethiopia’s border with Somalia. A total of 10 polio cases are recorded in Ethiopia during the outbreak. Working closely with national and regional authorities, WHO and UNICEF established an Operations base in Wardher, Doollo Zone, in August 2014 to bring together the needed expertise to support polio interventions in the zone and kick polio permanently out of Ethiopia.

A UNICEF immunisation campaign helps combat deadly outbreaks of measles and polio

By Elissa Jobson

Chou San Kote watches as her son Oratine Rase as he receives polio vaccination from Lemmi Kebede, supervisor of supplementary immunisation
Chou San Kote watches as her son Oratine Rase as he receives polio vaccination from Lemmi Kebede, supervisor of supplementary immunisation 24, June 2014 Pagak South Sudanese refugee reception centre, Gambela Ethiopia. ©UNICEF Ethiopia/2014/Ayene

GAMBELA, ETHIOPIA, 24 JUNE 2014 – At Pagak entry point, on the border between Ethiopia and South Sudan, a long line of parents and their children wait patiently in the intense heat of the refugee registration tent. They anxiously watch as four health workers swiftly administer life-saving vaccinations to the children ahead of them.

UNICEF, in conjunction with the Gambela Region Health Bureau, has rolled out a programme of vaccination for South Sudanese children seeking asylum in Ethiopia as a result of the deadly civil conflict currently raging in their home country. Since fighting began in December last year and the first refugees crossed into Ethiopia at the beginning of January 2014, UNICEF has helped vaccinate 91,785 children against measles and 74,309 against polio. A further 41,333 children have been given vitamin A supplements to help combat malnutrition.

“Registration and screening is done by ARRA (the Ethiopian Administration for Refugee and Returnee Affairs) and UNHCR,” says Lemmi Kebede, supervisor of supplementary immunisation at Pagak entry point and Kule refugee camp. Priority, he adds, is given to pregnant women and lactating women with children less than six months old. “After registration, the children come to the vaccination point. Because levels of immunisation are low in South Sudan, eligible children are given vaccinations irrespective of whether they have had them in South Sudan or not. They are given an immunisation card which they take with them when they are transferred to the refugee camps,” Lemmi explains.

Health and nutrition
Meaza, a health professional gives a measles jab to a South Sudanese refugee baby being comforted by his mother in Pagak South Sudanese refugee reception centre. Gambela Ethiopia. ©UNICEF Ethiopia/2014/Ayene

Tesluoch Guak, just two and a half weeks old, is one of the beneficiaries of this programme. He cries as the health assistant gives him his measles injection. Despite her baby’s discomfort, his mother, Chuol Gadet, is pleased that Tesluoch is receiving his vaccination. “I understand that this is important for the health of my child,” she says.

So far, all the refugees have been willing to have their children immunised. “There is no resistance from the parents,” Lemmi confirms. “They are informed before they register as asylum seekers that their children will be vaccinated and why this is needed. There have been no refusals even though the parents haven’t previously received much health education. They have faced many challenges on the way to Ethiopia and they are open to our help.”

Chuol was heavily pregnant when she left her home in Malou county. She travelled on foot for days with her three children, aged 10, 7 and 4, to reach safety in Pagak where she delivered Tesluoch. Her husband, a solider in the government army, doesn’t even know that he has a new-born son. “The journey was hard for me. It wasn’t easy to find food and water. I don’t have words to express how difficult it was.”

The health situation of the newly arrived refugees is very poor. “In general, most of the asylum seekers are malnourished when they come from South Sudan. They have walked long distances without much food. Many have malaria and respiratory tract infections. They are really in a stressed condition,” says Bisrat Abiy Asfaw, a health consultant for UNICEF Ethiopia. This makes them highly susceptible to communicable diseases like measles and polio, he continues.

In February and March there was an outbreak of measles in Pagak – at the time more than 14,000 refugees were waiting to be registered and transferred to refugee camps within Ethiopia. UNICEF quickly rolled out a vaccination programme and helped ensure that children with signs of infection were quickly diagnosed, quarantined and treated.

“We were detecting new cases every day,” says Bisrat. “We tried to vaccinate all the children. We did a campaign on measles to increase and develop immunity within the refugee community.

The focus of the vaccination programme has been on the registration sites, although immunisation also takes place at the refugee camps. “Our strategy is to vaccinate the children as soon as possible after they enter the country, and that means working seven days a week. We are aiming for 100% coverage,” Bisrat says. And the strategy appear to be working. “The cases of measles has significantly decreased and we have had no reports of measles during the last 6 weeks,” Bisrat affirms.

World Polio Day 2014 commemorated in Ethiopia

By Shalini Rozario

On 24 October 2014, UNICEF, WHO, Rotary International and Federal Ministry of Health (FMOH) gathered to commemorate World Polio Day, which also coincided with United Nations Day. In a Joint Statement issued by WHO, UNICEF and Rotary, the partners appreciated frontline workers in the fight against polio and called for sustained support for eradication efforts.

World Polio Day celebrated in Addis Ababa Ethiopia in the premises of the UNECA compound.
World Polio Day celebrated in Addis Ababa Ethiopia ©UNICEF Ethiopia/2014/Ayene

The World Polio day commemoration commenced with a moment of silence for the late Past District Governor (PDG) Nahu Senaye Araya, President of the Rotary National Polio Plus Committee. Ato Araya’s family, in attendance, was presented with a certificate of appreciation by WHO, UNICEF and Rotary for his years of dedicated service to the polio programme.

Dr. Pierre Mpele-Kilebou, WHO Representative to Ethiopia, stated in his welcoming remarks, “Today is a reminder of our duty to make sure that no more children are paralyzed by the disease that can be prevented with a simple, easy to administer vaccine.” The screening of two short videos, Help #EndPolio Forever and Curbing the polio spread through nation wide immunisation campaign, followed his welcoming remarks.

Patrizia DiGiovanni, Acting Representative to UNICEF Ethiopia commended the contribution of partners in her key note address and emphasized the gains being made to reach all children with the polio vaccine and improved child survival interventions. “As the World Polio Day coincides with UN Day, we place our efforts within the broader context, as we work to uphold a child’s right to health as a basic human right for all. With the deadline fast approaching for measuring progress against achievement of the MDGs, our minds turn to the Ethiopia’s remarkable achievement of reaching MDG4. I believe, if we had the ability to achieve this goal three years ahead of schedule, we can certainly work together to ensure all eligible children are fully immunized by their first birthday.”

PDG Tadesse Alemu speaks at the World Polio Day
PDG Tadesse Alemu speaks at the World Polio Day commoration in Addis Ababa, Ethiopia ©UNICEF Ethiopia/2014/Ayene

On a keynote address by PDG Dr. Tadesse Alemu, who recalled the commitment and dedication of PDG Nahu Senaye Araya, said “Swift and unprecedented changes in the world has impacted efforts of polio eradication. We must have strong push to end polio now. Dr. Taye Tolera, Special Advisor to the State Minister of Health, Federal Democratic Republic of Ethiopia, delivered remarks from the Ministry of Health. He stated, “This joint commemoration clearly shows that all partners and allies have maintained the stamina in the commitment and support to the Expanded Programme on Immunization and the Polio Eradication Initiative.” He called for continued commitment: “We all should be proud of our shared achievements. But, we should continue the journey until this highly interconnected world we all share is free of polio before 2018.”

As part of the World Polio Day events, Rotary International announced earlier in the week a US$44.7 million grant to fight polio in Africa, Asia and the Middle East on 21st October this year with Ethiopia to receive US$ 2 million for polio eradication efforts in the country.

Read the press release by UNICEF here.

World Health Organization, UNICEF and Rotary International, appreciate frontline workers in the fight against polio and call for sustained support for eradication efforts.

World Polio Day 2014 banner
Addis Ababa, 24 October 2014 – The World Health Organization, UNICEF and Rotary International stand together in the fight against polio and in commemoration of World Polio Day, 24 October 2014.

Despite significant progress made in polio eradication since the launch of the initiative in 1988, the wild poliovirus (WPV) continues to infect people, causing life-long paralysis and disability. The Horn of Africa was struck with a polio outbreak in April 2013. To date, 223 cases of WPV1 have been confirmed in Somalia, Kenya and Ethiopia. The date of onset of the last case confirmed in Somalia was in August 2014.

Up until 2013, Ethiopia was polio-free since 2008. However, since last year, Ethiopia has confirmed 10 cases of polio in Doolo Zone, Somali Region. Ethiopia’s response to this crisis has been fast and aggressive. Since June 2013, 11 rounds of polio immunization campaigns have been conducted in addition to ongoing border vaccination at 45 permanent vaccination posts along the border with Somalia. National immunization days (NIDs) in October and December 2013 reached over 12 million and 15 million children, respectively. Due to these aggressive efforts, the last case of WPV in Ethiopia was confirmed more than 9 months ago, in January 2014.

The success of these polio immunization efforts is a result of national commitment and the coordinated efforts of immunization partners. We recognize those who are in the forefront of the fight against this debilitating disease: health workers, vaccination teams, mobilizers, traditional and religious leaders, partners and others who work long hours, and walk long distances, to ensure all children are reached with the polio vaccine.

Rotary International launched a new campaign that promises every dollar donated to Rotary will be matched 2-to-1 by the Bill & Melinda Gates Foundation. On 21 October 2014, Rotary International announced the release of US$ 2 million to support polio eradication efforts in Ethiopia. UNICEF supports communication and social mobilization, vaccine procurement, cold chain and logistics and technical assistance while WHO is providing technical assistance, coordination support, including across cross border coordination, and surveillance support.

As World Polio Day is commemorated on the same day as UN Day today, we remember our efforts within the broader context, a day when we uphold a child’s right to health as a basic human right for all. As we look to 2015, we measure the success of our efforts against achievement of the Millennium Development Goals, acknowledging the contribution of polio immunization efforts to MDG achievement. In two weeks, Ethiopia will conduct the first of two rounds of the 2014 NIDs aiming to vaccinate over 13 million children. We look to all partners, decision makers, donors, leaders and other stakeholders to provide their support so that we can ensure no child is left behind. We will continue to work together to END POLIO NOW.

 

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For further information, please contact:

Mohammed Idris, Rotary International, +251911197755, mohammedsany@gmail.com

Wossen Mulatu, UNICEF, +251 11 518 4028, wmulatu@unicef.org

Fiona Braka, WHO, +251 11 553 4777, brakaf@who.int