Strategy to eradicate polio in Angola
Context
Angola has not reported a case of polio since July 2011. However, it remains at high risk, with the possibility that low-level circulation is continuing in some parts of the country, in addition to the constant threat of re-introduction.
Many children in the capital, Luanda, and the greater province surrounding it, continue to miss out on receiving Oral Polio Vaccine (OPV). In its most recent report from June 2012, the Independent Monitoring Board (IMB) in particular highlighted ongoing risk to Luanda, which it calls the ‘natural home for polio’ in the country and where ‘poor surveillance and unacceptable levels of missed children are putting Luanda at high risk’. Independent monitoring data indicates that upwards of 10% of children are missed during supplementary immunization activities (SIAs).
Communication in Action: overview of community engagement
Strategic approach in Africa
Compared with Asia, poliovirus transmission persists over a broad area in Africa. In addition, polio outbreaks due to importations generally result in more polio cases over longer periods of time than in Asia. Both are due to weak health systems, resulting in low immunization coverage.
These challenges are off-set by consistently high per-dose efficacy of oral polio vaccine in Africa, and a lower population immunity threshold (80–85%) needed to stop poliovirus transmission.
Consequently, the immunity thresholds needed to stop polio transmission in Africa can be achieved with relatively fewer vaccination campaigns over wide areas and maintaining high coverage.
II. Strategic approach in Angola
The 2012 National Emergency Action plan for Angola recommends the following emergency approach.
- Focus on Luanda and barrier measures along Angola’s northern border with the Democratic Republic of Congo.
- Improve quality of vaccination campaigns by transferring responsibility for micro-planning and control of vaccinator recruitment to community leaders.
- Strengthen cross-border activities, including preparation and implementation of immunization days in border areas.
- Implement post-campaign corrective actions based on the results of the independent monitoring and LQAS studies.
- Intensify epidemiological surveillance and water treatment through improving transport logistics and communication and assessment of visit performance as well as strengthening supportive supervision.
- Use support from helicopters of the armed forces and national police in difficult-to-access areas.
- Intensify routine immunization with all the antigens in 61 municipalities at high risk of polio using outreach and mobile teams. Strengthen the cold chain at all levels.
- Combine polio immunization with combating measles and maternal and neonatal tetanus.
Eradication targets
- Reduce to below 5% the number of children not vaccinated during campaigns against polio in the 61 priority municipalities (independent monitoring and LQAS data).
- Achieve a non-polio AFP rate of > 2/100,000, < 15 years and a timely sample rate of > 80%in 100% of municipalities with a population of > 50,000 inhabitants.
- Routine immunization coverage - 90% national coverage (Polio3, Penta-3, Measles, BCG, yellow fever) among infants up to 1 year of age.
- Achieve 95% use of treated water and hand washing in 200,000 families in the critical areas of 5 municipalities in Luanda Province.
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