Poliomyelitis

Polio in Nigeria

• Nigeria and Africa were officially certified by WHO as free from Wild Polio Virus (WPV) in August 2020, an incredible milestone in global polio eradication campaign;
• Another type of polio virus called cVDPV (Circulating Vaccine-Derived Polio Virus) is still causing polio outbreaks in Nigeria. Since 2016, there have been 61 confirmed cases of cVDPV. Nigeria’s neighboring countries including Benin, the Republic of the Niger and Cameroon are also experiencing the cVDPV outbreaks;
• Nigeria’s polio eradication programme has responded to the outbreaks by implementing polio immunisation campaigns and strengthening routine immunisation. Thanks to this, the number of cVDPV2 cases has decreased steadily, from 18 in 2019 to 8 in 2020;
• Nigeria needs to continue its outbreak and using all available tools to deal with cVDPV outbreak to keep Nigeria free from wild polio virus and other types of polio viruses.

Action in Nigeria

• With support from the Global Polio Eradication Initiative (GPEI), which includes WHO, UNICEF, GAVI, CDC and Rotary, NPHCDA plans to conduct two rounds of house-to-house polio nationwide campaign with an aim of vaccinating at least 95 per cent children aged 0-5 years while observing COVID-19 protocols to ensure vaccinators, health workers and communities adhere to COVID-19 precautions and are protected from COVID-19;
• With support from partners, the NPHCDA will conduct trainings for vaccinators and other health workers on polio immunization and COVID-19 precautions such as wearing of masks, keeping a safe distance and frequent handwashing with soap and clean water. In addition, personal protective equipment such as masks will be provided to all health workers participating in the polio campaign;
• To better address ongoing outbreaks of type 2 cVDPV, as recommended by WHO, the government of Nigeria is deploying an additional outbreak response tool, the novel oral polio vaccine (nOPV2), which is clinically proven to reduce the risk of cVDPV and is specifically designed to protect children from the only type of poliovirus that remains in Nigeria.

Polio, cVDPV and nOPV2

• Polio virus, both WPV and cVDPV, cause lifelong paralysis in children under five years of age;
• There is no cure for polio, but it can be prevented with two drops of the oral polio vaccine;
• The best protection against polio is ensuring all children are vaccinated during routine and supplementary immunization campaigns, and maintaining strong disease surveillance;
• Millions of doses of polio drops have been administered throughout the world and have saved millions of children from paralysis;
• All vaccines for children are safe even if a child is suffering from fever, cough, or diarrhea. Polio vaccine is also safe for newborns, even if they have been born a few hours before;
• Polio vaccine has little to no side effects and can be given multiple times to boost immunity against the polio virus;
• If a population is optimally immunized with polio vaccines, they will be protected from all types of polio including WPV and cVDPV;
• cVDPV occurs when weakened strain of the poliovirus contained in the oral polio vaccine (OPV) circulates among under-immunized population for a long time;
• cVDPV outbreaks are stopped using same tactics that enabled progress against WPV polio, ensuring every child is given oral polio vaccine in high-quality immunization campaigns;
• nOPV2 is an improved oral polio vaccine which based on the current oral polio vaccine, that has been proven effective and safe in eradicating wild polio virus from Nigeria;
• nOPV2 is a modified version of mOPV2, made available through a WHO Emergency Use Listing recommendation to combat type 2 cVDPV outbreak/s affecting Nigeria;
• nOPV2 is a safe and effective polio vaccine that has been in development for over 10 years and has been thoroughly tested in adults, children and infants across multiple countries;
• nOPV2 has been approved by the National Agency for Food and Drugs Administration and Control (NAFDAC) and is recommended by WHO for use in controlling polio outbreaks.

Public and Media Support

• Share accurate information with the public contained on this page to ensure parents are aware of the risk from polio and seek vaccination for their children;
• Counter rumors and misinformation whenever identified, without repeating the rumors, through facts and correct information on this page;
• Report rumors and misinformation to NPHCDA so that it can be immediately responded to and stop spread of harmful behaviors;
• Refrain from exacerbating or repeating rumors and misinformation which can result in negative attitudes towards health workers and the polio campaign by the community;

• Maintain ethical reporting standards by protecting identities of persons infected with the disease to prevent stigmatization of patients and their families;
• Inform your families and communities about protecting all children below five years from contracting polio by getting vaccinated during both rounds of the polio campaign 13- 16 March 2021 and 10-13 April 2021;
• Inform people to seek medical help if their child or a child in their community is suffering from sudden paralysis of one or multiple limbs;
• Create awareness on the disease and encourage parents to immunize their children against polio;
• Distribute accurate information with the public based on this document so that parents in Nigeria are aware of the risk from polio virus;
• Counsel and encourage parents who refuse the polio vaccine and convince them to vaccinate their children, so that their own child and other children in the community can remain safe;
• Encourage vaccinators and parents to observe all COVID preventive measures; always wash hands with soap and clean water, wear face masks and continue social distancing;
• Encourage parents and caregivers to always take their children to the nearest health facility so their children can be vaccinated against all vaccine-preventable diseases;
• Reach out to NPHCDA for accurate information, clarifications interviews and support for stories.

Key Messages

• All children in Nigeria aged 0-59 months are at an immediate risk of contracting polio virus;
• Tests have confirmed that polio virus is already circulating in Monrovia. Polio does not respect borders or boundaries hence every child below five years must be protected from the disease;
• There is an urgent need to ensure all children aged 0-59 months are protected against polio by giving them two drops of the polio vaccine;
• Polio is a dangerous disease that has no cure and can only be prevented through multiple doses of polio vaccine;
• Polio vaccine requires multiple doses to achieve complete immunity and ensure the child’s full protection from polio; multiple doses of the polio vaccine pose no harm to children;
• The best protection against polio is ensuring all children are vaccinated during routine and supplementary immunization campaigns;
• NPHCDA is conducting two-rounds of house-to-house national polio immunization campaign from 13-16 March 2021 and 10-13 April 2021 in five states: Zamfara, Niger, Sokoto, Bayelsa and Delta and one LGA in FCT: Gwagwalada.;
• All children below five years must be vaccinated against polio with two drops of polio vaccine during the two rounds of national house-to-house polio immunization campaigns;
• The polio vaccine is free, safe and efficacious to protect children in Nigeria from the remaining type of polio;
• Polio vaccine is given in the mouth of the child and only protects from polio. Children need other vaccines to be protected from other diseases;
• Polio drops have successfully protected millions of children around the world from polio for decades, and continuous protection is needed;
• Polio drops have safely eradicated the wild poliovirus in Nigeria and globally, with an exception of Pakistan and Afghanistan only;
• Polio vaccine is recommended for use in Nigeria by the World Health Organization and NAFDAC because it can provide continuous, urgently needed protection against the remaining type of poliovirus;
• The polio vaccine to be used is clinically shown to be a safe and efficacious option for vaccination against the remaining type of polio in Nigeria.

POLIO FREQUENTLY ASKED QUESTIONS (FAQ)

1. What is Polio?

Poliomyelitis (polio) is a highly infectious disease caused by poliovirus, a virus which affects mostly children. It has no cure, causes lifelong paralysis in children, and in some cases, it can cause death. The only way to protect children is to give them two drops of the oral polio vaccine during routine immunization and supplementary polio immunization days.

2. Africa was declared polio free by the World Health Organization, can you explain why we have an outbreak in the country despite the polio free certification?

There are two forms of polio: the wild polio virus (WPV) and circulating vaccine-derived polio virus(cVDPV). Nigeria and therefore the whole Africa eradicated WPV.  WPV remains only in Afghanistan and Pakistan. Nigeria currently has an active outbreak of cVDPV with presence of the virus confirmed in several states.

cVDPV outbreaks occur when the weakened strain of the polio virus contained in the Oral Polio Vaccine (OPV) circulates in under-immunized communities for a long time. While Nigeria has been declared free from WPV, a lot of children remain at risk of cVDPV due to the low immunization rates in Nigeria.

cVDPV outbreaks are stopped using same tactics that enabled progress against WPV polio, ensuring every child is given oral polio vaccine in high-quality immunization campaigns

3. Why are we reporting cases of the vaccine-derived polio in Nigeria?

Circulating vaccine-derived polio virus (cVDPV) is spreading due to the low immunization coverage in Nigeria and other countries. The COVID-19 pandemic has worsened the already low coverage in the country as most activities were put on hold.

Many parents and caregivers did not immunize their children for fear of leaving their houses due to COVID-19. Rumors and misconceptions around vaccines, especially COVID-19 vaccines, have created fear in communities, leading parents and caregivers to not seek immunization for their children.

The outbreak is attributed to importation and poor hygiene and sanitation in the country. Nigeria is amongst 24 African countries that have reported cVDPV polio outbreaks from 2020-2021

4. How is cVDPV polio transmitted?

cVDPV, like wild polio virus, is transmitted through the oral-fecal route. The weakened virus is excreted through feces after a child is vaccinated and can easily spread in places with poor hygiene, sanitation, open defecation and overcrowding. This weakened virus can also be transmitted when water, food or hands become contaminated by stool containing the weakened virus. The weakened virus can offer what is called passive immunity to those who have not received the vaccine. However, if a population is seriously under-immunized and the virus is allowed to spread between people for a long period of time, it can become cVDPV.

5. Who is at risk of contracting polio?

Due to the low immunization rates in the country, all children aged below five years are at high risk especially unvaccinated children or children with low immunity. The best protection against polio is ensuring all children are vaccinated during routine and supplementary immunization campaigns. If a child is optimally immunized with polio vaccines, he/she will be protected from all types of polio.

6. Why is it important to immunize children again and again with the polio vaccine?

Oral Polio Vaccine (OPV) requires multiple doses to achieve complete immunity in the child and ensure the child’s full protection from polio. Receiving multiple doses of the polio vaccine poses no harm to your child and is completely safe for children.

7. Will the NPHCDA use the same vaccine to stop the outbreak?

With recommendation from WHO, the NPHCDA is using type 2 Novel Oral Polio vaccine (nOPV2) to stop the polio outbreak. This vaccine is clinically shown to be safe and more efficacious at reducing the risk of cVDPV.

8. How do we know the vaccine against polio is safe?

nOPV2 is clinically shown to be safe and efficacious in protecting children from the remaining type of polio in Nigeria – type 2 cVDPV. The vaccine is recommended by the World Health Organization (WHO) and the NAFDAC to address this specific type of outbreak. The vaccines are supplied through UNICEF.

Polio vaccines are safe even if the child is suffering from fever, cough, or diarrhea, and is also safe for newborns as young as a few hours old. Polio vaccines have little to no side effects and can be safely given to children multiple times.  All countries except Pakistan and Afghanistan have used oral polio vaccines to eradicate wild polio virus and to protect millions of children from paralysis.

9. How does the NPHCDA plan to vaccinate all eligible children in the country?

Through two rounds of house-to-house polio campaigns in March and April 2021 in five states (Bayelsa, Delta, Zamfara, Sokoto and Niger) and one LGA in FCT, NPHCDA is targeting to vaccinate more than 7.2 million children below five years while strictly observing COVID-19 protocols to ensure children, vaccinators, health workers and communities are protected.

11. How will NPHCDA ensure safety of community, health workers and children from COVID-19 during the house-to-house polio campaign?

All vaccinators and health workers who will be engaged in the polio vaccination campaign will strictly adhere to the COVID-19 protocols by wearing masks, keeping a safe distance while in the communities and frequently cleaning their hands with alcohol-based sanitizer.

NPHCDA also urges the public to adhere to all COVID-19 protective measures and support health workers by presenting all children under the ages of five for vaccination whenever a polio team arrives.

The NPHCDA requests the public to ensure that only parents/caregivers support children to open their mouths for the vaccine to be administered. The vaccinators will not have any physical contact with children. All vaccinators must sanitize or wash their hands with soap and clean water before administering the polio vaccine in each home. Mothers/caregivers should wear a mask or cover their nose and mouth with a cloth while holding child for vaccination.

12. What impact do COVID-19, rumors, misconceptions and disinformation have on the polio campaigns?

COVID-19 rumors and misconceptions have affected routine immunization services as well as polio campaigns all over the world, including in Nigeria. Dissemination of false information regarding vaccines have led to vaccine hesitancy.

NPHCDA would like to reiterate that the polio vaccine is free, safe and efficacious. Polio vaccines have been used globally to protect millions of children from lifelong paralysis. NPHCDA would also like to urge to the public to desist from spreading false information and encourages health workers, community influencers, the media and health experts to counter rumors by providing accurate information to the public.

13. What is nOPV2 and why is it being used?

nOPV2 is an improved type of polio vaccine that has been in development for over 10 years and has been thoroughly tested in adults, children and infants across multiple countries. It has been declared safe and efficacious by the NPHCDA and is recommended for use by WHO to stop cVDPV2 outbreaks around the world.