Polio: Five African Countries Vaccinating 23 Million Children After Poliovirus Detected In One Child

Lorraine L. Janeczko, MPH

March 29, 2022

When polio paralyzed a 3-year-old girl in Lilongwe, Malawi, in November 2021, public health experts in Malawi's Ministry of Health responded quickly. The ministry partnered with the Global Polio Eradication Initiative (GPEI), the World Health Organization (WHO), and the United Nations International Children's Emergency Fund (UNICEF) to mobilize a surge team of personnel and resources to vaccinate all 2.9 million Malawian children under 5 years of age, WHO reported in a news release.

The first of four sequential campaigns began on March 20 and expanded on March 24 to neighboring Mozambique, Tanzania, and Zambia. The multinational, multiagency effort aims to include Zimbabwean children as well and deliver over 80 million supplemental doses of bivalent oral polio vaccines to over 23 million children in these five countries by July.

Because it takes multiple polio vaccine doses to become fully immunized, the children are expected to receive four rounds of vaccine regardless of their vaccination history.

"It is important to conduct the campaigns now to boost the immunity of our children," Annie Chauma-Mwale, MBBS, MPH, the chief medical officer of epidemiology and surveillance in Malawi's Ministry of Health in Lilongwe, told Medscape Medical News in an email. "Polio is not only a medical issue. Polio is also a socioeconomic issue with long-term impacts on the child, the country, and the globe.

"In Malawi, we are using our community health and healthcare facility structures to ensure we do not miss any eligible child," Chauma-Mwale, who is also the deputy incident manager of the Poliovirus Outbreak Response, explained. "We aim to play our role in the global eradication of polio by protecting the vulnerable and curtailing any potential transmission as early as possible."

Of the three variants of wild, naturally occurring poliovirus, types 2 and 3 have been eradicated, but wild poliovirus type 1 (WPV1) remains endemic in Afghanistan and Pakistan.

As reported recently by Medscape Medical News, the girl in Malawi was infected with a WPV1 strain that had been circulating for years in Pakistan's Sindh Province.

Malawi's most recent clinically confirmed WPV1 case was reported in 1992, and this is the first WPV1 case detected in Africa since 2016. The continent was declared free of indigenous wild polio in 2020 and is still considered free of wild poliovirus because the child's illness was imported from elsewhere.

The 3-year-old girl developed acute flaccid paralysis in November 2021. In February 2022, virus from her stool was sequenced by the National Institute of Communicable Disease (NICD) in South Africa and the Centers for Disease Control and Prevention in the United States. On February 16, Malawi was notified of the case, which was genetically linked to a sequence detected in Sindh Province around 2 years earlier.

"Do Not Ignore Polio"

Within 24 hours, the Government of Malawi declared a public health emergency and activated the national Emergency Operations Centre. Within 72 hours, the GPEI Rapid Response Team arrived in the country. The Ministry of Health partnered with GPEI, WHO, and UNICEF to mobilize the campaign and begin vaccinating children on March 20.

''We rely on clinicians to support the surveillance of polio through case searches, both active and passive," Mike Nenani Chisema, MBBS, MPH, the program manager of the expanded program on immunization and the polio response operations manager in Malawi's Ministry of Health, told Medscape Medical News in an email.

He noted that the young girl was diagnosed correctly and millions of children are now being protected against the disease, thanks to the acumen of one hospital clinician.

"Remember, we still have polio in some countries, and every country is at risk," he cautioned. "Don't forget to look for the obvious and do not ignore polio, regardless of economic status.''

According to GPEI, all countries — especially those with weak immunization and other public health programs whose residents trade or travel to and from endemic countries — are at risk for imported polio.

Dr Anita Gupta

Anita Gupta, DO, MPP, PharmD, an adjunct assistant professor of anesthesiology and critical care medicine and pain medicine at the Johns Hopkins University School of Medicine in Baltimore, Maryland, said that she welcomes this effort.

"Given the decades of published evidence and understanding on the vaccine's safety and efficacy, this program in Malawi is the right step to take," Gupta, who is not involved in the campaigns, said in an email. "Polio is preventable, and acting now will prevent spread later."

Chauma-Mwale and Chisema are employees of Malawi's Ministry of Health. Gupta has disclosed no relevant financial relationships.

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