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Polio vaccination coverage in Somalia

2014; Elsevier BV; Volume: 383; Issue: 9936 Linguagem: Inglês

10.1016/s0140-6736(14)61079-5

1474-547X

Harry Jeene, Abdirizak Hersi Hassan,

Viral gastroenteritis research and epidemiology

On May 5, 2014, WHO declared polio a public health emergency of international concern.1WHOWHO statement on the meeting of the International Health Regulations Emergency Committee concerning the international spread of wild poliovirus.http://who.int/mediacentre/news/statements/2014/polio-20140505/en/Google Scholar Somalia has not eradicated polio yet and has done five national immunisation campaigns in 2013, at considerable expense. Much attention has been given to low immunisation coverage in the conflict-affected south of Somalia. A cooperation between the Ministry of Health, Save the Children, UNICEF, and the UK Department for International Development looking at barriers to accessing health care in Puntland, an area not affected by conflict, found an unexpected low polio vaccination coverage rate in March, 2014, in the Karkaar region—an arid desert where pastoralism is the main activity. Although the study was not designed as a polio coverage survey, it met Lot Quality Assurance Sampling criteria. The study looked at whether children younger than 5 years old had received at least one polio vaccination, using a combination of card and caretaker recall. We noted a proportion of children younger than 5 years who had been vaccinated against polio at least once in their lifetime of 81·5% (SD 4·9, range 77–92) in small towns, of 58·8% (SD 23·9, range 20–90) in small villages, and of 34·4% (SD 24·5, range 0–79) in pastoralist populations. This survey was not designed to measure polio coverage and the sample size (385) is rather small. No reliable population estimates are available for the region, but the Ministry of Planning estimates that pastoralists represent 60–70% of the Karkaar population, while Puntland health authorities' estimates are at 40–50%. Pastoralists can freely cross unmarked borders. Moreover, Karkaar region is an important crossroad (connecting Gulf states, South Central Somalia [the epicentre of the 2013 polio outbreak], Ethiopia, and Kenya, but also between Yemen and Ethiopia). The WHO–UNICEF Joint Strategic Action Plan for the Polio Outbreak Response in the Horn of Africa in November, 2013, focused on the South Central region of Somalia where polio immunisation is hampered by ongoing insecurity. However, our data are from a region that has not been affected by conflict for at least a decade, and polio immunisation coverage still seems very low, especially in the population most likely to act as a vector for polio transmission. The recent WHO statement1WHOWHO statement on the meeting of the International Health Regulations Emergency Committee concerning the international spread of wild poliovirus.http://who.int/mediacentre/news/statements/2014/polio-20140505/en/Google Scholar will lead to a new round of planning to contain polio, and our data suggest that attention should also be given to transmission vectors outside the conflict area. Our observations highlight that pastoralist populations are underserved. Because polio is a global concern, undoubtedly funding will be found for this specific intervention. It should however also be a wake-up call that pastoralist populations need health-care services, and thus funding. We declare no competing interests.