Friday, April 22, 2016

The Complete Background to Lao PDR’s Polio Outbreak and Response

Nabua Village, Vientiane Capital: Children in the local Hmong community show us their polio immunization marks ‪#‎endpolio‬ ‪#‎Laos‬ ‪#‎UNICEF‬
In October 2015, the Ministry of Health in Laos reported a case of circulating Vaccine Derived Polio Virus (cVDPV1) in an 8-year old boy who showed symptoms of weakness of the muscles and the muscles and respiration (Acute Flaccid Paralysis – AFP) and died on 11 September 2015. On 29 September a 4-year old boy also showed onset of the symptoms and died a short time later. On 13 January 2016, the Prime Minister of Lao PDR declared cVDPV1 outbreak as a public health emergency. By March 2016, there were 11 confirmed cVDPV 1 cases concentrated in 3 provinces (Bolikhamxay, Xieng Khouang and Xaisomboun) among some ethnic groups. The subsequent investigations and analysis revealed significant immunity gaps. Chief among them an immunization hesitancy among certain population groups.

The Ministry of Health’s National Immunisation Program (NIP) with support from UNICEF, and partners the WHO, promptly responded to the polio outbreak through the activation of the National Emergency Operations Centre (EOC) and the implementation of a comprehensive polio immunization campaign. In order to interrupt polio transmission, between October 2015 and April 2016, the country conducted five sub-national and national polio immunization rounds, covering cumulatively an estimated 8 million children under 15 years of age and 2 million adults. The fifth round of nationwide OPV vaccination was concluded in Feb 2016, with an estimated target coverage of 95%. The target group selected for vaccination are 0-15 year’s age group nationwide and ‘all age group population’ in the 63 high risk districts. Communication and social mobilisation activities are playing a significant role in addressing barriers to high immunisation coverage among some parts of the population. Social mobilisation activities in line with the national communication and social mobilisation plan for polio outbreak response, supported by UNICEF have included:
  • Advocacy for strong High level commitment and engagement at national, sub-national, district and village level including active involvement of line ministries to support campaign
  • Community mobilization conducted by district/village authorities, village/ Kumban /Singsao chiefs, village health volunteers, etc
  • Locally tailored information, education and communication  materials (posters, t shirts, caps, fliers, USBs, loudspeakers) and key messages (TV-radio spot and other audio visual materials; production in 5 local vernacular. 
  • Media groups oriented (TV, National and Community Radio)
  • Partnership with mass organisation mobilized and engaged to support campaign i.e.  Lao National Front for Construction, Lao Women’s Union, etc.
  • Inter-Personal Communication training of health workers, district staff and mass organizations.
  • Wider use of local radio station, loudspeakers/USBs and IEC materials to spread the information on importance of immunization.
  • Continue special mobilization events in identified high risk areas and among high risk communities
  •  In collaboration with MoH and WHO, identify and strengthen risk communication, especially around AEFI.

A Hmong family showing their figure marks after vaccination.

On 18 March 2016, the National Immunisation Technical Advisory Group (NITAG) reviewed the current situation to develop the strategy for the coming months. They recognise the extensive support of partners in achieving significant progress in the coverage nationwide. However, it also identified the persistent challenges in some geographical areas and among some ethnic groups and actions for the remainder of 2016. Included in those are the strengthening of the surveillance around the initial symptoms of Acute Flaccid Paralysis (a weakness of the muscles and the muscles of respiration) especially in the ‘silent provinces’ and sustained, intensified communication and social mobilisation efforts to engaging and ultimately reach the unreached target populations.

Four additional supplementary immunization rounds (May, July, November and December 2016) to boost the immunity among the target population and improve the routine immunisation coverage. Lastly but importantly, in coming months, more intensified communication and social mobilization efforts will be required to sustain the momentum and motivation of the health workers and local authorities and to reinforce the positive messages about the need, importance and acceptance of multiple OPV doses and routine immunisation in general.  

By Ruchin Sharma, Polio Outbreak C4D Lead (International Consultant) 

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