Polio vaccination refusal in Nigeria continues to thwart eradication efforts

The number of reported cases of wild poliovirus (WPV) infection in northern Nigeria has risen significantly in the last few years, which researchers say is largely due to vaccine refusals and problems with healthcare infrastructure in the country.

In the report, published in the US Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report, Stacie Dunkle (Center for Global Health, CDC, Atlanta, Georgia, USA) and co-authors explain that the rise in cases in Nigeria may put the polio-free status of surrounding African countries and southern Nigeria at risk if not adequately addressed.

The team reports that the number of WPV type 1 and 3 cases reported in Nigeria in 2011 almost tripled compared with 2010, from 21 (8 WPV1; 13 WPV3) to 62 (47 WPV1; 15 WPV3).

Similarly, the number of cases in the first 9 months of 2012 almost doubled compared with the same period in 2011, from 42 (33 WPV1; 9 WPV3) in 2011 to 99 (82 WPV1; 17 WPV3) in 2012.

Dunkle and colleagues believe that "long-standing weaknesses in health system infrastructure, programmatic limitations in implementation of vaccination campaigns, weak accountability mechanisms, and a loss of public confidence in oral poliovirus vaccine since 2003 in some areas," have all allowed the number of cases to increase.

Speaking at the annual meeting of the American Society of Tropical Medicine and Hygiene in Atlanta, Georgia, USA, Adamu Nuhu (Nigeria National Primary Healthcare Development Agency) agreed that opposition to the vaccine due to religious or political differences is a problem in the northern part of Nigeria.

"We are working now with traditional leaders in the north who are respected by local people to change the perceptions of polio immunization and encourage more participation in immunization efforts," Nuhu commented in a press statement.

"Even though they are often moving, they have a leadership structure and we can work through these leaders to provide polio immunizations," he said.

The problems with vaccine uptake seen in Nigeria are similar to those that have been experienced in Pakistan and Afghanistan, as previously reported by medwireNews.

Recent initiatives to increase vaccine uptake in Nigeria show promise, but have not yet demonstrated epidemiologic impact, say Dunkle and colleagues, who add that if improvements are not seen in 2013 additional preventative measures may need to be introduced.

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