Harare, Zimbabwe – In the wake of wild-polio outbreak in Malawi and Mozambique, neighbouring countries have stepped up surveillance to detect cases while preparing for vaccination campaigns recommended by the World Health Organization. Recent reported cases in Mozambique in particular, have put Zimbabwe on very high alert due to high traffic volumes between the two countries. The report of wild polio virus outbreak in Malawi in February 2022 necessitated Zimbabwe to conduct a detailed Polio Risk Analysis that informed development of a response plan. The risk analysis identified sub-national surveillance and routine immunization gaps that put the country at high risk of Polio virus importation. For example, in 2021, 30 out of 63 districts had not met the polio surveillance Acute Flaccid Paralysis (AFP) case detection standard, with 11 of them not having detected any case. In addition, only 6 out of 63 districts had above 90% routine immunization coverage for the third dose of Polio.
As part of the response, health authorities in Zimbabwe with support of partners including Bill and Melinda Gates Foundation (BMGF), UNICEF and WHO are implementing polio surveillance strengthening activities. Zimbabwe is currently using the AFP surveillance system to detect any potential Polio outbreaks.
Critical activities to strengthen the Polio surveillance include training of health workers at all health institutions and sensitization of clinicians at central, provincial, district, mission and major private hospitals. Additionally, intensified active case search focusing on high priority sites such as health institutions at all levels is being done. Community sensitization meetings with Village Health Workers (VHW) and Health Center Committees (HCC) while routine immunization and surveillance review and planning meetings with provinces and districts are also being conducted. Furthermore, integrated Supportive Supervision targeting low performing districts and health facilities is being prioritized.
“Surveillance exercises help us unearth things that we have to adjust not only focusing on the planned polio campaign but as we provide routine immunisation services beyond the campaign. We get to appreciate the gaps and challenges our clinics face in providing vaccination services to communities surrounding them and provide necessary support to the clinics,” notes Matron Lorraine Mukwemu Harare City Acting Chief Nursing Officer.
MoHCC continues to organize integrated awareness campaigns at community level as well as through regular engagements with the media.
WHO epidemiologists are supporting MoHCC technical staff to undertake detailed Polio risk analysis, prepare surveillance improvement plans, undertake training of health workers at all levels of health system and strengthen specimen collection and transportation. WHO staff working with MoHCC staff and partners are also supporting the strengthening of integrated supportive supervision activities.
These efforts have resulted in improvement in the AFP surveillance performance. The AFP detection has increased to 5.9/100,000 children 0 – 14 years compared with 1.9/100,000 children 0 -14 years, same period in 2021. The proportion of AFP samples with adequate stool has increased from 89% in 2021 to the current 95%. The number of districts not detected a case has decreased from 11 in 2021 to two (2). However, more work still need to be done to improve the quality of AFP specimens so that they reach the laboratory in good condition. There is also need to improve routine immunization coverage rates in tandem with the ongoing efforts to prepare for high quality polio vaccination campaign.
“We commend the national authorities for intensifying polio eradication activities in response to the polio outbreak in the Southern Africa sub-region. We are grateful to the frontline health workers, volunteers, community based organizations, faith based organizations, and non-governmental organizations as well as technical and financial partners for supporting efforts to improve polio surveillance in Zimbabwe,” said Dr Maxwell Rupfutse, WHO National Professional Officer for the Expanded Program on Immunization (EPI).