Polio workers in Nigeria tapped for response to meningitis C outbreak

Plans underway to transition polio infrastructure to support broader health efforts across Nigeria

Children standing in line for their meningitis vaccine in Sokoto state, Nigeria

“The dawn of 18 April was like every other day until my WHO supervisor called telling me to report for meningitis C vaccination training at 7 am,” said Fatima Ahmed, a polio vaccinator in Sokoto State. “I dressed quickly and left knowing that another responsibility beckoned.”

From 13 December 2016 to 14 May 2017, a total of 13 943 suspected cases and 1112 deaths of meningitis have been reported from 24 States in Nigeria. Sokoto State was one of the hardest hit by the outbreak that required a major vaccination campaign in April.

Meningitis C is a strain of meningitis which first emerged in Nigeria in 2013 that can be fatal in 50% of cases if untreated. Vaccination is a key part of the response to contain the highly contagious disease.

500 000 doses of meningitis C-containing vaccine were sent to Nigeria to combat the epidemic. Needing on the ground support to rapidly vaccinate thousands of people, the Government of Nigeria, WHO and other partners turned to the experienced network of workers focused on eradicating polio.

“Nothing prepared me more for the task than my experiences in polio eradication activities, such as supplemental and routine immunization,” said Fatima, who has worked with the Polio Eradication Initiative for six years. “My experiences as a polio vaccinator allowed me to immediately swing into action. So, when I got that call, I realized the need to use my expertise to serve my community.”

Over the course of 7 days, Fatima vaccinated 2100 people against meningitis C.

More than pinpricks

Dr Fiona Braka, polio team leader for WHO Nigeria, noted that besides helping with vaccinations, polio workers performed other functions critical to containing the outbreak.

“Polio workers assisted with case identification, reporting, detailed investigation and follow-ups of treated meningitis C cases, as well as searching for suspected cases in health facilities and communities,” Dr Braka said.

Other activities included data collation, analysis, reporting and archiving using mobile phones fashioned after the real-time tracking and reporting by polio vaccination teams in northern Nigeria. These activities fit into the polio essential functions of surveillance, outbreak response and containment that vaccine-preventable disease surveillance and laboratory networks rely on to save millions of lives threatened by diseases such as measles, yellow fever and meningitis.

While the meningitis C outbreak has largely been contained, pockets of the disease remain. In support of the Nigerian Government, WHO and partners are planning a second round of vaccinations expected to include support from polio workers.

The polio infrastructure

Fatima is one of over 390 000 polio vaccination team members paid through WHO’s Direct Disbursement Mechanism to support polio eradication in Nigeria. At times, polio workers have been a stalwart of frontline support for outbreak response. For example, polio workers were essential to containing an Ebola virus outbreak in 2014.

With the real possibility of polio being eradicated globally, plans are underway to determine how best to transition polio workers to retain their knowledge and skills and keep the infrastructure in place.

“The polio infrastructure was originally designed towards achieving the polio eradication goals,” said Dr Wondimagegnehu Alemu, WHO Country Representative to Nigeria. “Now polio infrastructure has incorporated new functions such as basic health services and response to outbreaks of other diseases, and is in the process of possible transition into the broader Nigerian health system.”

According to Dr Alemu, every facet of public health in Nigeria is permeated by the polio infrastructure. Thus, when Fatima received the call to participate in the meningitis C vaccination campaign, she was adequately prepared to be part of a system to save lives.

Future of public health interventions assured

Huge investments by donors and partners have gone beyond polio eradication to saving lives and impacting positively on people’s health. WHO and other partners are currently supporting the National transition plan to ensure these investments are not wasted, but made available to support other National public health efforts and priorities.

“We must carefully consider how we transition many of the polio workers and the polio infrastructure to help with managing other health needs,” Dr Alemu said. “Future funding and partnerships will be a key part of this work.”

Support for polio eradication to the Federal Government of Nigeria through the WHO is made possible by funding from the Bill & Melinda Gates Foundation, European Union, Government of Germany through KfW, Global Affairs Canada, USAID, KOFIH (Korea), DFID (UK), Rotary International and the World Bank.