Polio Eradication Immunisation Campaign

Ethiopia's outbreak response comprises:

1. a round of Sub National Immunization Days, conducted the first week in March, which focused on Tigray and areas of the country at highest risk of importation of poliovirus from Sudan. Organisers state that 3.5 million children under 5 in all emerging regions and in 9 zones of Amhara, Oromia, Tigray, and Southern Nations, Nationalities and Peoples Region (SNNPR) were vaccinated from March 4-8 2005.
2. several rounds of National Immunization Days (NIDs) - one set carried out from April 1-5 and May 23-27 2005 and another set carried out from October 28-31 and November 25-28 2005. During these rounds, 100,000 volunteers and health workers go door-to-door to administer oral polio vaccine (OPV) to Ethiopia's children. In the April and May rounds, 26 national and 6 international facilitators were deployed to all regions, where they worked with local health authorities to plan, train, and supervise the vaccination teams and monitor the quality of the campaign. To facilitate this process, 2.5 million copies/sheets of 9 types of guides and forms were prepared, printed, and distributed. Vaccination coverage for the October NIDs is estimated at 96%.
3. heightening of acute flaccid paralysis (AFP) surveillance to ensure that any cases of poliovirus are rapidly detected and an appropriate and timely response is launched.

The main communication strategies used during this campaign are:

Advocacy

• The State Minister wrote a circular letter to all Regional Health Bureaux asking them to support, plan, organise, and implement the campaign in their respective regions. Similarly, the State Minister notified all Regional State Presidents to render all necessary political and financial support toward the successful implementation of the two rounds of the campaign.
• Two days before the launching of the campaign, a press conference was conducted at the Federal Ministry of Health in the presence of partners such as WHO, Rotary International, USAID, JICA, UNICEF, OCHA (Office for Coordinating Humanitarian Affairs), and national and international media corps. To foster wide media coverage, a press release was prepared and dispatched via e-mail to all media agencies.
• Most regions conducted colourful launching ceremonies to declare the commencement of the campaign and express the political commitment of the respective regional states. Organisers state that these ceremonies enjoyed wide media coverage.

Social Mobilisation

Communication/social mobilisation activities associated with the NIDs and AFP surveillance are guided by the Interagency Coordinating Committee (ICC) Technical Committee, an advisory body under the National ICC, with the following objectives:

1. to provide technical support and resource identification and mobilisation for programme implementation
2. to participate in the planning, follow-up, management, monitoring, and evaluation mechanisms of the Expanded Programme on Immunisation (EPI)-Plus programme.

These activities have included:

• radio and TV spots transmitted on a national network in different national languages to inform the general public about the date, strategy, and benefits of the campaign
• a roundtable TV talk in which experts from WHO, Ministry of Health, and the Addis Ababa University Medical Faculty and Private Practitioner took part. This programme was transmitted to the general public to help communicate the campaign strategies, and to discuss the surveillance and isolation of the two WPVs. An interactive component was designed to address queries of caretakers regarding the vaccination
• messages about the date and strategies of the campaign developed for health workers, regional radio stations, town criers, and religious leaders. Banners have been developed and sent out to all regions through the facilitators.
• face-to-face efforts carried out by the Stop Transmission of Polio (STOP) team, who travelled (from September 25 to December 15 2005) to Ethiopia with the motto to "strengthen active surveillance for acute flaccid paralysis in Ethiopia". The STOP team included in their activities sensitisation efforts to rural drug vendors, private clinics, traditional healers and holy water sites in 6 zones (Arsi, Borena, East Shewa, East Tigray, Jimma and West Shewa). In all, they visited 373 health facilities and sensitised 1,524 health workers and community members.

Capacity Building

Facilitators were trained in how to assist the Regional Health Bureau officials in mobilising the community and local resources. Similarly, the Bureaux have conducted training sessions for volunteers and health workers.

Immunisation and Vaccines, Children.

A massive polio outbreak in Sudan that has paralysed 132 Sudanese children since May 2004 has spread to Ethiopia. In February 2005, WHO confirmed two cases of polio in the Tigray region; genetic sequencing data confirmed that the two cases are linked to polio circulating in Sudan. As of March 20 2006 a total of 24 polio cases have been confirmed in Ethiopia; the polio virus transmission has been geographically restricted to the three regions of Amhara, Oromia and Tigray. WHO indicates that there is a rapidly narrowing epidemiological window in which to eradicate the disease.

Prior to these newly-reported cases, Ethiopia had been polio-free since January 2001. Routine immunisation coverage rose from 52% in 2002 to 65% in 2004. Similarly, in 2004 the country satisfactorily achieved all the AFP surveillance performance indicators (NPAFP rate 1.5, target > 1/100,000; population under 15 years of age and stool adequacy rate 85%, target > 80%).

Polio-affected countries have set as their target the interruption of polio transmission by the end of 2005, as part of the 18-year effort to eradicate the disease.