Doses Of Oral Polio Vaccine Research Articles

Circulating vaccine-derived poliovirus type 2 outbreak in Democratic Republic of Congo 2011-2012

According to the WHO records of 2013, the incidence of poliomyelitis was reduced by more than 99%, the number of endemic countries decreased from 125 in 1988 to 3 in 2013 and over 10 million cases were prevented from poliomyelitis thanks to the intensive use of Oral polio vaccine (OPV). However, the emergence of circulating vaccine-derived poliovirus strains (cVDPV), causing serious epidemics like the wild poliovirus, is a major challenge on the final straight towards the goal of eradication and OPV cessation. This paper describes the cVDPVoutbreak that occurred in the Democratic Republic of Congo (DRC) from November 2011 to April 2012. All children under 15 years of age with acute flaccid paralysis (AFP) and confirmed presence of cVDPV in the stool samples were included. Thirty (30) children, all from the administrative territories of Bukama and Malemba Nkulu in the Katanga Province (south-east DRC), were reported. The virus responsible was the cVDPV type 2 (0.7% -3.5% divergent from the reference Sabin 2 strain) in 29 children (97%) and the ambiguous vaccine-derived poliovirus strain (0.7% divergent) was confirmed in one case (3%), a boy seventeen months old and already vaccinated four times with OPV. Twentyfive children (83%) were protected by any of the routine EPI vaccines and 3 children (10%) had never received any dose of OPV. In reaction, DRC has conducted five local campaigns over a period of 10 months (from January to October 2012) and the epidemic was stopped after the second round performed in March 2012. As elsewhere in similar conditions, low immunization coverage, poor sanitation conditions and the stop of the use of OPV2 have favoured the emergence of the third cVDPV epidemic in DRC. The implementation of the Strategic Plan for Polio eradication and endgame strategic plan 2013-2018 will prevent the emergence of cVDPV and set up the conditions for a coordinated OPV phase out.

Rural-Urban Differences in Reasons for Incomplete Vaccination in Children Under Six Years, Southeast Iran 2013

Background: Geographical differences in vaccination programs are a major public health problem, which is often linked to the availability of healthcare services and socioeconomic factors. Objectives: The current study aimed to identify the differences in the patterns and the reasons for incomplete vaccination of children in urban and rural areas. Patients and Methods: In the current cross-sectional study, a total of 1039 children under six years (612 rural and 427 urban subjects) were recruited from a databank of partially vaccinated children from March to December 2013. A group of trained Community Health Volunteers completed the study questionnaires by interviewing the parents of the identified children during their routine home visits. The Chi square test and Fisher’s Exact test were used to compare the distribution of categorical variable between urban and rural areas. Results: The patterns of the number of missed doses of vaccine were similar for urban and rural subjects, but urban children 1 - 6 years were significantly more likely to miss subsequent doses of Oral Polio Vaccine (OPV) and Diphtheria-Tetanus-Pertussis (DTP). A statistically significant association was found between mother’s age, place of birth and the number of missed vaccine doses. Rural healthcare providers more frequently disseminated vaccination information than urban vaccinators (P < 0.001). A greater proportion of rural parents reported the lack of vaccines and healthcare staff misconduct as a reason for postponing vaccination, while over-crowdedness of health center, mother illness and forgetfulness, child illness and following physician recommendations were mentioned by a greater fraction of urban mothers. Conclusions: Efforts to improve vaccination coverage should be taken into account regarding the differences in the factors that contribute to the incomplete vaccination status of children in the rural and urban areas. The current study findings indicate that vaccination services especially in the urban areas need to be reassessed to ensure that all children are covered. To develop and promote childhood vaccination strategies, special attention should be paid to address maternal barriers for children under-vaccination.

The Global Context of Vaccine Refusal: Insights from a Systematic Comparative Ethnography of the Global Polio Eradication Initiative.

Many of medical anthropology's most pressing research questions require an understanding how infections, money and ideas move around the globe. The Global Polio Eradication Initiative (GPEI) is a $9 billion project that has delivered 20 billion doses of oral polio vaccine in campaigns across the world. With its array of global activities, it cannot be comprehensively explored by the traditional anthropological method of research at one field site. This paper describes an ethnographic study of the GPEI, a collaborative effort between researchers at eight sites in seven countries. We developed a methodology grounded in nuanced understandings of local context but structured to allow analysis of global trends. Here, we examine polio vaccine acceptance and refusal to understand how global phenomena-in this case, policy decisions by donors and global health organizations to support vaccination campaigns rather than building health systems-shape local behavior. This article is protected by copyright. All rights reserved.

Immunogenicity of Two Different Sequential Schedules of Inactivated Polio Vaccine Followed by Oral Polio Vaccine Versus Oral Polio Vaccine Alone in Healthy Infants in China.

Two vaccination schedules where inactivated polio vaccine (IPV) was followed by oral polio vaccine (OPV) were compared to an OPV-only schedule. Healthy Chinese infants received a 3-dose primary series of IPV-OPV-OPV (Group A), IPV-IPV-OPV (Group B), or OPV-OPV-OPV (Group C) at 2, 3, and 4 months of age. At pre-Dose 1, 1-month, and 14-months post-Dose 3, polio 1, 2, and 3 antibody titers were assessed by virus-neutralizing antibody assay with Sabin or wild-type strains. Adverse events were monitored. Anti-polio 1, 2, and 3 titers were ≥8 (1/dil) in >99% of participants, and Group A and Group B were noninferior to Group C at 1-month post-Dose 3 as assessed by Sabin strain-based assay (SSBA). In Group A 1-month post-Dose 3, there was no geometric mean antibody titers (GMT) differences for types 1 and 3; type 2 GMTs were ≈3-fold higher by wild-type strain-based assay (WTBA) versus SSBA. For Group B, GMTs were ≈1.7- and 3.6-fold higher for types 1 and 2 via WTBA, while type 3 GMTs were similar. For Group C, GMTs were ≈6.3- and 2-fold higher for types 1 and 3 with SSBA, and type 2 GMTs were similar. Antibodies persisted in >96.6% of participants. Adverse event incidence in each group was similar. A primary series of 1 or 2 IPV doses followed by 2 or 1 OPV doses was immunogenic and noninferior to an OPV-only arm. SSBA was better at detecting antibodies elicited by OPV with antibody titers correlated to the number of OPV doses (NCT01475539).

The "Performance of Rotavirus and Oral Polio Vaccines in Developing Countries" (PROVIDE) study: description of methods of an interventional study designed to explore complex biologic problems.

Oral vaccines appear less effective in children in the developing world. Proposed biologic reasons include concurrent enteric infections, malnutrition, breast milk interference, and environmental enteropathy (EE). Rigorous study design and careful data management are essential to begin to understand this complex problem while assuring research subject safety. Herein, we describe the methodology and lessons learned in the PROVIDE study (Dhaka, Bangladesh). A randomized clinical trial platform evaluated the efficacy of delayed-dose oral rotavirus vaccine as well as the benefit of an injectable polio vaccine replacing one dose of oral polio vaccine. This rigorous infrastructure supported the additional examination of hypotheses of vaccine underperformance. Primary and secondary efficacy and immunogenicity measures for rotavirus and polio vaccines were measured, as well as the impact of EE and additional exploratory variables. Methods for the enrollment and 2-year follow-up of a 700 child birth cohort are described, including core laboratory, safety, regulatory, and data management practices. Intense efforts to standardize clinical, laboratory, and data management procedures in a developing world setting provide clinical trials rigor to all outcomes. Although this study infrastructure requires extensive time and effort, it allows optimized safety and confidence in the validity of data gathered in complex, developing country settings.

Seroprevalence of poliovirus antibodies among 7-month-old infants after 4 doses of oral polio vaccine in Sistan-va-Baluchestan, Islamic Republic of Iran.

Despite high coverage rates of polio vaccine in the Islamic Republic of Iran, the seroconversion rates of infants may be inadequate. This study measured seroprevalence of antibodies against poliovirus serotypes 1 to 3 (PV1, PV2 and PV3) in 7-month-old infants who had received at least 4 doses of trivalent oral polio vaccine. A serosurvey was conducted in 2010 in rural areas of Chabahar, Sistan-va-Baluchestan province. Using cluster sampling, 72 eligible infants were tested for antibody against the 3 poliovirus serotypes according to WHO guidelines. Antibody titres ≥ 1:10 were considered positive. The seropositive rates for antibody against PV1, PV2 and PV3 were 84.7%, 95.8% and 70.8% respectively. Only 63.9% of participants were seropositive for antibodies against all 3 poliovirus serotypes. Except for PV2, the seroprevalence of antibody against the other 2 poliovirus serotypes, especially PV3, was unsatisfactory.

Acute flaccid paralysis surveillance: A 6 years study, Isfahan, Iran.

Background:Poliomyelitis is still an endemic disease in many areas of the world including Africa and South Asia. Iran is polio free since 2001. However, due to endemicity of polio in neighboring countries of Iran, the risk of polio importation and re-emergence of wild polio virus is high. Case definition through surveillance system is a well-defined method for maintenance of polio eradication in polio free countries.Methods:In a cross-sectional survey from 2007 to 2013, we reviewed all the records of under 15 years old patients reported to Acute Flaccid Paralysis Committee (AFPC) in Isfahan province, Iran. All cases were visited by members of the AFPC. Three stool samples were collected from each reported case within 2 weeks of onset of paralysis and sent to National Polio Laboratory in Tehran, Iran, for poliovirus isolation. Data were analyzed by SSPS software (version 22). Student's t-test and Chi-square was used to compare variables. Statistical significance level was set at P < 0.05.Results:In this 6-year period 85 cases were analyzed, 54 patients were male (63.5%) and 31 were female (36.5%). The mean age of patients was 5.7 ± 3.9 years. The most common cause of paralysis among these patients was Guillian–Barré syndrome (83.5%). We did not found any poliomyelitis caused by wild polio virus. Only one case of vaccine associated poliomyelitis was reported.Conclusion:Since 1992, Iran has a routine and high percent coverage of polio vaccination program for infants (>94%), with six doses of oral polio vaccine (OPV). Accurate surveillance for poliomyelitis is essential for continuing eradication.

Assessment of oral polio vaccine coverage in the Nigeria demographic and health surveys 1990, 1999, 2003, and 2008

Introduction: By 1988, when the Global Polio Eradication Initiative began, there was an estimated 350,000 cases of poliomyelitis were occurring annually worldwide. By 2015, due to global vaccination efforts, indigenous transmission of wild poliovirus had been eliminated from all countries, except Afghanistan and Pakistan. A cornerstone of the polio eradication strategy is achieved by ensuring high levels of routine immunization coverage with 3 doses of oral polio vaccine (OPV) in children <1 year. Routine OPV coverage was assessed including some of the factors affecting coverage including region, place of residence, and mother's level of education. Methods: Secondary dataset analysis of the Nigeria Demographic and Health Survey carried out in Nigeria in 1990, 1999, 2003, and 2008 with available datasets was conducted. Results: Lowest coverage rates of 9%, 11%, 11% for 1999, 2003, and 2008, respectively, were recorded for the Northwest of Nigeria. OPV 0 coverage was twice that in urban areas compared to rural areas in 1999 and 2003 (42% vs. 19.91% in 1999 and 35.35% vs. 18.35% in 2003). OPV 0 coverage in children of mothers with no education was 12% in 1999, 2003, and 2008 compared to children of mothers with a tertiary education that were 56% in 1999, 50% in 2003, and 81% in 2008. Conclusion: OPV coverage was generally lower in the Northern region and in rural areas. Children of mothers with lower levels of education were less likely to receive OPV. Campaigns to improve routine immunization coverage should be targeted to the Northern regions, rural areas, and mothers with low educational levels.

Seroprevalence rate of Poliovirus antibodies among the Healthy and Protein Energy Malnutrition children.

Objective:To study the association between Protein energy malnutrition and polio-specific immunoglobulin G antibodies production among children in Gadap Town Karachi, Pakistan.Methods:Comparative cross sectional survey conducted at fixed EPI center and Pediatric OPD of a tertiary care hospital Karachi. Children were selected by convenient sampling method during the period from 17 March to 17 May 2013. It was ensured that they must have received more than seven oral polio vaccine doses as eligibility criteria for the study. A total of 170 blood samples were collected and tested for the presence of polio-specific IgG antibodies using Poliomyelitis IgG ELISA Test Kit produced.Results:Statistically significant relation was found between PEM and IgG antibodies production OR (P = 0.000). Overall Seroprevalence rate among the study population was 98.8%, PEM group 97.6% and healthy group 100%.Conclusion:The study demonstrated that there is a need to focus on the protein energy malnutrition among the children as an immunization strategy for the 100% seroprevalence rate in all population against polio in Pakistan.

Assessing the impact of polio eradication initiative and routine immunization in Zamfara State, North-West, Nigeria

Background: Evaluation of effectiveness of polio immunization has to be monitored continuously, particularly in endemic countries so that the immunity status can be precisely and effectively established. The aim of the present study was to determine the seroprevalence of poliovirus antibody in Zamfara State, Nigeria. Materials and Methods: This was a cross-sectional study of children aged 0–59 months. The children were randomly selected across the state. Blood samples collected from the children were tested for the presence of antibodies to poliovirus. Results: Blood samples from 63 (78.8%) of the 80 children had antibodies to all the three poliovirus serotypes. Seventy-five (93.8%), 68 (85.0%), and 75 (93.8%) of blood samples had antibodies to poliovirus serotypes 1, 2, and 3 respectively. All (100.0%) blood samples from children in the age group of 48–59 months tested positive for poliovirus. All (100.0%) the females had poliovirus antibody. In general, poliovirus antibody prevalence increased with increase in oral polio vaccine doses received. Urban children had higher poliovirus antibody prevalence of 81.0%, higher than their rural counterpart. Children whose fathers were educated up to tertiary level had 100.0% poliovirus antibody. There was no association among seroprevalence of poliovirus antibody and number of vaccine doses received and location of child's place of residence. Prevalence of poliovirus antibody was statistically significant based on age and father's educational level ( χ [2] = 0.1360, χ [2] = 0.2923, respectively, P Conclusion: For the state to sustain the gains made in interrupting poliovirus transmission, more work need to be done so as to close the gap observed in the study.

Post-polio eradication: vaccination strategies and options for India

In 1988, the World Health Organization (WHO) resolved to eradicate poliomyelitis globally. Since then, the initiative has reported dramatic progress in decreasing the incidence of poliomyelitis and limiting the geographical extent of transmission. 2013 is recorded as the second consecutive year not reporting wild poliovirus (WPV) from India. If the country can retain this position for one more year India will be declared as polio eradicated. What should be the future vaccination strategies? We searched and reviewed the full text of the available published literature on polio eradication via PubMed and examined Internet sources and websites of major international health agencies. The oral polio vaccine (OPV) has been the main tool in the polio eradication program. Once WPV transmission is interrupted, the poliomyelitis will be caused only by OPV. India could expect 1 vaccine-associated paralytic polio per 4.2-4.6 million doses of OPV. Considering the threat of vaccine-derived viruses to polio eradication, WHO urged to develop a strategy to safely discontinue OPV after certification. The ultimate aim is to stop OPV safely and effectively, and eventually substitute with inactivated polio vaccine (IPV). The argument against the use of IPV is its cost. From India, field based data were available on the efficacy of IPV, which was better than OPV. IPV given intradermally resulted in seroconversion rates similar to full-dose intramuscular vaccine. The incremental cost of adopting IPV to replace OPV is relatively low, about US $1 per child per year, and most countries should be able to afford this additional cost.

Polio supplementary immunization activities and equity in access to vaccination: evidence from the demographic and health surveys.

Every year, large numbers of children are vaccinated against polio during supplementary immunization activities (SIAs). Such SIAs have contributed to the >99% decline in the incidence of poliovirus cases since the beginning of the Global Polio Eradication Initiative. It is not clear, however, how much they have also contributed to reducing poverty-related inequalities in access to oral polio vaccine (OPV). We investigated whether the gap in coverage with 3 doses of OPV between children in the poorest and wealthiest households was reduced by SIA participation. To do so, we used data from 25 demographic and health surveys (DHS) conducted in 20 countries since 2002. We found that, in several countries as well as in pooled analyses, poverty-related inequalities in 3-dose OPV coverage were significantly lower among children who had participated in SIAs over the 2 years before a DHS than among other children. SIAs are an important approach to ensuring equitable access to immunization services and possibly other health services.

Introduction of sequential inactivated polio vaccine-oral polio vaccine schedule for routine infant immunization in Brazil's National Immunization Program.

In August 2012, the Brazilian Ministry of Health introduced inactivated polio vaccine (IPV) as part of sequential polio vaccination schedule for all infants beginning their primary vaccination series. The revised childhood immunization schedule included 2 doses of IPV at 2 and 4 months of age followed by 2 doses of oral polio vaccine (OPV) at 6 and 15 months of age. One annual national polio immunization day was maintained to provide OPV to all children aged 6 to 59 months. The decision to introduce IPV was based on preventing rare cases of vaccine-associated paralytic polio, financially sustaining IPV introduction, ensuring equitable access to IPV, and preparing for future OPV cessation following global eradication. Introducing IPV during a national multivaccination campaign led to rapid uptake, despite challenges with local vaccine supply due to high wastage rates. Continuous monitoring is required to achieve high coverage with the sequential polio vaccine schedule.

Polio eradication in the World Health Organization African Region, 2008-2012.

A renewed commitment at the regional and the global levels led to substantial progress in the fight for polio eradication in the African Region (AFR) of the World Health Organization (WHO) during 2008-2012. In 2008, there were 912 reported cases of wild poliovirus (WPV) infection in 12 countries in the region. This number had been reduced to 128 cases in 3 countries in 2012, of which 122 were in Nigeria, the only remaining country with endemic circulation of WPV in AFR. During 2008-2012, circulation apparently ceased in the 3 AFR countries with reestablished WPV transmission-Angola, the Democratic Republic of the Congo, and Chad. Outbreaks in West Africa continued to occur in 2008-2010 but were more rapidly contained, with fewer cases than during earlier years. This progress has been attributed to better implementation of core strategies, increased accountability, and implementation of innovative approaches. During this period, routine coverage with 3 doses of oral polio vaccine in AFR, as measured by WHO-United Nations Children's Fund estimates, increased slightly, from 72% to 74%. Despite this progress, challenges persist in AFR, and 2013 was marked by new setbacks and importations. High population immunity and strong surveillance are essential to sustain progress and assure that AFR reaches its goal of eradicating WPV.

Determinants of routine immunization coverage in Bungudu, Zamfara State, Northern Nigeria, May 2010.

IntroductionImmunization is a cost-effective public health intervention to reduce morbidity and mortality associated with infectious diseases. The Nigeria Demographic and Health Survey of 2008 indicated that only 5.4% of children aged 12-23 months in Bungudu, Zamfara State were fully immunized. We conducted this study to identify the determinants of routine immunization coverage in this community.MethodsWe conducted a cross-sectional study. We sampled 450 children aged 12-23 months. We interviewed mothers of these children using structured questionnaire to collect data on socio-demographic characteristics, knowledge on immunization, vaccination status of children and reasons for non-vaccination. We defined a fully immunized child as a child who had received one dose of BCG, three doses of oral polio vaccine, three doses of Diptheria-Pertusis-Tetanus vaccine and one dose of measles vaccine by 12 months of age. We performed bivariate analysis and logistic regression using Epi-info software.ResultsThe mean age of mothers and children were 27 years (standard error (SE): 0.27 year) and 17 months (SE: 0.8 month) respectively. Seventy nine percent of mothers had no formal education while 84% did not possess satisfactory knowledge on immunization. Only 7.6% of children were fully immunized. Logistic regression showed that possessing satisfactory knowledge (Adjusted OR=18.4, 95% CI=3.6-94.7) and at least secondary education (Adjusted OR=3.6, 95% CI=1.2-10.6) were significantly correlated with full immunization.ConclusionThe major determinants of immunization coverage were maternal knowledge and educational status. Raising the level of maternal knowledge and increasing maternal literacy level are essential to improve immunization coverage in this community.

Polio-like disease in the news: much ado about nothing?

Polio-like disease in the news: much ado about nothing?

Risk of polio reintroduction to border regions of Islamic Republic of Iran: seroprevalence study of children with at least 5 doses of oral polio vaccine

Movements of populations from countries where polio has not been eradicated is a concern in the Islamic Republic of Iran. A cross-sectional, community-based study was implemented in 2010 in 2 districts in Sistan-va-Baluchestan Province near the south-east border. The aim was to determine the seroprevalence of antibodies in children aged 20 (± 2) months who had received at least 5 doses of trivalent oral polio vaccine. Using cluster sampling, 365 children were enrolled for serological testing. Antibody titres ≥ 1:10 were considered positive. Seropositive rates for antibody against poliovirus serotypes 1, 2 and 3 were 94.1%, 96.7% and 78.3% respectively. The lowest seropositive rate was for antibody against polio serotype 3 (PV3) among boys (58.3%). Exclusive breastfeeding showed a direct relationship with antibody response to PV3 (OR = 2.0; 95% CI: 1.1-3.6). Improving community protection against PV3 is an urgent programme priority.

An outbreak of circulating vaccine derived poliovirus in Yemen, 2011-2012

Background: Yemen has been polio free since 2006. However, recently civil unrest and popular uprisings across the country arose with intermittent armed conflicts in the Northern governorates especially Sa’ada led to low routine immunization coverage and suspending supplementary immunization activities (SIAs). Such widening immunity gap known to be predisposing factors for Circulating Vaccine Derived Poliovirus (cVDPV) outbreak. We reviewed acute flaccid paralysis (AFP) cases to identify any emerging cVDPV Methods & Materials: Cases of AFP identified through routine AFP surveillance from April 8,2011,through 24 August 2012 were investigated for any fecal excretion of cVDPV. WHO-recommended virological classification scheme was used. Results: Nine cases of laboratory confirmed type 2 cVDPV and 2 cases type3 cVDPV were identified from six governorates: Sa’ada (1.3/100,000 <15 years children), Amran (0.2/100,000), Hajjah (0.1/100,000), Ibb (0.08/100,000), Sana’a city (0.07/100,000) and Hodeida (0.07/100,000). The corresponding third dose of Oral polio vaccine (OPV) coverage is 49%,78%,89%,87%,83% and 80% respectively. The median age was 22 months with a male to female ratio of 2.7:1. Most reported symptoms were fever (100%), asymmetrical paralysis (73%), and intact sensation (73%). OPV immunization status among cases was: zero dose: 36%, < 3 doses: 36%, and ≥ 3 doses: 27%. Conclusion: The rate of cVDPV is highest in the armed conflict Sa’ada and its neighboring Amran where the lowest vaccination coverage was also achieved. There is an urgent need to maintain high OPV coverage in at-risk populations to prevent the spread of endogenous cVDPV. Sensitive and timely AFP surveillance systems are essential to ensure quick identification of cVDPV and response

Characteristics of Acute Flaccid Paralysis Reported by the Surveillance System and Verified by WHO Officer in Akwa Ibom State-Nigeria, 2006-2012

Background: Acute Flaccid Paralysis (AFP) was adopted by World Health Organization (WHO) in 1988 as a key pillar used in monitoring progress towards the global polio eradication initiative. High quality AFP surveillance is essential to support this global initiative. We applied recently developed case verification methods for the quantitative evaluation of AFP cases reported to the surveillance systems to evaluate the quality of AFP reports in Akwa Ibom State, Nigeria. Objectives: The aim of this study is to identify the demographic, clinical and epidemiological attributes and quality of acute flaccid paralysis surveillance. Methods: All AFP cases reported in children 0 - 14 years during January 2006 to December 2012 were investigated and verified by WHO surveillance officers, using standard questionnaire. Two stool samples 24 - 48 hours apart from a total of 1184 AFP cases were collected within 14 days of onset of paralysis with the prior oral/verbal informed consent and transported to the national polio laboratory under reverse cold chain. Result: In all, 885/1184 representing 75% of the AFP cases reported were verified by WHO officers in the period under review. Overall, 534/885 (60.3%) of AFP cases had more than >3 doses of Oral Polio Vaccine (OPV), while 196/885 (22.2%) received 3 dose of OPV and 128/885 (14.5%) received between 1 - 2 doses of OPV. It was interesting that 27/885 (3%) never received OPV before. Overall, 743/885 (84.0%) were reported within ≤14 days of paralysis onset, while 142/885 (16%) were reported after ≥14 days of paralysis onset. In total, 797/885 (90.1%) of cases were found to have fever at the onset of paralysis; paralysis was found to be asymmetric in 805/885 (91%). Wasting or diminished muscle tone was observed in 34.0% of cases verified, while deep tendon reflexes were good (normal) in 79% of cases. Gullain-Barre syndrome was observed in 50.9% of the reported cases followed by injection neuritis (25.0%) and transverse myelitis (2.0%). However, other causes recorded 22.1%. The legs (90.2%) are the parts of the body mostly affected, while arm recorded 9.8% of the AFP cases reported and verified. Conclusions: The result of this study indicates that the characterization of AFP cases reported to the surveillance network could provide better understanding of age, and sex distribution, common clinical causes of AFP and impact of distance to health facilities on the health seeking behaviours of AFP cases.

Determinants of routine immunization coverage in Bungudu, Zamfara State, Northern Nigeria, May 2010

INTRODUCTION: Immunization is a cost-effective public health intervention to reduce morbidity and mortality associated with infectious diseases. The Nigeria Demographic and Health Survey of 2008 indicated that only 5.4% of children aged 12-23 months in Bungudu, Zamfara State were fully immunized. We conducted this study to identify the determinants of routine immunization coverage in this community. METHODS: We conducted a cross-sectional study. We sampled 450 children aged 12-23 months. We interviewed mothers of these children using structured questionnaire to collect data on socio-demographic characteristics, knowledge on immunization, vaccination status of children and reasons for non-vaccination. We defined a fully immunized child as a child who had received one dose of BCG, three doses of oral polio vaccine, three doses of Diptheria-Pertusis-Tetanus vaccine and one dose of measles vaccine by 12 months of age. We performed bivariate analysis and logistic regression using Epi-info software. RESULTS: The mean age of mothers and children were 27 years (standard error (SE): 0.27 year) and 17 months (SE: 0.8 month) respectively. Seventy nine percent of mothers had no formal education while 84% did not possess satisfactory knowledge on immunization. Only 7.6% of children were fully immunized. Logistic regression showed that possessing satisfactory knowledge (Adjusted OR=18.4, 95% CI=3.6-94.7) and at least secondary education (Adjusted OR=3.6, 95% CI=1.2-10.6) were significantly correlated with full immunization. CONCLUSION: The major determinants of immunization coverage were maternal knowledge and educational status. Raising the level of maternal knowledge and increasing maternal literacy level are essential to improve immunization coverage in this community.