Djibouti carries out mass immunization to protect children against polio

Early analysis of campaign data points to a successful vaccination round in a polio-free country at risk of possible importation.

During the last week of October, Djibouti’s Ministry of Health, working with WHO, UNICEF and other partners, successfully carried out the country’s first polio National Immunization Day (NID) since 2015.

Djibouti is considered low risk for a polio outbreak, with the last case of polio reported in 1999. However, the recent circulation of circulating vaccine-derived poliovirus type 2 (cVDPV2) and type 3 (cVDPV3) in neighbouring countries in the Horn of Africa, and the low levels of routine immunization coverage in some areas in the country, indicate a heightened risk of importation of the polio virus.

“Djibouti is on a major migration route in the Horn of Africa, and shares porous borders with Somalia and Ethiopia. This calls for effective and coordinated preparedness measures. Our strategy is to prevent, rather than respond to, polio cases,” said Dr Ahmed Zouiten, acting WHO Representative in Djibouti

With preparedness in mind, the NID planned for 2019 was pushed forward and carried out over 23–26 October. The target was 120 000 children under five years of age, a number suggested by Djibouti’s last census in 2009. Two strategies were proposed: one approach, where children would be vaccinated at fixed points (health facilities); and a complementary door-to-door approach using two-person teams (a vaccinator and a registration person).

In the days and weeks before the NID, all partners, including the government, WHO and UNICEF, used a variety of communication channels – from outdoor signage to radio spots – to ensure communities were informed, not just of the risks of polio, but also of the importance of protecting children from vaccine-preventable diseases.

The campaign’s official launch ceremony was held at the Youssouf Abdillahi Iftini polyclinic in Balbala neighbourhood, in the presence of Djibouti’s Minister of Health, WHO and UNICEF representatives, and other partners. Over the course of the following week, vaccinators surpassed targets and vaccinated all children under five living on Djibouti territory regardless of origin. Nomadic populations, refugees and migrant children were vaccinated. Of children vaccinated, 65% were in the city of Djibouti and 35% in the rest of the country.

Although final numbers are still being tabulated through independent monitoring mechanisms, initial results suggest a coverage rate of 114% of the target population. This means vaccinators reached the estimated target number of children and more: most likely newer cohorts of children not accounted for in earlier estimates. Catching these children helps to further inform immunization estimates for future campaigns.

For Dr Zouiten, a result like this is something to celebrate. “Today, our children are on their way to being protected, and we are launching a second campaign in the coming few weeks to ascertain that,” he said.

“Before, we had some worries; we thought that the circulation of poliovirus in the region posed a risk. Now with this first vaccination campaign, reaching close to 114% of national levels, we know we are on the right path to ensure the children of Djibouti are protected. These results were not easy to achieve, but were made possible through collaboration between the Ministry of Health, WHO, UNICEF and others.”

Given the high risk of importation of poliovirus, WHO, UNICEF and the Government of Djibouti are not taking any chances: plans are in the works for a second and third NID to be carried out in 2019. With an outbreak in the region, it is critical for nearby countries to strengthen their own immunity levels, carry out routine immunization and ensure that disease surveillance systems are strong enough to detect any virus circulation. Despite the cost and effort of staging national immunization activities, in this case, all partners agree: an ounce of prevention really is worth a pound of outbreak response.