title: Progress toward poliomyelitis eradication in Nigeria.
abstract: BACKGROUND
  Transmission of wild poliovirus (WPV) has never been interrupted in Afghanistan, Pakistan, and Nigeria. Since 2003, infections with WPV of Nigerian origin have been detected in 25 polio-free countries. In 2012, the Nigerian government created an emergency operations center and implemented a national emergency action plan to eradicate polio. The 2013 revision of this plan prioritized (1) improving the quality of supplemental immunization activities (SIAs), (2) implementing strategies to reach underserved populations, (3) adopting special approaches in security-compromised areas, (4) improving outbreak response, (5) enhancing routine immunization and activities implemented between SIAs, and (6) strengthening surveillance. This report summarizes implementation of these activities during a period of unprecedented insecurity and violence, including the killing of health workers and the onset of a state of emergency in the northeast zone.
  
  
  METHODS
  This report reviews management strategies, innovations, trends in case counts, vaccination and social mobilization activities, and surveillance and monitoring data to assess progress in polio eradication in Nigeria.
  
  
  RESULTS
  Nigeria has made significant improvements in the management of polio eradication initiative (pei) activities with marked improvement in the quality of SIAs, as measured by lot quality assurance sampling (LQAS). Comparing results from February 2012 with results from December 2013, the proportion of local government areas (LGAs) conducting LQAS in the 11 high-risk states at the ≥90% pass/fail threshold increased from 7% to 42%, and the proportion at the 80%-89% threshold increased from 9% to 30%. During January-December 2013, 53 polio cases were reported from 26 LGAs in 9 states in Nigeria, compared with 122 cases reported from 13 states in 2012. No cases of WPV type 3 infection have been reported since November 2012. In 2013, no polio cases due to any poliovirus type were detected in the northwest sanctuaries of Nigeria. In the second half of 2013, WPV transmission was restricted to Kano, Borno, Bauchi, and Taraba states. Despite considerable progress, 24 LGAs in 2012 and 7 LGAs in 2013 reported ≥2 cases, and WPV continued to circulate in 8 LGAs that had cases in 2012. Campaign activities were negatively impacted by insecurity and violence in Borno and Kano states.
  
  
  CONCLUSIONS
  Efforts to interrupt transmission remain impeded by poor SIA implementation in localized areas, anti-polio vaccine sentiment, and limited access to vaccinate children because of insecurity. Sustained improvement in SIA quality, surveillance, and outbreak response and special strategies in security-compromised areas are needed to interrupt WPV transmission in 2014.
authors.affiliation: National Primary Health Care Development Agency.
authors.forename: J Mohammed
authors.initials: JM
authors.lastname: Ado
authors.affiliation: National Primary Health Care Development Agency.
authors.forename: Andrew
authors.initials: A
authors.lastname: Etsano
authors.affiliation: Federal Ministry of Health.
authors.forename: Faisal
authors.initials: F
authors.lastname: Shuaib
authors.affiliation: National Primary Health Care Development Agency.
authors.forename: Eunice
authors.initials: E
authors.lastname: Damisa
authors.affiliation: World Health Organization (WHO).
authors.forename: Pascal
authors.initials: P
authors.lastname: Mkanda
authors.affiliation: WHO Regional Office for Africa, Brazzaville, Republic of the Congo.
authors.forename: Alex
authors.initials: A
authors.lastname: Gasasira
authors.affiliation: World Health Organization (WHO).
authors.forename: Richard
authors.initials: R
authors.lastname: Banda
authors.affiliation: World Health Organization (WHO).
authors.forename: Charles
authors.initials: C
authors.lastname: Korir
authors.affiliation: World Health Organization (WHO).
authors.forename: Ticha
authors.initials: T
authors.lastname: Johnson
authors.affiliation: United Nations Children's Fund.
authors.forename: Boubacar
authors.initials: B
authors.lastname: Dieng
authors.affiliation: United Nations Children's Fund.
authors.forename: Melissa
authors.initials: M
authors.lastname: Corkum
authors.affiliation: United Nations Children's Fund.
authors.forename: Ogu
authors.initials: O
authors.lastname: Enemaku
authors.affiliation: United Nations Children's Fund.
authors.forename: Noah
authors.initials: N
authors.lastname: Mataruse
authors.affiliation: African Field Epidemiology Network.
authors.forename: Chima
authors.initials: C
authors.lastname: Ohuabunwo
authors.affiliation: Bill and Melinda Gates Foundation, Abuja, Nigeria.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Baig
authors.affiliation: Bill and Melinda Gates Foundation, Abuja, Nigeria.
authors.forename: Michael
authors.initials: M
authors.lastname: Galway
authors.affiliation: Bill and Melinda Gates Foundation, Abuja, Nigeria.
authors.forename: Vincent
authors.initials: V
authors.lastname: Seaman
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Eric
authors.initials: E
authors.lastname: Wiesen
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: John
authors.initials: J
authors.lastname: Vertefeuille
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Ikechukwu U
authors.initials: IU
authors.lastname: Ogbuanu
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Gregory
authors.initials: G
authors.lastname: Armstrong
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Mahoney
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D060740:Disease Eradication / Q000379:methods* / Q000458:organization & administration*; D019353:Endemic Diseases; D062665:Epidemiological Monitoring; D005260:Female; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D011051:Poliomyelitis / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission / Q000821:virology; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage* / Q000600:supply & distribution; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D011055:Poliovirus Vaccine, Oral
keywords: Nigeria; OPV; oral polio vaccine; poliovirus