March 2018
Overall: The Democratic Republic of Congo is currently conducting outbreak response to circulating vaccine-derived poliovirus type 2 (cVDPV2) cases detected in 2017. The country is a challenging environment to work in, with low population immunity, especially in security compromised areas. There has been transmission after the initial outbreak response immunization rounds, with virus detected in Tanganyika province. In February 2018, the government of the Democratic Republic of the Congo declared the cVDPV2 outbreak a public health emergency of international concern. The programme and government are responding strongly, working together to plan and conduct further campaigns using mOPV2.
The Global Polio Eradication Initiative (GPEI) continues to coordinate an experienced team in the region, and undertakes regular reviews of the country to strengthen response. The national government remains fully committed to closing the outbreak.
Progress
The Ministry of Health, supported by WHO and partners of the Global Polio Eradication Initiative (GPEI), has responded to the outbreak by implementing response activities to contain the virus. Since the response began, they have implemented four mOPV2 supplementary immunization campaigns and one mop-up campaign. They have also worked hard to strengthen surveillance and routine immunization in the outbreak zones and across the country. Planning is currently ongoing to decide on the date and scope of additional campaigns, in light of virus spread.
Measures taken to improve immunization campaign quality include:
- Setting up a three level coordination mechanism at central, regional and provincial level, and training new campaign supervisors at a national and provincial level to be deployed to health zones targeted by the mOPV2 campaigns.
- Updating and improving the quality of microplans, in order to accurately map all households, and ensure all children are visited by vaccinators.
- Increasing training for local supervisors, vaccinators and social mobilization teams.
- Since the beginning of response, UNICEF has trained over 600 independent monitors to ensure that polio vaccine is properly managed during immunization campaigns.
Risks
- Given the complexity of the region, it is important that outbreak response focuses on the core aspects needed to reach every child. This is the only way to fully raise population immunity. To achieve this, the programme is working to strengthen campaigns, and fill immunity gaps using tried and tested methods.
- The November 2017 Outbreak Risk Assessment for the country highlighted the need to improve surveillance, overcoming the security and geographical barriers to sample collection and delivery.
- Response is complicated by the complex humanitarian emergency situation currently ongoing in DRC, which has led to an estimated 4.1 million internally displaced people, and multiple health emergencies. The programme is working to overcome this and security issues where possible in the cVDPV2 affected provinces, to allow for effective outbreak response.
Addressing the risks
- Over the coming months, focus is on improving population immunity through prioritizing at-risk areas, mapping at-risk populations, updating target populations based on previous supplementary immunization activity populations, and increasing communication and social mobilization activities.
- As part of this, UNICEF has recruited community mobilizers from groups who are often reluctant to allow their children to be vaccinated, encouraging community ownership and greater engagement with campaigns.
- The programme is also aiming to improve surveillance through implementing a Surveillance Intensifying Plan, which focuses on implementing higher quality surveillance in the key at-risk areas.
- On 13 February, the government of the Democratic Republic of the Congo (DRC) announced the circulating vaccine-derived poliovirus 2 (cVDPV2) outbreak ongoing in the country as a Public Health Emergency of National Concern. This reflects the Ministry of Health’s ongoing full commitment to ending the outbreak.