- Report -

Ukraine

Making every school a health-promoting school: global standards and indicators

Credits

author

Outcome

Health emergencies rapidly detected and responded to

[COUNTRY STORY]

Containment of the cVDPV2 outbreak amidst COVID-19 and multiple emergencies in Sudan 2020-2022

Sudan

Photo: WHO Sudan. A child’s finger is marked after he receives the polio vaccine in Sudan.

Stopping a polio outbreak amid multiple emergencies

In August 2020, Sudan’s Federal Ministry of Health (FMoH) declared an outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) following the importation of the virus from a neighboring country and the subsequent paralysis of a child. The virus quickly spread to 58 children in 15 states. In response, the FMoH, with financial and technical support from the World Health Organization (WHO), implemented two nationwide Oral Polio Vaccine type-2 (mOPV2) vaccination campaigns. The first round was launched in November 2020 and the second in January 2021, reaching over 8 million children under five years of age across 18 states, with a coverage of over 95 percent in the target population. Additionally, the second vaccination round distributed vitamin A supplements to approximately 7.6 million children. After 18 December 2020, no further cases of poliovirus were identified, and the outbreak was declared successfully stopped in August 2022.

Key WHO Contributions

Technical, financial, and operational support for Acute Flaccid Paralysis and Environmental Surveillance networks
Developing risk assessment and outbreak response plans to respond to the Polio outbreak
Repurposing activities and mobilizing domestic funds for the response
Financial and technical support for the operationalization of the response plan
Capacity building of campaign workers through the provision of training including Adverse Event Following Immunization (AEFI) and Risk Communication
Post-campaign monitoring and support for a post-campaign review of the outbreak
Conducting an outbreak response assessment and verifying that transmission of Poliovirus type 2 had been successfully interrupted.

How did Sudan, with the support of the WHO Secretariat, achieve this?

The FMoH in Sudan identified the initial cVDPV2 case through its Acute Flaccid Paralysis (AFP) surveillance network. The network meets the requirements for polio certification and is supported by a WHO-team of 15 medical officers and 13 drivers. Physicians, traditional healers, community leaders, and members of civil society are engaged to ensure the surveillance reaches the wider population. WHO Sudan finances and provides technical assistance for an Environmental Surveillance (ES) programme, which was first launched in Khartoum State in 2018 and has since expanded to six additional states. WHO Sudan helped develop the ES expansion plan, helped states identify sites, and trained sample collectors and supervisors. WHO Sudan also assists the government with transporting samples to the national Polio laboratory.

Once the polio case was identified, WHO Sudan worked with the Federal Ministry of Health (FMoH) to rapidly develop an outbreak response plan using WHO Standard Operating Procedures for responding to Polio events or outbreaks. WHO Sudan requested additional funds from the WHO Regional Office and headquarters and the FMoH provided significant domestic resources to the response. WHO Sudan also connected to the health cluster coordination platform and requested aid from in-country donors, resulting in the receipt of USD 1 million from the Sudan Humanitarian Fund.

“Sudan remains at high risk of importation of poliovirus because of large numbers of people moving throughout the country. There are around 3.7 million internally displaced persons moving from areas of conflict in a number of states in addition to frequent movement between neighboring countries. The polio programme has worked to map nomadic populations, who are also considered at risk, to ensure that they can be reached with the vaccine during the campaign”

- Dr Mohammad Taufiq Mashal, WHO Team Leader for Polio and Immunization in Sudan.

To operationalize the plan, WHO Sudan provided financial and technical support to build the capacity of campaign workers in all of Sudan's 18 states. This included training national and subnational supervisors, team supervisors, and vaccinators. WHO Sudan also supported micro-planning and post-campaign monitoring, final data analysis and report writing, as well as providing indelible marker pens for marking children’s fingers after they had received the vaccine. To ensure safety in the context of the COVID-19 pandemic, safety measures such as using hand sanitizer, and wearing masks and gloves were implemented.

^{A child is vaccinated against polio by a WHO trained vaccinator during the 2020 outbreak in Sudan.}Photo credit: WHO Sudan.

WHO Sudan trained state and locality officers on Adverse Event Following Immunization (AEFI) and Risk Communication. Following the training, locality (district) supervisors collected data on AEFI from vaccination team and team supervisors and presented it daily to state and federal ministries of health. Additionally, the Health Promotion Department of the FoMH and United Nations Children’s Fund (UNICEF) ramped up community engagement and social mobilization efforts to ensure all households were aware of the dangers of the disease and the need to immunize every eligible child.

The vaccination team diligently recorded demographic data for each child under five years of age and submitted it to their team supervisor for compilation. The supervisor then sent the data to the district coordinator and provincial focal point, with the National Emergency Operation Center receiving aggregate data from across the country at the end of the day. In October and November 2021, and again between 24 July and 1 August 2022, an Outbreak Response Assessment (OBRA) team comprising representatives from WHO, UNICEF, and the United States Centers for Disease Control and Prevention (CDC), evaluated the response to the outbreak. They conducted monitoring visits, interviewing, and reviewing reports and records with surveillance and immunization staff at the state, locality, and health facility levels; analyzed data; and developed reports which were used to verify the reported coverage at the country level. The OBRA team verified that transmission of Poliovirus type 2 had been successfully interrupted and declared the outbreak over in August 2022.

“Despite the fact this outbreak is over it is important to maintain sensitive Acute Flaccid Paralysis surveillance, ensure better preparedness and response, enhance coverage of essential immunization, and strengthening cross-border coordination”

- Dr Ni’ma Saeed Abid, WHO Representative in Sudan

In 2020, Sudan faced a range of challenges, including political transition, the emergence of COVID-19, and financial crisis. Despite this, the country overcame them through careful planning, effective surveillance, strong governmental commitment, and successful vaccination campaigns. Nevertheless, Sudan's risk profile remains high due to political instability and population movement to and from countries with active circulating vaccine-derived poliovirus type 2 (cVDPV2). This increases the chance of importation and makes it difficult to ensure that every last child is vaccinated. The WHO continues to support Sudan in reinforcing their surveillance systems, preparedness, and response to polio outbreaks.