A. Situation analysis
Description of the disaster
The Ministry of Health reported a confirmed case of Type 1 wild poliovirus (WPV1) in Lilongwe district, Malawi on 17February 2022. Polio virus causes irreversible paralysis mainly in children zero to fifteen years of age. It also has the potential to infect immunocompromised adults. This is the first detection of a case of WPV1 in Africa since 2016. The African continent had been declared free of wild poliovirus since 2020. Genetic sequencing of this case has linked the virus to a strain circulating in Pakistan’s Sindh Province in 2019, indicating that this is an imported virus. The detection of a single case of WPV1 outside of the world’s two remaining endemic countries, Pakistan and Afghanistan, represents an emergency that requires effective and at-scale response to prevent spread. Normally, a child would present to a health facility with acute onset of limb weakness which progresses to paralysis. If it is a leg or an arm, it may become relatively smaller (wasted) than the normal body mass and lose. Polio is a disabling and life-threatening disease. Polio is an infectious disease that can be passed from one person to another through ingestion of food or water which is contaminated with polio virus. The high-risk groups are those that are unvaccinated or those that have received fewer doses of polio vaccines, particularly among communities with poor water and sanitation infrastructure.
Following this development, the Ministry of Health, with support from partners, has put in place strategies for elimination of polio in the country. These strategies are in line with the strategies recommended by the World Health Organization (WHO) through the Global Polio End Game Strategy. Vaccines are the most effective and available prevention strategy for this disease, in addition to improved water and sanitation practices.
The Malawi Government through the Ministry of Health established the National Expanded Programme on Immunization (EPI) in 1979 to deal with vaccine preventable diseases including Polio, Measles and Neonatal Tetanus. These diseases are undergoing eradication and elimination. The Ministry has therefore intensified surveillance for these diseases in line with the WHO recommendations. Malawi has sustained good coverage of its entire vaccine antigen above 80% now for two decades and polio vaccine is no exception. Like many other countries in the world, Malawi provides polio vaccine that targets Polio virus type 1 and type 3 following the global eradication of Poliovirus type 2. The country also vaccinates its children with Inactivated Polio Virus vaccine in all the 29 districts across the country with sustained good coverage to date since introduction in 2018. The overall Vax coverage for Lilongwe is over 80% which is beyond the coverage of most districts in the country. The location where the case was registered enjoys even better coverage than some areas within Lilongwe district.
Generally, there is high number of children who are vaccinated in urban areas as compared to the rural areas of the country. In order to reduce the spread and further risks and in line with the WHO guidance and the International Health Regulations (IHR), the country is immediately putting in place additional activities to help in reducing further spread of the virus in the country. The first step is declaring this as a Public Health Emergency: The President on 17 February 2022, through the minister of Health, declared a Public Health Emergency following confirmation of an imported case of polio in in Lilongwe districts.
The Emergency Operations Committee (EOC) was immediately established where meetings and a risk assessment of the situation is being done with support from partners such as the WHO. The country is also working very closely with the neighboring countries, as diseases know no borders. As stated earlier, the laboratory results show that this is an imported virus as there is no evidence of community circulation of the virus. The Ministry of Health has assured the nation that the situation is under control and would like to encourage the public to continue observing good personal hygiene practices since the virus is spread through ingestion of contaminated food or water. The public has therefore been informed that the polio outbreak has been declared a Public Health Emergency1 by the Malawi Government.
Meanwhile, the Ministry of Health with support from The World Health Organization has called for a mass vaccination for children under 5 years across the country. There are already rumors around that the vaccination is a plan by government to increase COVID-19 vaccination. These rumours if not corrected may lead to low polio vaccine coverage. The Polio emergency is coming at a time that the country is responding to the effects of Tropical Cyclone Ana which has also greatly affected the Malawi health systems requiring more attention and resources by the ministry of health. There is therefore great need for supporting community mobilization to ensure good public awareness as well as need to support management of vaccination sites as the ministry of health still face human resources challenges in undertaking mass vaccinations.
The last polio case in Malawi was reported in 1992 meaning that this is the first case in thirty years. Malawi also obtained a Polio free status in 2005 while the WHO African region received its Polio free status certificate in the year 2020. These are remarkable milestones in the polio eradication initiative in the country. In practice, any child from zero to fifteen years of age coming with acute onset of flaccid paralysis or weakness is supposed to be reported as a suspected Polio case. The minimum standard is to report 2 non-polio AFP per 100,000 population, as well as adequate stool specimen collection capacity. Malawi has been meeting these indicators throughout the years and sustained its Polio surveillance robustly.
Source: International Federation of Red Cross and Red Crescent Societies