Three new polio cases have been confirmed in Cameroon over the past two weeks, making it the country’s first outbreak since 2011 and causing alarm among health officials who link the virus’s spread to weak vaccine campaign coverage and displacement following violence in neighbouring northeastern Nigeria and the Central African Republic (CAR).
Cameroon has confirmed seven polio cases since 2013. Just one case is enough to instigate emergency country-wide vaccination measures under the national health policy. It last experienced a polio outbreak in 2009, the strain also identified in Nigeria and Chad.
The World Health Organization (WHO) has said the virus is at a “very high risk” of crossing borders, and one polio case of the same strain as in Cameroon has just been confirmed in Equatorial Guinea, which saw its last case in 1999.
Cameroon has put in place emergency measures to try to contain the virus, but weak or non-existent monitoring in the cross-border areas with Nigeria and CAR is seriously hampering any national efforts, said Paul Onambelle, a doctor at the Cité Vert district hospital in Yaoundé.
The estimated 100,000 refugees in Cameroon who have fled violence in Nigeria and CAR make control efforts even harder, said Elisse Clarisse Onambany of the National Expanded Program on Immunization (EPI), who insists refugee children must be included in any immunization campaign, “which means the supply and resources needed must increase”, she said. Half of the refugee population is made up of children aged 11 or under, according to the health authorities.
Immunization in the Far North Region has been extended to include some of the children in the Nigerian refugee population, but thousands of children are still not being accessed because of insecurity in the border area with Nigeria, families being continually on the move, and difficult terrain, said Maria Enjema, a nurse at Far North district hospital of Maroua. “Despite continuous effort by the government to reduce the risk of polio in the north, it is very difficult for health workers to reach all the children, particularly those living along the borders with Nigeria because of the high risk [of Boko Haram-related violence] involved,” she told IRIN.
Meanwhile, ongoing polio campaigns have not always successfully reached the 90 percent of children (aged 0-5 years) needed to eliminate the disease. Some 43 percent of children in Cameroon have not received the three doses required for immunity, and 30 percent have never been vaccinated, said health officials.
The government and partners issue regular polio campaigns for children aged 0-5 in the three northern regions: Far North, North and Adamawa, where the risk of infection is high, but cultural resistance in these areas has limited campaign efforts, said Onambany. “People have different beliefs when it comes to maternal care. Some communities with various religious standpoints on the vaccine say the body is sacred and does not need any chemical to feel better, while some Cameroonians see it as some sort of a public plot.”
Onambany said lack of resources also limited ongoing polio campaign coverage.
Many parents do not understand or believe that three oral vaccinations are required and so they drop out after the first or second round.
Loveline Penda, a mother of five in Yaoundé, told IRIN: “The numbers of vaccines keep increasing and I doubt sometimes what the difference will be if my child does not take a vaccine. Sometimes I miss out but I don’t have to worry because I just believe that my child will be fine.”
The government must take cultural resistance and lack of understanding more seriously and “work to change people’s opinions and knowledge [on polio],” said Idris Haman, a researcher at the University of Yaoundé.
Stepping up the response
Cameroon health officials are expanding the region-specific immunization campaign nationwide in April, May and June 2014, with the help of partners, said Onambany.
The National EPI will also soon launch an intensive awareness-raising campaign about the vaccination.
“The upcoming campaigns will ensure that the quality of campaign is improved by reaching children three times. We will also intensify communication and sensitization effort so that no family is left untold of the dangers of missing out vaccinations,” Onambany told IRIN.
Over recent years the government has stepped up its surveillance and response to polio, working through networks of trained staff in district hospitals, as well as with community-based monitoring networks and NGO partners. Without support from development partners like WHO and the UN Children’s Fund (UNICEF), containment issues would be lagging far behind, said the EPI.
But unless surveillance steps up across borders, the risk that the polio virus could continue to spread remains a top concern, said Onambelle.