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Somalia

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Mao of Somalia

Polio eradication activities were initiated in Somalia in 1997. Following the start of acute flaccid paralysis surveillance in 1998, an outbreak was detected in Mogadishu in 2000 and wild poliovirus cases were reported until 2002. In July 2005, a wild poliovirus outbreak secondary to an importation was detected and resulted in 228 cases from 2005–2007; the last case was reported in March 2007. Somalia has been polio-free for over 3 years. Despite achieving polio-free status, Somalia has had sustained circulation of vaccine-derived polioviruses since 2009 due to low routine immunization coverage rates and lack of supplementary immunization activities in insecure areas. The number of areas inaccessible for immunization activities has increased from 2009 to 2011, which is reflected in an increasing percentage of acute flaccid paralysis cases with no reported doses of oral polio vaccine (16% in 2011 up from 8% in 2010). 

Routine immunization

Routine immunization coverage or OPV3 is among the lowest in the Region. Since the fall of the government in 1991, Somalia has been without an effective central-level Expanded Programme on Immunization (EPI). The EPI programme has been implemented primarily by nongovernmental organizations. Since 2009, Child Health Days, a joint WHO/UNICEF initiative to provide an integrated package of health services, including immunizations from fixed-post sites, have been conducted twice annually in Somalia.

National immunization days

WHO and UNICEF conducted the first subnational immunizations days in Somalia in 1997 and the first national immunization days covering the entire country in 1998. Implementation of a house-to-house strategy was started in 1999 and all subsequent supplementary immunization activities have utilized this strategy in accessible areas. Following the 2005–2007 wild poliovirus outbreak, four rounds of national immunization days were conducted in 2008. Since 2009, two rounds of national immunization days have been conducted annually. Polio vaccination is also given as part of the package of services delivered during Child Health Days. However, coverage is limited due to insecurity; less than half of all eligible children are reached nationally via national immunization days and Child Health Days.  

Acute flaccid paralysis surveillance

Somalia initiated acute flaccid paralysis surveillance in 1998. Since 2000, Somalia has exceeded the rate of 1 non-polio acute flaccid paralysis case per 100 000 children aged

Laboratory

There is no poliovirus laboratory in Somalia; it is served by the Kenya Medical Research Institute, the national poliovirus laboratory in Nairobi, Kenya. 

Phase 1 of laboratory containment of polioviruses has not been implemented.

Strategic approach

Strategic approaches include:

enhancing sensitivity of acute flaccid paralysis surveillance to ensure no widespread circulation of vaccine-derived polioviruses and the timely detection of imported wild poliovirus through:implementating supplementary surveillance activitiesinvestigating every vaccine-derived poliovirus case and implementing outbreak measures, in accordance with global and regional guidance.

improving quality of supplementary immunization activities to increase population immunity and protect against emergence of vaccine-derived polioviruses and importations of wild poliovirus through:

using all means to negotiate for improved access and ability to conduct house-to-house supplementary immunization activities with all interested parties

employing mobile vaccination teams at entry and exit points of insecure areas

conducting subnational immunization days in geographic areas adjacent to insecure areas

enhancing social mobilization and communication strategies to promote vaccination-seeking behaviour among caregivers at fixed posts

supplementing vaccination services and mobile outreach at fixed posts 

ensuring plans are in place and funds available to implement supplementary immunization activities when a window of opportunity becomes available.

strengthening of the routine immunization programme at all levels. 

increasing resources to levels which are comparable to the investment in endemic areas.

Related links

WHO Somalia country office

Somalia certification status

WHO/UNICEF estimates of immunization coverage in Somalia

Targets and percentage coverage by supplementary immunization activity in the Eastern Mediterranean Region by year

Acute flaccid paralysis surveillance indicators in the Eastern Mediterranean Region