Attachments
Executive summary
On 9 August 2020, the Federal Ministry of Health (FMOH), Government of the Republic of Sudan notified the World Health Organization (WHO) under the International Health Regulations (IHR) of the detection of circulating vaccine-derived poliovirus type 2 (cVDPV2) from two acute flaccid paralysis (AFP) cases in the country with dates of onset on 7 March 2020 and 1 April 2020. The delay in confirmation of the outbreak was related to the repurposing of the national polio laboratory of Sudan for COVID-19 testing.
Epidemiological data complemented by genomic sequencing concluded the establishment of person-toperson transmission in Sudan and a polio outbreak which was a consequence to the importation of the CHA-NAJ-1 cVDPV2 emergence from neighboring Chad. The first case in Sudan had onset of paralysis on 7 March 2020 and the most recent case on 18 December 2020. cVDPV2 was isolated from 58 AFP cases, 14 healthy children, and 14 environmental surveillance (ES) samples. Immediately following the cVDVP2 outbreak declaration, a full-scale outbreak response plan was developed and an emergency operations center established (11 August 2020). The FMOH and partners responded with two high quality response rounds at the national level using monovalent oral polio vaccine (mOPV2) in late November 2020 and late January 2021.
A poliovirus outbreak response assessment (OBRA) is carried out to determine whether the response was adequate, identify areas of improvement, and confirm outbreak closure. A first virtual OBRA was concluded on 7 October 2021, followed by a final OBRA in-country from 24 July to 1 August 2022.
The OBRA team – comprised of experts from WHO, UNICEF, and CDC – assessed the actions taken regarding the previous OBRA recommendations, surveillance system functionality and sensitivity, adequacy of preparedness and country capacity for timely response to any poliovirus importations/outbreaks, population immunity through EPI, and vaccine management.
A mixed methods approach was defined by the OBRA team including a thorough document review, and interviews at central (national) level with key FMOH departments/units, and subnational levels which included selected states, health facilities and environmental surveillance sites, in addition to AFP case validation.
Following an in-depth desk review and interviews in the six selected states, and based on findings thereof, the OBRA team concluded that the transmission of cVDVP2 in Sudan has been interrupted and recommed to WHO/EMRO and the GPEI to formally declare the outbreak as over and closed.
However, surveillance strengthening, preparedness and response, and improving routine immunization are the key enabling factors to maintain the gains.
Additionally, OBRA recommendations to the country team include actions aiming at:
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Enhancing surveillance for timely detection of any low-level transmission of any poliovirus.
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Maintaining core lab functions without delays or disruptions.
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Building on the well-developed preparedness plan and expanding the country’s capacity to mount a timely response to any poliovirus event or outbreak.
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Strengthening EPI to reach the unreached and avoid vaccine-preventable disease outbreaks 5. Ensuring regular and uninterrupted vaccine supply, storage and quality data for planning at all levels.
A final debriefing was delivered by the OBRA team to H.E. Sudan Federal Minister of Health, and the FMOH technical departments as well as WHO, UNICEF and partners on 1 August 2022.