Uganda detected poliovirus in May 2024, prompting health authorities to strengthen surveillance and outbreak response activities

Uganda and four other African countries have been cleared of recent polio outbreaks after independent assessments found no evidence that the virus is still spreading.

The World Health Organization (WHO) said Burundi, Ghana, Guinea-Bissau, the Republic of Congo and Uganda had successfully interrupted transmission of poliovirus type 2.

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The decision follows technical assessments carried out between January and June this year by teams from the Independent Outbreak Response Assessment (OBRA).

The teams reviewed disease surveillance, laboratory results and epidemiological data before concluding that transmission had stopped.

For Uganda, the announcement marks progress in efforts to protect children from a virus that can cause permanent paralysis.

But health officials say the country cannot afford to relax its vaccination and disease surveillance efforts.

“While this is an important milestone, it is not the end of the journey,” said Dr Mohamed Janabi, WHO Regional Director for Africa.

“Continued vigilance, strong surveillance and high immunization coverage remain essential to protect children and prevent future outbreaks.”

Polio is a highly infectious viral disease that mainly affects children. It can cause permanent paralysis and, in severe cases, death.

There is no cure for polio, but it can be prevented through vaccination.

The closure of a polio outbreak is a technical decision based on evidence that transmission has stopped. It does not mean there is no possibility of the virus being detected again.

Uganda’s response

Uganda detected poliovirus in May 2024, prompting health authorities to strengthen surveillance and outbreak response activities.

The response involved coordination between national and local health authorities, vaccination activities and efforts to identify possible cases and virus circulation.

The country also upgraded laboratory capacity earlier this year, strengthening its ability to detect poliovirus and other vaccine-preventable diseases.

The latest assessment looked not only at whether new cases had been detected, but also at the strength of Uganda’s surveillance systems and the level of immunity among the population.

The closure therefore means that the specific outbreak has been interrupted. It does not mean Uganda is permanently free from the risk of polio.

Polio spreads easily, particularly among children who have not received all the recommended vaccines.

In most cases, infection may cause few or no symptoms. But in some children, the virus attacks the nervous system and can result in irreversible paralysis.

There is no cure for polio, but vaccination can prevent it. This means health workers need to continue looking for signs of the disease, even after an outbreak has been declared closed.

The recent detection of poliovirus in Madagascar after an earlier outbreak closure is a reminder of that risk, WHO said.

Poliovirus can also cross borders, making surveillance particularly important in countries with large movements of people.

For Uganda, this is especially relevant in communities near international borders and areas where reaching children with routine immunisation can be difficult.

What Uganda can learn

The experiences of the five countries show the importance of finding cases quickly and vaccinating children before the virus has a chance to spread.

In the Republic of Congo, authorities strengthened surveillance and carried out several vaccination campaigns after poliovirus was detected. The country’s last detection was reported in December 2023.

Burundi responded to a circulating poliovirus type 2 outbreak declared in March 2023 by intensifying routine immunisation, vaccination campaigns and epidemiological investigations.

In Guinea-Bissau, health authorities focused on reaching children in underserved communities and strengthening surveillance. No poliovirus has been detected there since July 2021.

Ghana combined stronger laboratory capacity with disease surveillance and rapid outbreak response.

The approaches were different, but the lesson was similar: vaccination must reach children who are most likely to be missed, while health workers must be able to identify possible infections quickly.

Across Africa, health authorities have been strengthening two important ways of detecting poliovirus.

One is surveillance for acute flaccid paralysis — the sudden weakness or paralysis of a limb, particularly in children.

The other is environmental surveillance, which involves testing sewage and other environmental samples for poliovirus.

Laboratories across the region have also been upgraded to speed up testing and help health authorities respond more quickly when the virus is found.

Geospatial technology is increasingly being used to identify settlements that may have been missed by vaccination teams, track population movements and improve vaccination planning.

For families, however, the most important protection remains vaccination.

Mike McGovern, Chair of the Global Polio Eradication Initiative’s Polio Oversight Board and Rotary International’s International PolioPlus Committee, said each outbreak closure represented children being protected from the disease.

“Every outbreak closed means more children protected from a disease that can cause lifelong paralysis,” he said.

Keeping the gains

UNICEF said the progress was the result of the work of governments, health workers and communities.

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The agency’s regional directors for Eastern and Southern Africa and West and Central Africa, Etleva Kadilli and Gilles Fagninou, said the achievement showed that progress was possible even in difficult settings.

But they warned that outbreak closure should not lead to complacency.

The priority, they said, should remain strengthening routine immunisation and ensuring children do not miss lifesaving vaccines.

Gavi, the Vaccine Alliance, also said the investments made during the polio response could strengthen health systems more broadly.

“The investments countries have made in reaching missed children, community engagement, strengthened surveillance, mapping, and outbreak response will have impact far beyond these polio outbreaks,” said Thabani Maphosa, Gavi’s Chief Country Delivery Officer.

The five countries received support from international partners, including Canada, the European Investment Bank, the Gates Foundation, Germany and the United Arab Emirates, as well as other donors supporting the Global Polio Eradication Initiative.

The initiative brings together national governments and six major partners — WHO, Rotary International, the US Centers for Disease Control and Prevention, UNICEF, the Gates Foundation and Gavi — with the goal of ending polio worldwide.

For Uganda, the latest announcement is an important step. But the final measure of success will be whether the country can maintain high vaccination coverage and strong surveillance long enough to ensure that the virus does not return.