GRRT Deployment Polio mOPV2 Campaign Kenya June 30-July 21, 2018 Global Rapid Response Team (GRRT).

International Polio Campaign Supplemental Immunization Activity (SIA) Somalia-Kenya-Ethiopia The Global Rapid Response Team (GRRT) deployed 6 Tier 3 members from CDC to participate in Polio Campaign as International Monitor for the Supplemental Immunization Activity (SIA) in Kenya. CDC team worked collaboratively with WHO and UNICEF to implement the campaign. Total of 12 high-risk Counties (with 89 Sub-counties) were selected for this SIA campaign. Each GRRT member was assigned to work with the MOH County Supervisor. The 6 counties assigned to GRRT members included: Nairobi, Meru, Machakof, Kitui, Isiolo and Kaimbu. Two EIS officers (second year) also joined GRRT members. Two GRRT members were assigned to work with Nairobi County. The population of Kenya is estimated to be about 50 million (April 2018), of which 21 million are below 5 years old. Kenya Population: *Total Population: 50,657,855 (2018 est.) Target Population: *Children below 5 years old: 21 million

Monitoring and Supervision

mOPV2 SIA schedule Kenya and scope First round conducted 9th – 13th May 2018 Target pop 817,782 <5 yrs. in all ten sub counties of Nairobi Coverage: 94% administrative and 96% by Independent monitoring Second round dates: 11 July – 15 July 2018 12 high risk counties 2.41 million children <5 yrs. Third round: 8 August – 12 August 2018 2.41million children <5 yrs The primary purpose of the deployment was to assist WHO and UNICEF in responding to cVDPV2 outbreak where Kenya is part of the Horn of Africa campaign. Endemic countries also included Somalia and Ethiopia. The environmental sample tested on March 21, 2018 was confirmed to be cVDPV type 2. The outbreak response for cVDPV2 was implemented. The first Round campaign was implemented on May 9-13, 2018. Coverage = 94% of target population with 96% Independent Monitoring (IM).   Specific objective of the 2nd Round campaign was to immunize every child aged below 5 years with “mOPV2”. The duties of CDC deployed staffs included: Identify problems with the implementation of the campaign and guide actions for corrective measures. Monitor performance during the “Supplemental Immunization Activity” (SIA), and observe the work of vaccination teams. Visit houses or other areas to check the vaccination status of children based on finger marking after the campaign. Working under the guidance and leadership of Dr. Christie Reed of the CDC Kenya-Nairobi Office.

mOPV2 SIA Kenya, July-August Garissa( 217176) Isiolo (30217) Kajiado (150362) Kiambu (243920) Kitui (178675) Lamu ( 21217) Machakos (161823) Mandera (205468) Meru(211323) Nairobi (817782) Tana River (65008) Wajir (113780) Total 2,416,751 under 5s 12 counties 2,416,751 children <5 Y.O. mOPV2 (Oral) 5

CDC Deployer Activities Pre-campaign Attended and facilitated sub-counties’ trainings Supported teams with preparation and micro-planning Attended and facilitated the training of vaccinators and volunteers Intra-campaign Assisted with logistics and transport Supervised, monitored, and assisted teams and teams’ supervisors in the field Conducted in-process monitoring Monitored and supported vaccine management and logistics Debriefed sub-county team on a daily basis Supported Open Data Kit (ODK) training, implementation, and troubleshooting Post-campaign Attended and facilitated independent monitoring (IM) and Lot Quality Assuarance Sampling (LQAS) Supervised and monitored IM activities

SIA strategies Mobile Teams HH marking Transit Teams House-to-House Teams Mobile Teams HH marking The SIA strategies included: House-to-house teams; Mobile teams-other vaccination onsite; and Transit teams (on street, market, bus stops, playground, hospital and clinic, radio station, etc.). Logistic preparation included: Mobile teams scattered outside village with a long walk distance to reach children. Duplications are avoided by using pen marker (on left little finger) OPV vaccine: 1 vial has about 20 doses; 2 drops per one child Household marking: to inform vaccinators/monitors on updated info (complete or need a revisit). Transit Teams 7

Assessing level of SIA preparedness Checklist 8

SIAs supervisory checklist 4/12/2019 9

Polio SIA In Process Monitoring and Rapid Assessment Form 10

Post campaign-Key activities End process monitoring LQAS (Lot quality assessment sampling) activity Data compilation Analyse performance by supervisor area and plan for mop up if required Ensure all the mOPV2 vials are recalled from the field, counted and stored in a safe and secured place All the reports are submitted to the National level within 3 days of completion of the activities 11

Nairobi County Report Target population: 817,782 Total vaccinated: 822,870 Coverage: 101% Total AFP identified: 4 Zero dose: 4 Vaccine management: Unopened = 5,084; Unaccounted for = 20 (15 are from Ward 1) Refusals: 3 (all resolved) Best Practice: Team work/Daily review meeting/Special team for high rise buildings Gaps/Challenges/Way forward ODK not friendly user/HH marking/wrong finger marked Inadequate supply: Cold chain, Chalk, Apron, Advocacy Communication & Social Mobilization (ACSM) materials Door marking messy Explore stickers over chalk Provide Public Admin to help resolve refusal Harmonize allowance for all teams and static sites

Opening Campaign

Field Activity

Household marking during Polio Campaign

Efforts to deliver vaccine to hard-to-reach sites is a challenge!

Daily report submission: Accountability of used and broken vaccine vials. Great effort to successfully recover a vial accidentally dropped into the sewage drainage!

Submit data using Open Data Kit (ODK) via android mobile devices (cellphone and tablet) outside Nairobi is a challenge!

Debriefing at CDC Country Office on the last day of deployment. Meeting with the MOH and WHO teams during Pre-campaign.

Thank you--Asante Sana

Total population: 49,659,319 (2018 estimate) Children below 5 years old 21 million (2018 estimate)