Responding to a Poliovirus Outbreak: Standard Operating Procedures (SOPs) for a New Polio Outbreak in a Polio-Free Country

Based on experience from many countries, these guidelines from the World Health Organization (WHO) provide rules and recommendations on how to respond to a polio outbreak. The guidelines also present a timeline indicating the key events that need to take place for a response campaign to happen within the required timeframe (4 months). These standard operating procedures (SOPs) provide details that are consistent with the International Health Regulations (IHR), the provisions of the World Health Assembly (WHA)'s Emergency Response Framework (ERF), previous resolutions of the WHA on polio outbreak response, and past experience of the Global Polio Eradication Initiative (GPEI) in successfully interrupting polio outbreaks. The SOPs document the roles and responsibilities - including those related to strategic communication - of GPEI partners who are mandated to support government-led action.

Specifically, these SOPs introduce several new concepts for polio outbreak response, such as specifying six critical functions that the GPEI should fulfil to deliver on its commitment to stop transmission within 120 days of detecting a new outbreak: (i) outbreak confirmation, grading, response assessment, and closure; (ii) coordination and advocacy (e.g., convene the government and partners as needed to discuss and determine strategy); (iii) technical and human resources; (iv) information management; (v) external communication, social mobilisation, and behaviour change communication (e.g., the training of frontline workers to deliver key messages through effective interpersonal communication (IPC) and information, education, and communication (IEC) materials; and (vi) finances and logistics.

To delve more deeply into one strategy for rapidly interrupting a poliovirus outbreak, the document recommends ensuring effective communication and social mobilisation to build demand for oral polio vaccine (OPV) and mitigating the risk of population fatigue of repeated polio vaccination campaign through: mass communications informing the population of the outbreak, the risks of permanent disability and death from polio, and the need to take multiple doses of polio vaccine; rapid analysis of the knowledge, attitudes, and practices (KAP) regarding vaccination, including social profiling of polio confirmed and zero-dose non-polio accute flacid paralysis (AFP) or contact cases, to design strategic messages through communications for development (C4D) and mass media; engagement of community and religious leaders as suitable to the local context; engagement and support of the medical and health-worker community during the outbreak and response plan, in accordance with the key messages identified; targeted community-level mobilisation during the immunisation campaigns; engagement with the existing humanitarian, development, United Nations (UN) country team and/or government communication networks to ensure the coordinated and coherent dissemination of messages; and systematic reporting of specific social indicators, especially for missed children, refusals, and absences, as part of the overall national outbreak reporting mechanism.

GPEI's performance standards for responding to a poliovirus outbreak highlight the importance of communication at every step after outbreak confirmation. GPEI's outbreak response procedures are described in tables in the concluding pages of the resource. They define expected outputs from each partner and level of the organisation by the six critical functions listed above, with concrete deliverables and timelines.

Editor's note: Below please find a September 22 2016 webinar recorded by the United Nations Children's Fund (UNICEF), a GPEI partner, which provides an overview of the SOPs, including classification of an event or outbreak, risk assessment, key strategies for interrupting polio transmission, and GPEI's critical functions.