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Background: Schools based vaccination provide opportunity for the delivery of routine vaccines, using the school as the venue of delivery. During the 2017/2018 measles vaccination campaign, the school system stakeholders were systematically engaged for buy-in to vaccinate 9-59 months old children in Lagos State, Nigeria. This paper is a report of how the Lagos state school authority were engaged for the 2018 measles vaccination campaign. It also highlights the contribution of the engagement in the overall performance of the state looking at the vaccination coverage data and comparing that with the previous campaign. Method: We reported on the role of engaging the school health system in improving coverage using a descriptive mixed-method study design. The stakeholders cutting across the government, education sector, public and private schools were identified and engaged through coordination meetings, dialogues, lobby and sensitization to support vaccination in schools. We summarized the outcome of the engagement activities, analyzed the administrative, post-campaign coverage data and compared it with the 2016 measles supplemental activities coverage. Results: A total of 12,903 schools were used as venues (vaccination posts), while 22 sensitization meetings were held with school associations. About 80% of all eligible children vaccinated in the Local Government Areas (LGAs) during the 2018 Measles Vaccination Campain (MVC), received the vaccine at schools. The lowest proportion of children vaccinated at school was 45.0% in Oshodi LGA. Surulere LGA had the highest proportion of children vaccinated in schools (95.0%). Overall, Lagos state had a weighted average coverage of 93.8% for the post-campaign coverage survey. Conclusion: The implementation of the school engagement process for supplemental immunization activities contributed to achieving high vaccination coverage as most of the children aged 9-59 months were vaccinated in schools.

Background The global polio eradication initiative has made giant stride by achieving a 99% reduction in Wild poliovirus (WPV) cases, with Nigeria on the verge of being declared polio-free following over 36 months without a WPV. The initiative has provided multiple resources, assets and lessons learnt that could be transitioned to other public health challenges, including improving the quality and vaccination coverage of measles campaigns in order to reduce the incidences of measles in Nigeria. We documented the polio legacy and assets used to support the national measles campaign in 2017/2018. Methods We documented the integration of the measles campaign coordination with the Polio Emergency Operation Centre (EOC) at national and state levels for planning and implementing the measles SIA. Specific polio strategies and assets, such as the EOC incident command framework and facilities, human resource surge capacity, polio GIS resource These strategies were adapted and adopted for the MVC implementation overcome challenges and improve vaccination coverage. We evaluated the performance through a set process and outcome indicators. Results All the 36 states and Federal Capital Territory used the structure and resources in Nigeria and provided counterpart financing for the MVC 2017/ 2018. The 11 polio high-risk states deployed the use of GIS for microplanning process, while daily call-in data were tracked in 99.7% of the LGAs and 70,846 reports were submitted real-time by supervisors using Open data kit (ODK). The national coverage achieved was 87.5% by the post-campaign survey with 65% of states reporting higher coverage in 2018 compared to 2015. Conclusion Polio eradication assets and lessons learned can be applied to measles elimination efforts as the eradication and elimination efforts have similar strategies and programme implementation infrastructure needs. Leveraging these strategies and resources to support MVC planning and implementation resulted in more realistic planning, improved accountability and availability of human and fiscal resources. This approach may have resulted in better MVC outcomes and contributed to Nigeria’s efforts in measles control and elimination.

Background Measles causes significant childhood morbidity in Nigeria. Routine immunization (RI) coverage is around 40% country-wide, with very high levels of spatial heterogeneity (3–86%), with supplemental immunization activities (SIAs) at 2-year or 3-year intervals. We investigated cost savings and burden reduction that could be achieved by adjusting the inter-campaign interval by region. Methods We modeled 81 scenarios; permuting SIA calendars of every one, two, or three years in each of four regions of Nigeria (North-west, North-central, North-east, and South). We used an agent-based disease transmission model to estimate the number of measles cases and ingredients-based cost models to estimate RI and SIA costs for each scenario over a 10 year period. Results Decreasing SIAs to every three years in the North-central and South (regions of above national-average RI coverage) while increasing to every year in either the North-east or North-west (regions of below national-average RI coverage) would avert measles cases (0.4 or 1.4 million, respectively), and save vaccination costs (save $19.4 or $5.4 million, respectively), compared to a base-case of national SIAs every two years. Decreasing SIA frequency to every three years in the South while increasing to every year in the just the North-west, or in all Northern regions would prevent more cases (2.1 or 5.0 million, respectively), but would increase vaccination costs (add $3.5 million or $34.6 million, respectively), for $1.65 or $6.99 per case averted, respectively. Conclusions Our modeling shows how increasing SIA frequency in Northern regions, where RI is low and birth rates are high, while decreasing frequency in the South of Nigeria would reduce the number of measles cases with relatively little or no increase in vaccination costs. A national vaccination strategy that incorporates regional SIA targeting in contexts with a high level of sub-national variation would lead to improved health outcomes and/or lower costs.