INTRODUCTION: High quality, timely and complete immunization data are essential for program planning and decision-making. In Nigeria, the National Health Management Information System (NHMIS) Routine Immunization (RI) module and dashboard (on the District Health Information System version 2 (DHIS2) platform) support the use of real time RI data. We deployed an automated short message service (SMS) notification system that works with the existing RI module to facilitate improvements in RI data in the DHIS2. METHODS: A pilot project was performed using intervention and control local government areas (LGAs). A mixed methods approach using both qualitative and quantitative methods was used to evaluate the system. We assessed changes in reporting rates across different reports. The evaluation also included baseline and post-intervention surveys of health facility (HF) staff. RESULTS: Reporting timeliness (76% pre and 99% post intervention) and completeness (83% pre and 99% post intervention) were consistently higher during the post-intervention than the pre-intervention period for facilities in the intervention LGA while reporting timeliness (65% pre and 66% post intervention) and completeness (71% and 77% post intervention) for facilities in the control LGA showed no change. Users reported that the SMS system was easy to understand and helped to facilitate improvements in consistency of data and timeliness of reporting. Inability of health care workers to effect changes at the HF level and the lack of immediate feedback were reported as key challenges to timeliness and quality of reports. CONCLUSION: An SMS-based intervention improved timeliness and completeness of health data reporting. However, the intervention should be evaluated on a larger scale over a longer time period before considering a national implementation.

INTRODUCTION: a district health information system 2 tool with a customized routine immunization (RI) module and indicator dashboard was introduced in Kano State, Nigeria, in November 2014 to improve data management and analysis of RI services. We assessed the use of the module for program monitoring and decision-making, as well as the enabling factors and barriers to data collection and use. METHODS: a mixed-methods approach was used to assess user experience with the RI data module and dashboard, including 1) a semi-structured survey questionnaire administered at 60 health facilities administering vaccinations and 2) focus group discussions and 16 in-depth interviews conducted with immunization program staff members at the local government area (LGA) and state levels. RESULTS: in health facilities, a RI monitoring chart was used to review progress toward meeting vaccination coverage targets. At the LGA, staff members used RI dashboard data to prioritize health facilities for additional support. At the State level, immunization program staff members use RI data to make policy decisions. They viewed the provision of real-time data through the RI dashboard as a "game changer". Use of immunization data is facilitated through review meetings and supportive supervision visits. Barriers to data use among LGA staff members included inadequate understanding of the data collection tools and computer illiteracy. CONCLUSION: the routine immunization data dashboard facilitated access to and use of data for decision-making at the LGA, State and national levels, however, use at the health facility level remains limited. Ongoing data review meetings and training on computer skills and data collection tools are recommended.

Background. Kano State, Nigeria, introduced inactivated polio vaccine (IPV) into its routine immunization (RI) schedule in March 2015 and was the pilot site for an RI data module for the National Health Management Information System (NHMIS). We determined factors impacting IPV introduction and the value of the RI module on monitoring new vaccine introduction. Methods. Two assessment approaches were used: (1) analysis of IPV vaccinations reported in NHMIS, and (2) survey of 20 local government areas (LGAs) and 60 associated health facilities (HF). Results. By April 2015, 66% of LGAs had at least 20% of HFs administering IPV, by June all LGAs had HFs administering IPV and by July, 91% of the HFs in Kano reported administering IPV. Among surveyed staff, most rated training and implementation as successful. Among HFs, 97% had updated RI reporting tools, although only 50% had updated microplans. Challenges among HFs included: IPV shortages (20%), hesitancy to administer 2 injectable vaccines (28%), lack of knowledge on multi-dose vial policy (30%) and age of IPV administration (8%). Conclusion. The introduction of IPV was largely successful in Kano and the RI module was effective in monitoring progress, although certain gaps were noted, which should be used to inform plans for future vaccine introductions.

BACKGROUND: Some human poxvirus infections can be acquired through zoonotic transmission. We report a previously unknown poxvirus infection in two patients, one of whom was immunocompromised, and both patients had known equine contact. METHODS: The patients were interviewed and clinical information was abstracted from the patients' medical files. Biopsies of the skin lesions were collected from both patients for histopathology, immunohistochemistry, and transmission electron microscopy analysis. Oral and skin swabs were collected from animals with frequent contact with the patients and environmental sampling including rodent trapping was performed on the farm where the immunosuppressed patient was employed. 'Pan-pox and high GC' PCR assays were performed on patient, animal, and environmental isolates. Amplicon sequences of the viral DNA were used for agent identification and phylogenetic analysis. RESULTS: Specimens from both human cases revealed a novel poxvirus. The agent shares 88% similarity to viruses in the Parapoxvirus genus and 78% to those in the Molluscipoxvirus genus but is sufficiently divergent to resist classification as either. All animal and environmental specimens were negative for poxvirus and both patients had complete resolution of lesions. CONCLUSION: This report serves as a reminder that poxviruses should be considered in cutaneous human infections especially in individuals with known barnyard exposures. The clinical course of the patients was similar to that of parapoxvirus infections and the source of this virus is currently unknown but is presumed to be zoonotic. This report also demonstrates the importance of a comprehensive approach to diagnosis of human infections caused by previously unknown pathogens.

Molluscum contagiosum (MC), a common childhood condition, is a cutaneous viral infection caused by poxvirus that replicates in the cytoplasm of epidermal cells.1 It typically produces benign, self-limiting eruptions on skin and mucous membranes. MC lesions are commonly seen on the face, trunks, limbs and genital areas (in sexually active young adults; for more information on molluscum contagiosum, visit the Centers for Disease Control and Prevention website at http://www.cdc.gov/ncidod/dvrd/molluscum/). MC is 1 of the easily overlooked causes of chronic unilateral conjunctivitis refractory to routine treatment,2 and eyelid lesions may assume atypical appearances or may be initially inconspicuous, thereby delaying diagnosis and subsequent treatment. We hereby present 1 such case in a child with several months of chronic conjunctivitis. | On October 25, 2012, a 13-year-old female with a 4-month history of chronic conjunctivitis was referred to an ophthalmologist. Her symptoms began in July with a red, itchy left eye. At that time, she was evaluated by her pediatrician and received a presumptive diagnosis of viral conjunctivitis. When her symptoms failed to resolve, she was referred to an ophthalmologist who felt the condition was consistent with bacterial conjunctivitis and prescribed an antibiotic ointment. When symptoms again did not improve, a second opinion was sought resulting in a presumptive diagnosis of allergic conjunctivitis. At this visit, patanol eye drops were prescribed. Again, symptoms persisted and in September, the patient additionally developed a left upper lid lesion, precipitating a visit to a third ophthalmologist, who diagnosed her with a chalazion and suggested warm compresses. The symptoms failed to resolve and on October 25, 2012, the patient presented to a 4th ophthalmologist. Here, a slit lamp examination revealed follicular conjunctivitis with punctate epithelial erosions on her cornea. Her left upper lid also showed a small umbilcated lesion on the central lid margin. She was diagnosed with a chronic follicular conjunctivitis of the left eye caused by molluscum contagiosum. Excision of the lesion was recommended, and the procedure was performed on November 14, 2012. The patient followed up 10 days after the procedure with complete resolution of symptoms. Two months after the procedure, the patient continued to be symptom free. The excised lesion was sent to Centers for Disease Control and Prevention’s Poxvirus branch. Extracted DNA was found to be positive for MC DNA using a real-time quantitative PCR (qPCR) targeting the MC virus DNA polymerase gene locus (see Supplemental Digital Content 1, http://links.lww.com/INF/B798, which describes assay).