Abstract
Among the three wild poliovirus (WPV) serotypes, only WPV type 1 (WPV1) has been reported in polio cases or detected from environmental surveillance globally since 2012. Pakistan remains one of only three countries worldwide (the others are Afghanistan and Nigeria) that has never had interrupted WPV1 transmission. This report documents Pakistan's activities and progress toward polio eradication during January 2017-September 2018 and updates previous reports (1,2). In 2017, Pakistan reported eight WPV1 cases, a 60% decrease from 20 cases in 2016. As of September 18, 2018, four cases had been reported, compared with five cases at that time in 2017. Nonetheless, in 2018, WPV1 continues to be isolated regularly from environmental surveillance sites, primarily in the core reservoir areas of Karachi, Quetta, and Peshawar, signifying persistent transmission. Strategies to increase childhood immunity have included an intense schedule of supplemental immunization activities (SIAs), expanding and refining deployment of community-based vaccination implemented by community health workers recruited from the local community in reservoir areas, and strategic placement of permanent transit points where vaccination is provided to mobile populations. Interruption of WPV1 transmission will require further programmatic improvements throughout the country with a focus on specific underperforming subdistricts in reservoir areas.
Highlights
During January 2017-September 2018, wild poliovirus type 1 (WPV1) cases in Pakistan continued to decrease compared with previous periods
Stopping WPV1 transmission will require further enhancing the quality of vaccination and surveillance, augmenting cross-border coordination with Afghanistan, strengthening efforts to reach mobile populations at high risk, and focusing on poorperforming areas
In 2018, as of September 18, a total of 13 WPV1 cases have been reported in neighboring Afghanistan
Summary
Progress Toward Poliomyelitis Eradication — Pakistan, January 2017–September 2018. Christopher Hsu, MD, PhD1; Abdirahman Mahamud, MD2; Muhammad Safdar, MD3; Joanna Nikulin, MD4; Jaume Jorba, PhD5; Kelley Bullard, MS6; John Agbor, MD7; Milhia Kader, MD1; Salmaan Sharif, PhD8; Jamal Ahmed, MD9; Derek Ehrhardt, MPH, MSN1. Strategies to increase childhood immunity have included an intense schedule of supplemental immunization activities (SIAs), expanding and refining deployment of communitybased vaccination implemented by community health workers recruited from the local community in reservoir areas, and strategic placement of permanent transit points where vaccination is provided to mobile populations. Variation in OPV3 coverage among provinces is high; the highest reported administrative OPV3 coverage rates in 2017 (based on records from vaccination sites) were in Azad Jammu and Kashmir (95%) and Islamabad (91%), and the lowest were in Balochistan (35%) and the Khyber Pakhtunkhwa Tribal Districts (KP-TD) (50%). Two SIA rounds using injectable inactivated poliovirus vaccine (IPV) combined with bOPV were implemented in the high-risk districts and core reservoirs, targeting 3,081,900 children in 2017 and 1,287,835 children in 2018 in Balochistan, KP-TD, and Karachi. There are currently 1,106 permanent transit points strategically placed along major domestic migration routes and at transport hubs in all provinces and at the Afghanistan official border crossings
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