Afghanistan

Status: has never stopped indigenous wild poliovirus (WPV) circulation

Afghanistan is one of only three countries in the world with ongoing wild poliovirus transmission, alongside Nigeria and Pakistan. The Global Polio Eradication Initiative is focusing on reaching every last child in Afghanistan with vaccines, strengthening surveillance and maintaining political commitment, financial resources and technical support at all levels.

Polio this week in Afghanistan

  • One wild poliovirus type 1 (WPV1) case in Uruzgan province, Shahid-e-Hassas district with onset of paralysis on 9 October has been reported.  So far, the total number of WPV1 cases in 2018 in the country is 20.
  • Two WPV1 positive environmental samples were reported this week: one from Kandahar district, Kandahar province, and one from Hilmand province, Lashkargarh district. Samples were collected on 5 November.
  • Nominal variations (up or down) in the number of newly-reported cases at this point of the polio endgame – although tragic for the affected children and their families – are not operationally overwhelming, especially considering the population size in the 3 remaining endemic countries (upwards of 90 million children aged less than five years).  However, confirmation of even a single polio case anywhere points to remaining vaccination coverage gaps which must be filled, to achieve eradication.
  • Over and beyond case numbers, the GPEI and its partners actively and continuously evaluate a wide range of epidemiological, virological, programmatic, operational, surveillance, financial and social data, the analysis of which drives strategic planning and enables target eradication efforts.
  • The three remaining endemic countries continue to intensify their eradication efforts, through implementation of national polio emergency action plans.  Underpinning these plans is the data analysis, to identify area-specific challenges and reasons why children are being missed (ie due to population movement, inaccessibility, lack of infrastructure, inadequate microplanning, resistance, etc), and putting in place area-specific solutions to overcome those reasons.  By clearly identifying high risk areas, teams are able to allocate and prioritize technical assistance to those areas. Afghanistan recently concluded a targeted national campaign. Read more here.
  • Analysis in 2018 by both GPEI partners and independent technical advisory groups, reviewing all available evidence, concludes that the near-term feasibility of eradication is possible, if remaining vaccination coverage gaps are rapidly filled, and the GPEI and its partners continue to work towards this goal.
  • The aim is to urgently interrupt the remaining strains of wild poliovirus transmission, not only to eradicate such strains in their own right and prevent their global re-emergence, but also to subsequently remove oral polio vaccines (OPV) from routine immunization programmes globally, to eliminate the long-term risks of vaccine-derived polioviruses (VDPVs).
  • The ultimate aim of the GPEI is to secure and sustain a world where no child will ever again be paralysed by any poliovirus – be it wild or vaccine-derived.
  • Read the latest polio update from Afghanistan to see information on cases, surveillance and vaccination campaigns.

Stopping Polio in Afghanistan

To ensure more children than ever before are reached with the polio vaccine, the campaigns in Afghanistan in 2017 must be the highest-quality in the programme’s history. The focus is on reaching every child with vaccines, particularly those who have been persistently missed. Afghanistan and Pakistan must work together to stop the virus for good, with an emphasis on high-quality immunization activities and surveillance to close remaining immunity gaps and quickly find the virus wherever it is hiding.

Afghanistan’s Emergency Operations Centres are working under a National Emergency Action Plan to ensure that chronically missed children are consistently reached now and in the future. Cross border teams, permanent transit teams and special nomadic teams are helping reach children on the move.

Much of the country remains polio-free, despite the deteriorating security situation throughout the country. However, these gains are fragile, and we must continue to focus on improvements in surveillance and campaign quality to find and respond to the virus wherever it emerges and stop it for good.

International Health Regulations

Afghanistan is classified by the International Health Regulations (IHR) as a state infected with WPV1, cVDPV1 or cVDPV3 with potential risk of international spread. It is therefore subject to temporary recommendations as of November 2018.

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Key at-risk: no longer poliovirus-infected, but at high risk of outbreaks
Outbreak: has stopped indigenous WPV circulation but affected by outbreak of imported WPV or circulating vaccine-derived poliovirus
Endemic: has never stopped indigenous wild poliovirus (WPV) circulation

Travel advice

WHO’s International Travel and Health recommends that all travellers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than 4 weeks) from infected areas should receive an additional dose of OPV or inactivated polio vaccine (IPV) within 4 weeks to 12 months of travel.

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