Pakistan

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

Pakistan is one of only three countries in the world with ongoing wild poliovirus transmission, alongside Afghanistan and Nigeria. The country is also affected by a circulating vaccine-derived poliovirus type 2 (cVDPV2). The Global Polio Eradication Initiative is focusing on reaching every last child in Pakistan with vaccines, strengthening surveillance and maintaining political commitment, financial resources and technical support at all levels.

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.

Polio this week in Pakistan

  • No new wild poliovirus type 1 (WPV1) cases were reported in the past week.  The total number of WPV1 cases for 2016 remains 20.  The most recent case had onset of paralysis on 22 December 2016, from Killa Abdullah, Balochistan
  • One new environmental WPV1 positive sample was reported in the past week, from Killa Abdullah, Balochistan, collected on 19 January.
  • The year 2016 saw the lowest ever annual number of polio cases in the country but poliovirus continues to be isolated through environmental surveillance over a significant geographical range.
  • Two of the three polio core reservoirs (Karachi and Peshawar) have demonstrated encouraging progress in 2016.  Of particular note is Karachi, which has not reported a wild polio case for almost one year and only three positive environmental samples since March 2016.
  • The situation in the reservoir of Quetta block is concerning as there is continued local transmission of wild poliovirus together with the emergence of circulating vaccine-derived poliovirus type 2 since June 2016.  Efforts are being escalated to strengthen programme operations as well as supervision and monitoring mechanisms.
  • A national emergency action plan for the disease is being overseen directly by the office of the Prime Minister. Emergency Operations Centres (EOCs) at federal and provincial/regional levels ensure almost real-time monitoring of activities, implementation of corrective action and increased accountability and ownership at all levels. Pakistan and Afghanistan national and provincial/regional EOCs are closely coordinating on implementing programme operations in a synchronized manner (see ‘Afghanistan’ section for further details).

Stopping Polio in Pakistan

Pakistan made important progress in 2015, with the lowest number of cases in its history. However, in high-risk areas of the country, unvaccinated children remain vulnerable.

An array of new approaches and tools are being used to bring Pakistan to the finishing line, including the Emergency Operations Centres to coordinate the program effectively and a National Emergency Action Plan with a strong accountability framework, improved surveillance, fewer unvaccinated children and fewer strains of the virus.

The virus is cornered in a few remaining sanctuaries Karachi, Quetta block and Khyber-Peshawar corridor. Stopping transmission in these core reservoirs will be critical to success. However, virus is regularly detected in every province through environmental surveillance in the sewage, indicating that pockets of under-immunised children are allowing the virus to survive and spread.

Pakistan has a real opportunity to end transmission this year, but it must remain focused on reaching children in high-risk areas of the country, increase and enhance surveillance quality in core reservoirs, conduct high-quality campaigns and ensure the safety and security of health workers.

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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

 

IHR Classification

Pakistan is classified by the International Health Regulations (IHR) as a state currently exporting wild poliovirus or circulating vaccine-derived poliovirus and hence it is subject to temporary recommendations as of February 2017.

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