Pakistan

Status: has never stopped circulation of indigenous wild poliovirus and is affected by circulating vaccine-derived poliovirus

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.

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 2017 remains two.  The most recent case had onset of paralysis on 13 February, from Diamir district, Gilgit Baltistan.
  • One new WPV1 isolate from an environmental sample was reported in the past week, collected on 5 June from Karachi Gadap, Sindh.
  • 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. Efforts are ongoing through implementation of the national emergency action plan to address remaining gaps in coverage and surveillance, in close coordination with neighbouring Afghanistan.
  • The National Polio Management Team met on 8-9 June to review implementation of the National Emergency Action Plan during the low transmission season, and to agree on essential adjustments to the plan for the second half of 2017

Stopping Polio in Pakistan

Pakistan has made important progress towards stopping polio in the country. Case numbers are the lowest they have ever been, and the immunity gaps continue to decline. However, in high-risk areas of the country, unvaccinated children remain vulnerable.

An array of approaches and tools are being used to bring Pakistan to the finishing line, including tailoring vaccination approaches to  children in high-risk mobile populations, Emergency Operations Centres to coordinate the programme 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, the Federally Administered Tribal Areas, the Quetta block and the Khyber-Peshawar corridor. Stopping transmission in these core reservoirs will be critical to success. However, virus is regularly detected in across the country through environmental surveillance, 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, and conduct high-quality campaigns to close immunity gaps.

Also critical to success will be working together with Afghanistan in fighting the virus. The remaining strongholds of wild poliovirus transmission are in areas linking the two countries, and country programmes are jointly focused on improving the quality of immunization activities and surveillance in these areas.

International Health Regulations

Pakistan is classified by the International Health Regulations (IHR) as a state infected with WPV1, cVDPV1 or cVDPV3 with potential risk of international spread, and as a state infected with cVDPV2.  It is therefore subject to temporary recommendations as of April 2017.

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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 Recommendations

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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