WHO: GAR – Poliomyelitis in Pakistan

WHO: Global Alert and Response (GAR): Poliomyelitis in Pakistan
[Initial text; bolding by editor]  7 July 2011

Pakistan has reported wild poliovirus type 3 (WPV3) isolated from a 16-month old child with onset of paralysis on 9 June 2011, from a conflict-affected, inaccessible area of Khyber Agency, Federally Administered Tribal Areas (FATA). This is the only case of WPV3 detected in Asia in 2011. WPV3 transmission in Asia is on the verge of elimination, with the last case occurring more than six months ago, on 18 November 2010 (also from Khyber Agency, FATA).

Confirmation of continuation of WPV3 transmission in tribal areas of Pakistan has significant implications for the global effort to eradicate WPV3, particularly as Asia is on the verge of eliminating circulation of this strain. The detection of WPV3 in Pakistan represents the risk that it may spread from this transmission focus to other WPV3-free areas of Asia and beyond. Globally, WPV3 transmission is at historically low levels in 2011, with other circulation of this strain restricted to parts of west Africa (17 cases in Côte d’Ivoire, Guinea, Mali and Niger), Nigeria (five cases) and Chad (three cases). The risk of onward spread of WPV3 is deemed as high by the World Health Organization (WHO), particularly given large-scale population movements within Pakistan, between Pakistan and Afghanistan, and expected large-scale population movements associated with Umrah and the upcoming Hajj (pilgrimage to Mecca, Kingdom of Saudi Arabia) in the coming few months.

In 2011, supplementary immunization activities (SIAs) in Pakistan have been inadequate in quality in key high-risk areas and a significant proportion of children remained inaccessible in conflict affected tribal areas. In FATA, particularly in Khyber agency, nearly 50% of children have been regularly missed during SIAs for the last two years. In addition to challenges relating to reaching children in insecure areas of Khyber Pakhtunkhwa and FATA, significant operational challenges continue to mar the quality of SIAs in accessible areas of Khyber and in other key transmission areas of the country, notably in the provinces of Balochistan and Sindh. In addition to confirmation of the only WPV3 case in Asia in 2011, Pakistan is affected by country-wide geographical transmission of wild poliovirus type 1 (WPV1), with 57 confirmed WPV1 cases in 2011 (as at 5 July 2011), compared with 14 WPV1 cases for the same period in 2010…