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Pakistan: Polio Outbreak - May 2019

Status
Ongoing
Countries
Pakistan
Disaster types
Epidemic

The Committee is gravely concerned by the significant further increase in WPV1 cases globally in 2019, particularly in Pakistan where 15 cases have already been reported. In Pakistan transmission continues to be widespread, as indicated by the number of positive environmental isolates in many areas of the country, and the proportion of samples that detect WPV1 is rising. The recent cluster of cases in Lahore also indicates that vulnerabilities still exist outside the high-risk corridors. Notably, the increased rate of infection during what is usually the low season may herald even higher rates of infection in the coming high season unless urgent remedial steps are taken. The committee was very concerned about attacks on vaccinators and on the police protecting them. The increasing refusal by individuals and communities to accept vaccination also needs to be actively addressed. While the committee understood that the recent elections and political transition may have adversely affected delivery of the polio program, it is now essential that the new government renews its efforts, noting that the eradication program in the country is no longer on-track. The committee suggested a thorough analysis of the situation in Pakistan be urgently undertaken, to understand what factors have led to the recent but most serious deterioration in polio eradication seen since 2014. Government, program and community factors need to be all included in such a review. (Emergency Committee under the International Health Regulations (IHR), 29 May 2019).

One wild poliovirus type 1 (WPV1) case was reported in the past week, from North Waziristan, Khyber Pakhtunkhwa (KP) province, with onset of paralysis on 19 May, bringing the total number of WPV1 cases in 2019 to 19. (GPEI, 12 Jun 2019).

According to National Emergency Operations Center, since in 2019, there are 23 cases of wild poliovirus reported in the country including seven from district Bannu, one from district Hangu, one from DIKhan and one from district Shangla in Khyber Pakhtunkhwa, three cases from Mir Ali, two cases from Miran Shah, one from Khyber and one from Bajaur of tribal districts of Khyber Pakhtunkhwa, two from Karachi and one from Larkana in Sindh and three cases from Lahore in Punjab. The special polio vaccination campaign will start on June 17, targeting 10.25 million children under five years old. (Govt. of Pakistan, 16 Jun 2019)

Two wild poliovirus type 1 (WPV1) cases were reported in the past week, from Khyber Pakhtunkhwa (KP) province, one from Shangla district and the other one from Bannu district. The onset dates of paralysis are 18 and 22 May respectively, bringing the total number of WPV1 cases in 2019 to 24. (GPEI, 19 Jun 2019)

On 27 June 2019, the National Emergency Operation Center (NEOC) announced that five new polio cases have been detected in Bannu, Torghar and North Waziristan districts in Khyber Pakhtunkhwa. So far in 2019, a total of 32 polio cases have been reported including 26 from Khyber Pakhtunkhwa and Tribal districts, 3 from Punjab and 3 from Sindh. (Govt. of Pakistan, 27 Jun 2019)

Nine wild poliovirus type 1 (WPV1) cases have been confirmed: one each from Jaffarabad and Killa Abdullah districts, Balochistan province, five from Bannu district and two from Torghar district, Khyber Pakhtunkhwa province. The total number of WPV1 cases are 41. (GPEI, 10 Jul 2019)

Four wild poliovirus type 1 (WPV1) cases have been reported in the past week: One each from Jehlum and Lahore districts, Punjab province, with onset of paralysis on 21 and 22 June 2019; one each from Bannu and Lakkimarwat districts, Khyber Pakhtunkhwa province, with onset of paralysis on 22 June and 01 July 2019. The total number of WPV1 cases are 45. Three WPV1-positive environmental samples were reported in the past week: one each from Quetta district in Balochistan province; Karachi district in Sindh province; Bannu district in Khyber Pakhtunkhwa province. The samples were collected between 20-27 June 2019. (GPEI, 17 Jul 2019)

Five wild polioviruses type 1 (WPV1) cases were reported in the past week: three from Bannu district and one from Charsadda district, Khyber Pakhtunkhwa province; and, one from South Waziristan, Khyber Pakhtunkhwa province. All cases had onset of paralysis in July 2019. There are 53 WPV1 cases in 2019 and 12 WPV1 cases were reported in 2018. (GPEI, 14 Aug 2019)

Four wild poliovirus type 1 (WPV1) cases were reported this week: one each from Killa Abdullah district, Balochistan province; Lakki Marwat and South Waziristan districts, Khyber Pakhtunkhwa province; and, Orangi Town, Karachi district, Sindh province. The onsets of paralysis were on 8, 5, and 20 August 2019 respectively. There are 62 WPV1 cases reported in 2019. There were 12 WPV1 cases reported in 2018. (GPEI, 11 Sep 2019)

Three wild poliovirus type 1 (WPV1) cases were reported: two from Bannu and Lakki Marwat districts in Khyber Pakhtunkhwa province and one from Jamshoro district, Sindh province. The onsets of paralysis were on 19, 26 and 23 August 2019 respectively. As of this week, total 69 WPV1 cases reported in 2019. Full year total of WPV1 cases for year 2018 is 12. (GPEI, 04 Oct 2019)

As of 16 October, there were 72 confirmed cases of WPV1. In 2018, there were 12 WPV1 cases. This is six times the amount of reported cases over the whole year of 2018. (GPEI, 16 Oct 2019)

As of 23 October, four wild poliovirus type 1 (WPV1) cases were reported: three from Lakki Marwat in Khyber Pakhtunkhwa province and one from Harnai in Balochistan province. The onsets of paralysis were between 19 September and 6 October 2019. There are now 76 WPV1 cases reported in 2019. (GPEI, 23 Oct 2019)

As of 6 November, three wild poliovirus type 1 (WPV1) cases were reported: One from Sujawal in Sindh province and one each from Lakki Marwat and Tank in Khyber Pakhtunkhwa province. The onsets of paralysis were between 25 September and 11 October 2019. There are now 80 WPV1 cases reported in 2019. (GPEI, 6 Nov 2019)

As of 7 November, national authorities have confirmed the detection of type 2 vaccine derived poliovirus (VDPV2) through the disease surveillance system in Pakistan. The outbreak has paralyzed 7 children in northern Pakistan in areas with weak routine immunization coverage. This is the first time in two years this strain of virus has been detected in Pakistan. (Gov't of Pakistan, 10 Nov 2019)

As of 13 November, two wild poliovirus type 1 (WPV1) cases were reported: both from Lakki Marwat in Khyber Pakhtunkhwa province. The onsets of paralysis were 21 October 2019. There are now 82 WPV1 cases reported in 2019. There were 12 WPV1 cases in 2018. Three WPV1-positive environmental samples were reported: One each from Lahore and Karachi site in Punjab and Sindh provinces respectively and one from Rawalpindi in Punjab province. The samples were collected between 6 August and 25 October 2019. Seven cVDPV2 cases were reported: Four from Diamer in Gilgit Batistan province, one each from Torghar and Kohistan Lower in Khyber Pakhtunkhwa province and one from CDA in Islamabad. The onsets of paralysis were between 7 July and 10 October 2019. Nine cVDPV2 positive environmental samples were reported: Three from Rawalpindi in Punjab province, two from Diamer, one from Gilgit in Gilgit Baltistan province, one from Abbotabad in Khyber Pakhtunkhwa province and one each from Lahore and Karachi site in Punjab and Sindh provinces respectively. The samples were collected between 11 April and 9 October 2019. (GPEI, 13 Nov 2019)

Four wild poliovirus type 1 (WPV1) cases were reported: three from Lakki Marwat in Khyber Pakhtunkhwa province and one from Karachi Jamsheed in Sindh province. There are now 86 WPV1 cases reported in 2019. (GPEI, 20 Nov 2019)

Between 7 July and 3 November 2019, 11 children have been paralysed from cVDPV2 in Pakistan – four in Diamir district, Gilgit-Baltistan province, three in Kohistan, two in Torghar and one in Charsadda, Khyber Pakhtunkhwa (KP) province, and one in Metropolitan Corporation Islamabad. The median age for these cases was 22 months ranging from 8 to 66 months. (WHO, 28 Nov 2019)

As of 18 December, seven WPV1 cases were reported in the past week, from Sindh and KP, bringing the total number of WPV1 cases reported in 2019 to 101. Additionally, 12 WPV1-positive environmental samples were reported in the past week, from Punjab,Balochistan, Sindh, FATA, and KP. (GPEI, 18 Dec 2019)

During 16-20 December 2019 the anti-polio vaccination campaign that was conducted across Pakistan. This was the first nationwide campaign conducted since April 2019, 43.9 million children under the age of five were vaccinated. In the core reservoirs of Karachi, Peshawar, Khyber, Quetta, Pishin and Killa Abdullah, the catch-up activities were extended for a day to cover children who were missed during the door-to-door vaccination. (Govt of Pakistan, 29 Dec 2019)

Reflecting on 2019, the Government of Pakistan announced that as of 10 January 2020, 134 children had been paralysed as a result of contracting polio. Building on the successes of previous vaccination efforts, the Government has also announced that it will be targeting another 12 million children in under the age of five in a vaccination campaign starting 13 January 2020. (Govt. of Pakistan, 10 Jan 2020)

As reporting continues into the new year, an additional two WPV1 cases were recorded for 2019, bringing the total to 136 children affected by the polio outbreak in 2019. The first polio case for 2020 has also been reported, as of 22 January. (GPEI, 22 Jan 2020)

Six wild poliovirus type 1 (WPV1) cases were reported during the last week of January 2020: Four from Sindh province and one each from Balochistan and Khyber Pakhtunkhwa provinces. This brought the number of cases in 2020 to 4, and 139 for 2019. (GPEI, 29 Jan 2020)

Five wild poliovirus type 1 (WPV1) cases were reported this week: three from Sindh province and two from Khyber Pakhtunkhwa province. This brings the number of cases in 2020 to 12 and 144 for 2019. Twelve WPV1 positive environmental samples were reported: nine in Sindh province, two in Punjab province and one in Balochistan province. Three cVDPV2 positive environmental samples were reported: one from Khyber Pakhtoon and two from Khyber Pakhtunkhwa Tribal Districts (KPTD). (GPEI, 12 Feb 2020)

On 17 February, the Government started the first nationwide polio vaccination drive for 2020 aiming to vaccinate 39.6 million children under the age of five years across the country. (Govt. of Pakistan, 16 Feb 2020)

Five wild poliovirus type 1 (WPV1) cases were reported this week: four in Khyber Pakhtunkhwa province and one in Balochistan province. This brings the number of cases in 2020 to 17. Six WPV1 positive environmental samples were reported: two in Sindh province, two in Punjab province and two in Balochistan province. (GPEI, 19 Feb 2020)