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Pakistan: Polio Outbreak - May 2019

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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)

Four wild poliovirus type 1 (WPV1) cases were reported this week (as of 11 March 2020): One each in Khyber Pakhtunkhwa and Balochistan and two in Sindh. This brings the number of 2020 cases to 25. The total number of 2019 cases remains 146. (GPEI, 11 Mar 2020)

During the week of 12-18 March, five cases of wild poliovirus type 1 (WPV1) case were reported: two in Khyber Pakhtoon and one each in KPTD, Balochistan and Sindh. This brought the number of 2020 cases to 30. Thirteen new cVDPV2 cases were reported: five each in Khyber Pakhtoon and eight in the Khyber Pakhtunkhwa Tribal Districts (KPTD). (GPEI, 18 Mar 2020)

Two new cases of wild poliovirus type 1 (WPV1) were reported in Sindh during the week of 19-25 March, bringing the number of 2020 cases to 32. Six WPV1 positive environmental samples were reported: Four in Balochistan and one each in Punjab and Sindh provinces (GPEI, 25 Mar 2020).

Four cases of wild poliovirus type 1 (WPV1) case were reported during the week of 26 March - 1 April: one in Sindh and three in Khyber Pakhtunkhwa province. This brings the number of 2020 cases to 36 while the total number of 2019 cases remains 146. Nine WPV1 positive environmental samples were reported: Seven in Sindh and two in Punjab. Eight cVDPV2 cases were reported: Five in Khyber Pakhtunkhwa province, one in Khyber Pakhtunkhwa Tribal Districts and two Punjab. (GPEI, 01 April 2020).

One case of wild poliovirus type 1 (WPV1) was reported in Sindh province bringing the number of 2020 cases to 37 while the total number of 2019 cases remains 146. 16 WPV1 positive environmental samples were reported: two in Balochistan province, one in Khyber Pakhtoon, eight in Punjab and five in Sindh (GPEI, 10 April 2020).

Two cases of wild poliovirus type 1 (WPV1) were reported: one each in Balochistan and Sindh bringingthe number of 2020 cases to 41. Eight WPV1 positive environmental samples were reported: four in Balochistan and two each in Punjab and Sindh. Seven cVDPV2 cases were reported: one each in Balochistan and KPTD and five in Khyber Pakhtoon province (GPEI, 22 April 2020).

No case of wild poliovirus type 1 (WPV1) was reported this week. The number of 2020 cases stands at 41. The total number of cases reported in 2019 cases remains 147. Six WPV1 positive environmental samples were reported: one each in Balochistan, KhyberPakhtunkhwa and Sindh and three in Punjab. Two cVDPV2 cases were reported: one each in Khyber Pakhtunkhwa and KPTD. (GPEI, 28 April 2020).

Four cases of wild poliovirus type 1 (WPV1) were reported: three in Balochistan and one in Sindh bringing the number of 2020 cases to 47. The total number of cases reported in 2019 cases remains 147 (GPEI, 13 May 2020)

Nine WPV1 positive environmental samples were reported: four in Balochistan, two in Khyber Pakhtoon and three in Punjab. One cVDPV2 case was reported in Khyber Pakhtoon province. The number of cVDPV2 cases in the country now stands at 67. (GPEI, 19 May 2020)

Two wild poliovirus type 1 (WPV1) cases were reported: one each in Khyber Pakhtoon and Punjab. The number of cases reported in 2020 now stands at 49. (GPEI, 26 May 2020)

One wild poliovirus type 1 (WPV1) case was reported in Balochistan province. The number of cases reported in 2020 stands at 50 while the total number of cases reported in 2019 cases remains 147. 20 WPV1 positive environmental samples were reported: one each in Balochistan and Khyber Pakhtoon, four in Punjab and 14 in Sindh (GPEI, 9 Jun 2020).

One wild poliovirus type 1 (WPV1) case was reported in Balochistan province bringing the number of cases reported in 2020 to 51, while the total number of cases reported in 2019 cases remains 147. Eighteen WPV1 positive environmental samples were reported: seven in Balochistan, two in Khyber Pakhtoon, five in Punjab and four in Sindh (GPEI, 16 Jun 2020).

Two wild poliovirus type 1 (WPV1) cases was reported: one each in Balochistan and Sindh province. The number of cases reported in 2020 stands at 53 while the total number of cases reported in 2019 cases remains 147. Five WPV1 positive environmental samples were reported: one in Balochistan and four in Punjab (GPEI, 24 Jun 2020).

Two wild poliovirus type 1 (WPV1) cases was reported: one each in Balochistan and Punjab province. The number of cases reported in 2020 stood at 55 while the total number of cases reported in 2019 cases remains 147. Ten WPV1 positive environmental samples were reported: one each in Balochistan and Gilgit Baltistan, five in Punjab and three in Sindh (GPEI, 1 Jul 2020).

One wild poliovirus type 1 (WPV1) case was reported in KPTD bringing the number of cases reported in 2020 to 56 while the total number of cases reported in 2019 cases remained 147. Nine WPV1 positive environmental samples were reported: one in Balochistan, two in Punjab and six in Sindh. Three cVDPV2 cases were reported: one each in Khyber Pakhtoon, Punjab and Sindh. There are now 72 cVDPV2 cases in the country (GPEI, 7 Jul 2020).

Two wild poliovirus type 1 (WPV1) cases were reported in Sindh bringing the number of cases reported in 2020 to 58 while the total number of cases reported in 2019 cases remains 147. Seven WPV1 positive environmental samples were reported; three in Balochistan, one each in Khyber Pakhtoon and Punjab and two in Sindh. (GPEI, 14 Jul 2020).

Two wild poliovirus type 1 (WPV1) cases were reported; one each in Balochistan and Punjab bringing the number of cases reported in 2020 to 60 while the total number of cases reported in 2019 cases remains 147. Eight WPV1 positive environmental samples were reported; three in Balochistan, four in Punjab and one in Sindh. (GPEI, 21 Jul 2020).

No wild poliovirus type 1 (WPV1) cases were reported this week. There are 60 cases reported in 2020 so far while the total number of cases reported in 2019 cases remains 147. 12 WPV1 positive environmental samples were reported; six each in Punjab and Sindh provinces. (GPEI, 29 Jul 2020).

Three wild poliovirus type 1 (WPV1) cases were reported; one each in Khyber Pakhtoon, Punjab and Sindh. There are 63 cases reported in 2020 so far while the total number of cases reported in 2019 cases remains 147. 12 WPV1 positive environmental samples were reported; two in Balochistan, three in Punjab and seven in Sindh. (GPEI, 7 Aug 2020).

Polio immunization campaigns have resumed in Afghanistan and Pakistan – the last two polio-endemic countries in the world – months after COVID-19 left 50 million children without their polio vaccine. As a result, reported polio cases have reached 34 in Afghanistan and 63 in Pakistan, including in some previously polio-free parts of the country. In Pakistan, a initial round of vaccinations took place at the end of July, covering about 780,000 children. A nationwide vaccination campaign is slated to start later this month. (UNICEF, 11 Aug 2020).

Two wild poliovirus type 1 (WPV1) cases were confirmed this week, one in Quetta district, Balochistan province and one in Lahore district, Punjab province. There are 65 cases reported in 2020 so far while the total number of cases reported in 2019 cases remains 147. (GPEI, 19 Aug 2020).

More than 32 million children under the age of five vaccinated in 130 districts across Pakistan during the immunisation campaign on 13 August. The polio vaccination campaign has been conducted successfully in all provinces at a larger scale following an initial small-scale campaign in July. Campaign activities were affected in a few districts due to heavy rainfall and smart lockdowns in some areas, and therefore, extended catch up activities were also carried out to reach the intended target. Following the successful resumption of campaign activities, the Pakistan Polio Eradication programme plans to conduct other large scale national and sub-national campaigns between September and December. (Govt. of Pakistan, 25 Aug 2020).

Three wild poliovirus type 1 (WPV1) cases were reported; one in Balochistan and two in Punjab province. There are 68 cases reported in 2020 so far while the total number of cases reported in 2019 cases remains 147. (GPEI, 9 Sep 2020).

Two wild poliovirus type 1 (WPV1) cases were reported; one each in Balochistan and Sindh province. There are 70 WPV1 cases reported in 2020 so far while the total number of cases reported in 2019 cases remains 147. (GPEI, 17 Sep 2020).

Three wild poliovirus type 1 (WPV1) cases were reported; two in Balochistan and one in Punjab province. There are 73 WPV1 cases reported in 2020 so far while the total number of cases reported in 2019 cases remains 147. (GPEI, 23 Sep 2020).

One wild poliovirus type 1 (WPV1) case was reported in Punjab province. There are 74 WPV1 cases reported in 2020 so far while the total number of cases reported in 2019 cases remains 147. (GPEI, 30 Sep 2020).

Approximately 39 million children have been vaccinated against polio during a nationwide immunisation campaign from 21 to 25 September. This was the first nationwide campaign since February due to a four-month suspension on supplementary immunisation activities during the COVID-19 outbreak in Pakistan. (Govt. of Pakistan, 2 Oct 2020).

Three wild poliovirus type 1 (WPV1) cases were reported; one in Balochistan and two in Punjab province. There are 77 WPV1 cases reported in 2020 so far while the total number of cases reported in 2019 cases remains 147. (GPEI, 14 Oct 2020).

Two wild poliovirus type 1 (WPV1) cases were reported in Balochistan province. There are 79 WPV1 cases reported in 2020 so far while the total number of cases reported in 2019 cases remains 147. (GPEI, 21 Oct 2020).