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WHO EMRO Weekly Epidemiological Monitor: Volume 12, Issue 31 (04 August 2019)

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Current major event

Polio upsurge in Pakistan

Pakistan, Afghanistan and Nigeria, continue to be the last three polioendemic countries globally. Since late 2018, Pakistan has experienced significant upsurge in confirmed cases of polio. Since then, and as of epi week 30 of 2019, the country had reported a total of 59 cases of confirmed polio.

Editorial note

Polio (Poliomyelitis) is a highly infectious viral disease, which mainly affects young children. The polio virus is transmitted by person-to-person and is spread mainly through the faecaloral route, and less frequently by contaminated water or food. Thereafter, the virus multiplies in the intestine, from where it can invade the nervous system and cause paralysis. The initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. In a small proportion of cases, the disease can cause paralysis, which is often permanent.

In the Eastern Mediterranean Region, Afghanistan and Pakistan are the only two endemic Polio countries. As of 30 July 2019, a total of 59 cases of polio due to wild poliovirus type 1 (WPV1) had been reported in the Region in 2019: 47 from Pakistan and 12 from Afghanistan. The upsurge of cases in Pakistan is a major concern.

Furthermore WPV1 has been isolated from a total of 176 environmental samples in many parts of the country.

These include 31 positive samples from Balochistan, 6 from Fata, 2 from Islamabad, 23 from Kpakhtunkhwa, 42 from Punjab and 72 from Sindh.

The widespread isolation of the polio virus from environmental samples suggests the risk of further spread and increased intensity of transmission remains high, unless timely and effected interventions are initiated. There is no cure for polio, and it can only be prevented by immunization.

The government of Pakistan with the support of WHO has implemented series of vaccination campaigns to stop poliovirus transmission. A large mass polio vaccination campaign was conducted in April this year targeting high-risk areas. The vaccination campaign reached a total of 37.6 million children and 260,000 frontline heath workers. A second mass vaccination campaign is planned to take place in the second half of July 2019. Despite the ongoing mass vaccination interventions, the intensity of transmission of the disease especially in Khyber Pakhtunkhwa province does not appear to be subsiding.

Key barriers to the implementation of high quality vaccination campaigns include the ongoing conflict, community resistance, population movement, continuing ban by militants on immunization, and high level of insecurity encountered by the polio workers in the most affected parts of the country.