Largest reservoir of Polio virus in the world — the elusive way forward!

Global expansion of polio immunization resulted in a reduction of paralytic disease from an estimated annual pre-vaccine level of at least 600 000 cases to less than 1000 cases in 2000.¹ However, as of 2014, polio remains endemic to three countries (Nigeria, Pakistan, and Afghanistan). Pakistan is the only polio-endemic country in the world where polio cases rose from the year 2012 to 2013. According to the recent genomic sequencing results of the Regional Reference Laboratory for Polio Virus, 83 out of 91 cases in 2013 in the country are genetically linked to the polio virus circulating actively in Peshawar. Furthermore, 12 out of the total 13 cases reported last year from Afghanistan are also directly linked to Peshawar. During the last few years, samples of sewage water throughout the country are periodically tested for presence of the virus. Eighty-six samples of sewage water were collected from different locations of Peshawar in the last 4 years, and 72 of these collected samples showed the presence of highly contagious and paralytic wild polio virus strain. All sewage water samples collected during the last few months from various areas of Peshawar showed presence of the highly contagious virus. Peshawar alone reported 45 polio cases during the last 5 years. The explosive polio virus outbreak in Federally Administered Tribal Areas (FATA), which left 65 children paralysed in 2013, also originated from Peshawar. With more than 90% of the current polio cases in the country genetically linked to Peshawar (and adjoining areas), it is now the largest reservoir of endemic poliovirus in the world, the World Health Organisation (WHO) reported.

Right now, Pakistan is losing its battle against polio — with at least 85 cases recorded in the country in 2013 exceeding the 58 confirmed cases in 2012. One reason for this could be the frighteningly large number of refusals noted last year. Compared with 2012, when under 75 000 children were denied vaccination by their parents, in 2013, the number had almost doubled to around 155 000. Most of these came in Khyber–Pakhtunkhwa (K–P) and FATA, with propaganda by religious extremists naturally having an impact on the decisions people made. Also, the prevailing security situation in Peshawar has seriously affected the quality of polio campaigns in the city and is resulting in only a few children receiving polio drops. But there are other concerns too.

Provincial health authorities say a breakdown in communications between Unicef, which helps the Expanded Programme on Immunisation (EPI), and the EPI may have contributed to a rise in reported cases. Unicef has set up a communications body to help coordinate anti-polio efforts and states that it has 320 staff members working in K–P and 187 in FATA. The issue needs to be seen urgently. Just recently, on a single day, five new cases of polio among children were detected in North Waziristan. It is obvious that the situation must be amended. The problems caused by militancy have already been pointed out. Now it looks like that there is also a problem between agencies which need to work together if the problem is to be overcome. The existing state of polio eradication efforts in Peshawar by the provincial government needs to be improved to stop the virus from spreading. WHO recommended that high-quality, repeated vaccination campaigns — accompanied by strong monitoring — should be held in Peshawar to stop the polio transmission and protect children from the virus. The top officials involved in the anti-polio drive in the country must take up the matter seriously, determine where the faults lie, and work to resolve them. Unless this happens, there may still be a greater rise in polio cases, jeopardizing the safe future of our children and pushing the country further back in its battle against a disease which continues to inflict a huge amount of damage even though it can so easily be prevented.

Disclaimer Statement

Conflicts of interest The authors declare that they have no competing interests.