The confirmation of a type-1 polio case from Mastung — a newly infected district in Balochistan — and two type-3 cases from North Waziristan and Khyber Agency during last week has taken Pakistan’s total polio count for 2011 to 148 (146 type-1 and 2 type-3 cases). The country closed 2010 with 144 cases.
The latest victim from Mastuung is 36-month old Mahjabeen, who had onset of paralysis on October 23. The child resides in Killi Akhori, Molvi Shamsullah, Union Council (UC) Khad Kocha of tehsil Mastung. As per recall of the parents, the child did not receive any dose of oral polio vaccine (OPV) through routine immunization or Supplementary Immunization Activities (SIAs) due to parental refusal based on religious grounds.
This is first polio case from Mastung this year. The last case had onset of paralysis on January 10, 1999. A total of 7 vaccination campaigns have been conducted in Mastung since January 2011; all using vaccine containing component against type-1 poliovirus. The last campaign was conducted in October 2011. The case points to major gaps at the UC level.
In North Waziristan Agency (NWA), a 16-month old female child Sonehra had onset of paralysis on October 20. The child resides in an area of Tehsil Mir Ali. As per recall of the parents, the child had received 5 doses of OPV, all through SIAs. Vaccination in this area was stopped in the September campaign after distribution of a letter against the polio campaign; the issue was subsequently resolved. Reportedly, there are multiple militant groups in the area.
This is the 10th polio case from NWA this year, all within a span of 10 weeks, indicating substantial immunity gap. The agency reported 7 polio cases last year. A total of 8 vaccination campaigns have been conducted in NWA since January 2011; all of them using the vaccine-containing component against type-1 poliovirus. The last campaign was conducted from October 25-27, 2011.
In Khyber Agency, 18-month old Rashida had onset of paralysis on October 15. The child resides in village Zar Faqir Malik, area Akka Khel Maira in tehsil Bara. As per recall of the parents, the child had not received any OPV dose through routine or SIAs). The area where the family of the child is residing is included in the list of high-risk areas of the agency due to inaccessibility and persistent transmission/ repeated re-infection. The area has been inaccessible to vaccination teams since September 2009 to date.
A total of 16 polio cases have been reported from the agency this year so far (8 cases from Bara tehsil, 4 each from Tirah and Landi Kotal). Khyber agency is the only agency/ district in the country having both WPV1 and WPV3 circulation this year. There has been continued outbreak of polio in Khyber Agency since early last year (Khyber agency reported 33 polio cases last year; 25 type-1 and 8 type-3), indicating a large cohort of un-immunized and under-immunized children. Khyber agency had had 8 vaccination campaigns since January 2011. The last campaign was conducted as national immunisation days (NIDs) in accessible areas in October 2011. Coverage remained below 95 per cent in all campaigns in accessible areas except in two instances (January and April). More than 40 per cent children in the agency remained inaccessible to vaccination teams in most of the campaigns this year except July. The overall adjusted finger marking coverage in the agency has remained below 60% in all the campaigns in 2011.
Even in accessible areas, the coverage is not uniform as indicated by high number of areas having coverage below 95 per cent. A break-up of the 148 cases reported so far is as follows: 16 from Khyber Agency, 10 from North Waziristan Agency, 4 each from Mohmand, South Waziristan Agency and FR Kohat, 2 each from FR Lakki Marwat and Orakzai and one each from Kurram and Bajaur agencies in FATA; 5 from Peshawar, 2 each from Bunir and Torghar and 1 each from Bannu, Swabi and Dir Upper in Khyber Pakhtoonkhwa; 17 from Killa Abdullah, 15 from Pishin, 13 from Quetta, 4 from Khuzdar, 3 each from Noshki and Loralai and 1 each from Kohlu, Killa Saifullah, Mastung, Kalat and Dera Bugti in Baluchistan; 7 from Thatta, 3 from Badin, two each from Tando Mohammad Khan, Kambar, Sanghar, Gaddap and SITE towns of Karachi and one each from Tando Allah Yar, Kashmore, Hyderabad, Umerkot, Jamshoro, Saddar, Baldia, Gulshan-e-Iqbal and Orangi towns of Karachi in Sindh, one case each from Okara and Lodhran in Punjab and one case from Diamer district in Gilgit-Baltistan.
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