title: Progress and peril: poliomyelitis eradication efforts in Pakistan, 1994-2013.
abstract: Pakistan is one of 3 countries where transmission of indigenous wild poliovirus (WPV) has never been interrupted. Numbers of confirmed polio cases have declined by >90% from preeradication levels, although outbreaks occurred during 2008-2013. During 2012 and 2013, 58 and 93 WPV cases, respectively, were reported, almost all of which were due to WPV type 1. Of the 151 WPV cases reported during 2012-2013, 123 (81%) occurred in the conflict-affected Federally Administered Tribal Areas (FATA) and in security-compromised Khyber Pakhtunkhwa province. WPV type 3 was isolated from only 3 persons with polio in a single district in 2012. During August 2012-December 2013, 62 circulating vaccine-derived poliovirus type 2 cases were detected, including 40 cases (65%) identified in the FATA during 2013. Approximately 350 000 children in certain districts of the FATA have not received polio vaccine during supplementary immunization activities (SIAs) conducted since mid-2012, because local authorities have banned polio vaccination. In other areas of Pakistan, SIAs have been compromised by attacks targeting polio workers, which started in mid-2012. Further efforts to reach children in conflict-affected and security-compromised areas will be necessary to prevent reintroduction of WPV into other areas of Pakistan and other parts of the world.
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: James P
authors.initials: JP
authors.lastname: Alexander
authors.affiliation: Polio Eradication Initiative.
authors.forename: Mufti
authors.initials: M
authors.lastname: Zubair
authors.affiliation: Polio Eradication Initiative.
authors.forename: Muzaffar
authors.initials: M
authors.lastname: Khan
authors.affiliation: Office of the WHO Representative in Pakistan, World Health Organization, Islamabad.
authors.forename: Nima
authors.initials: N
authors.lastname: Abid
authors.affiliation: Polio Eradication Initiative.
authors.forename: Elias
authors.initials: E
authors.lastname: Durry
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D060740:Disease Eradication; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D011051:Poliomyelitis / Q000453:epidemiology* / Q000517:prevention & control*; D017955:Poliovirus / Q000145:classification / Q000302:isolation & purification*; D023321:Poliovirus Vaccines / Q000008:administration & dosage; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D023321:Poliovirus Vaccines
keywords: Pakistan; disease eradication; epidemiology; polio; surveillance