title: Polio eradication initiative in Afghanistan, 1997-2013.
abstract: BACKGROUND
  This article reviews the epidemiology of polio, acute flaccid paralysis (AFP) surveillance, and the implementation of supplemental immunization activities (SIAs) in Afghanistan from 1997 thru 2013.
  
  
  METHODS
  Published reports and unpublished national data on polio cases, AFP surveillance, and SIAs were analyzed. Recommendations from independent advisory groups and Afghan government informed the conclusions.
  
  
  RESULTS
  From 1997 thru 2013, the annual number of confirmed polio cases fluctuated from a low of 4 in 2004 to a high of 80 in 2011. Wild poliovirus types 2 and 3 were last reported in 1997 and 2010, respectively. Circulating vaccine-derived poliovirus type 2 emerged in 2009. AFP surveillance quality in children aged <15 years improved over time, achieving rates>8 per 100,000 population. Since 2001, at least 6 SIAs have been conducted annually.
  
  
  CONCLUSIONS
  Afghanistan has made progress moving closer to eliminating polio. The program struggles to reach all children because of management and accountability problems in the field, inaccessible populations, and inadequate social mobilization. Consequently, too many children are missed during SIAs. Afghanistan adopted a national emergency action plan in 2012 to address these issues, but national elimination will require consistent and complete implementation of proven strategies.
authors.affiliation: Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, Georgia.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Simpson
authors.affiliation: Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, Georgia.
authors.forename: Nahad
authors.initials: N
authors.lastname: Sadr-Azodi
authors.affiliation: Directorate of General Preventive Medicine, Afghanistan Ministry of Public Health.
authors.forename: Taufiq
authors.initials: T
authors.lastname: Mashal
authors.affiliation: Office of the Ministry of Advising for the President on Health and Education Affairs and National Focal Point for Polio Eradication.
authors.forename: Wrishmeen
authors.initials: W
authors.lastname: Sabawoon
authors.affiliation: Centers for Disease Control and Prevention.
authors.forename: Ajmal
authors.initials: A
authors.lastname: Pardis
authors.affiliation: Polio Eradication Unit, World Health Organization.
authors.forename: Arshad
authors.initials: A
authors.lastname: Quddus
authors.affiliation: Polio Eradication Unit, United Nations Children's Fund, Kabul, Afghanistan.
authors.forename: Carmen
authors.initials: C
authors.lastname: Garrigos
authors.affiliation: Communications Program, United Nations Children's Fund, New York, New York.
authors.forename: Sherine
authors.initials: S
authors.lastname: Guirguis
authors.affiliation: Pakistan Polio Regional Reference Laboratory, Islamabad, Pakistan.
authors.forename: Syed Sohail
authors.initials: SS
authors.lastname: Zahoor Zaidi
authors.affiliation: Pakistan Polio Regional Reference Laboratory, Islamabad, Pakistan.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Shaukat
authors.affiliation: Pakistan Polio Regional Reference Laboratory, Islamabad, Pakistan.
authors.forename: Salmaan
authors.initials: S
authors.lastname: Sharif
authors.affiliation: World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt.
authors.forename: Humayan
authors.initials: H
authors.lastname: Asghar
authors.affiliation: National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hadler
mesh_terms: D000293:Adolescent; D000346:Afghanistan / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D060740:Disease Eradication; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; 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: Afghanistan; disease eradication; epidemiology; polio; strategies