AFP Surveillance Update 2010

Expanded Program on Immunization,

Ministry of Health, Islamabad

(Polio Eradication Initiative – National Surveillance Cell)

AFP Surveillance Update 2010

Today, four new type-1 polio cases have been confirmed by laboratory. They include one case each from Ghotki and Sukkur districts in Sindh province, Mianwali district in Punjab province and Mohmand agency in Federally Administered Tribal Areas. This brings the total number of polio cases country-wide in 2010 so far to 78 including 58 type-1 and 20 type-3 cases. Mianwali and Sukkur are newly infected districts bringing the total number of infected districts/towns/tribal agencies in 2010 to 27.

Following the massive floods initiated in July 2010 badly affecting the region of central Pakistan (including southern Punjab, northern Sindh and adjoining parts of Balochistan), a total of 4 districts have been infected with WPV in the region (Ghotki, Khairpur and Sukkur in Sindh and Muzaffargarh in Punjab) which is of concern. Uniform high quality vaccination activities covering all the populations are obligatory to arrest the spread of poliovirus transmission in the region and beyond.

Detailed epidemiological investigation of the cases and genetic analyses of the isolated polioviruses are under process. The available information is mentioned below.

1.     Mianwali: Polio case (type-1)

Zar Muhammad S/o Gul Muhammad is a 36-months old male child having onset of paralysis on 21st September, 2010.  The child resides in Afghan Camp area UC Kot Chania of tehsil Essa Khel. As per recall of the parents, the child has received more than 7 OPV doses including 1 dose through Routine Immunization. Followings are important to highlight:

  • This is the first polio case from the district after over 10 years; last case was reported in November 1999 which was also a type-1 case.
  • Mianwali is one of the worst affected districts by the recent massive floods. The UC of the child’s residence was also severely affected.
  • The child belongs to an Afghan family and lives in an Afghan Refugees camp. There is frequent population movement between the camp and parts of Khyber Pakhtunkhwa and Afghanistan.
  • A total of 12 vaccination campaigns have been conducted in the district since January 2009 (5 in 2010), 11 of which were conducted using vaccine containing component against type-1 poliovirus (Table 1).
  • The overall coverage based on finger marking at district level has been more than 90% during all the campaigns since January 2009. However the proportion of union councils with coverage below 90% by finger marking was above 10% during two vaccination campaigns each in 2009 and 2010.

Table 1: Vaccination coverage verified by finger marking in less than 5 years children in Mianwali district – 2009 and 2010

Year SIAs  Month Type of SIAs Type of OPV % Coverage in below 5 years children % Union Councils with coverage below 90%
2009 January NIDs tOPV 97 8
March NIDs tOPV 98 0
May NIDs tOPV 98 0
July NIDs tOPV 96 11
August SNIDs mOPV3 98 3
October NIDs tOPV 98 10
November NIDs tOPV 99 5
2010 February NIDs tOPV 96 11
April NIDs tOPV 95 14
May SNIDs mOPV1 97 7
July NIDs tOPV 97 4
August High Risk UCs campaign bOPV 96 *

*Data not available

Recommendations:

  • Ensuring high quality vaccination activities during the upcoming vaccination round scheduled from 11-13 October (i.e. within 3 days of the notification of the polio case) with special focus on returning IDPs, migratory and other high risk population groups.
  • Intensifying surveillance activities in the district to ensure reporting of all paralyzed children below 15 years of age.
  • Enhanced routine immunization outreach activities in between the campaigns.

2. Ghotki: Polio case(type-1)

Asma D/o Peeral Faqir is a 42-month old female child having onset of paralysis on 20th September, 2010. The child resides in village Haji Rahab Mahar, UC Lohi of tehsil Khan Garh. As per recall of the parents, the child has received more than 7 OPV doses, all through SIAs. Followings are important to highlight:

  • This is the 4th type-1 case from the district this year. These cases have date of onset of paralysis within almost 4 weeks (18 August – 20 September).
  • Ghotki district is situated in the central Pakistan which has been adversely affected by the floods.
  • Ghotki district was included in phase-1 of the recent NIDs conducted from 27-29 September i.e. within one week of the date of onset of paralysis of the newly reported polio case.
  • A total of 18 vaccination campaigns have been conducted in Ghotki district since January 2009 (7 in 2010), fifteen of which were conducted with OPV containing component against type-1 poliovirus (Table 2).
  • Overall coverage by finger-marking in vaccination campaigns at district level is more than 90% except in 3 rounds in 2009 and one in 2010. However there is lack of uniformity in coverage at sub district level indicated by high proportion of union councils having finger-marking coverage below 90%.

Table 2:  Vaccination coverage verified by finger marking in less than 5 years children in Ghotki district 2009 and 2010

Year SIAs  Month Type of SIAs Type of OPV Coverage in children below 5 years (%) Percentage of  Union Councils with below 90% coverage
2009 January NIDs tOPV 91 30
March NIDs tOPV 95 19
April SNIDs mOPV1 95 9
May NIDs tOPV 94 19
June SNIDs mOPV1 97 9
July NIDs tOPV 96 13
August SNIDs mOPV3 92 34
September Case Response mOPV1 87 50
October NIDs tOPV 81 33
November NIDs tOPV 94 17
December SNIDs mOPV1 91 23
2010 January SNIDs mOPV3 93 31
February NIDs bOPV 92 15
March SNIDs bOPV 88 40
April NIDs tOPV 94 20
May SNIDs mOPV3 93 25
July NIDs bOPV 96 0
September NIDs bOPV Results awaited

Recommendations:

  • High Quality vaccination activities i.e. routine immunization and during scheduled SIAs.
  • Enhanced routine vaccination outreach activities in between the campaigns

3. Sukkur: Polio case (type-1)

Azizan d/o Nazir Ali is 36-month old female child having onset of paralysis on 26th September, 2010. The child resides in Village Muhammad Hareef, UC Pahnwaro of Tehsil Rohri. Child received more than 7 OPV doses, all through SIAs.

  • This is first polio case reported from the district since October 2006 which was a type-3 case while last type1 polio case from the district was reported in June 2002.
  • The child along with his family lived in an IDPs’ camp in Rohri city for 10-15 days in mid August (due to flood warning in their village) with flood displaced population from other areas in the region.
  • A total of 17 vaccination campaigns have been conducted in the district since January 2009 (6 in 2010), 14 of which were conducted with vaccine containing antigen against types-1 poliovirus (Table 3). Overall vaccination coverage in the district during SIAs has been above 90% except 3 campaigns in 2009. However, high proportion of the UCs with coverage below 90% verified by finger marking indicates performance gaps at the sub-district level.
  • Sukkur was included in the recently held mass vaccination campaign during which mOPV1 was given to all under 5 years’ children in addition to measles vaccine. Next NIDs in Sukkur are scheduled from 11-13 October with trivalent OPV.

Table 3:  Vaccination coverage verified by finger marking in less than 5 years children in Sukkur district 2009 and 2010

Year SIAs  Month Type of SIAs Type of OPV Coverage in children below 5 years (%) Percentage of  Union Councils with below 90% coverage
2009 January NIDs tOPV 88 46
March NIDs tOPV 95 16
April SNIDs mOPV1 96 3
May NIDs tOPV 93 28
June SNIDs mOPV1 93 28
July NIDs tOPV 94 22
August SNIDs mOPV3 98 3
September Case Response mOPV1 94 0
October NIDs tOPV 87 47
November NIDs tOPV 89 43
December SNIDs mOPV1 90 47
2010 January SNIDs mOPV3 93 27
February NIDs bOPV 95 17
March SNIDs bOPV 92 37
April NIDs tOPV 96 8
May SNIDs mOPV3 94 17
July NIDs bOPV 92 25

Recommendation:

  • Uniform High quality vaccination for routine immunization and scheduled SIAs
  • Enhanced AFP surveillance activities to ensure that every paralyzed child below 15 years of age is detected by the surveillance system
  • Enhanced routine vaccination outreach activities in between the SIAs

4.         Mohmand: polio case (type-1)

Nazia d/o Sher Bahadar is a 12-month old female child having onset of paralysis on 26th September, 2010. The child resides in Village Gharrai, Machine Karona, area Sagai of Tehsil Safi.  Child has not received any dose OPV through SIAs or Routine immunization

  • This is third type-1 polio case reported from the agency this year and 2nd from Tehsil Safi. The last type-1 case had onset of paralysis on 25th August.
  • A total of 19 vaccination campaigns have been conducted in the accessible areas of the agency since January 2009 (8 in 2010), 17 of which were conducted with vaccine containing antigen against the types-1 poliovirus.
  • NIDs with bivalent OPV in the agency have already been conducted from 27-29 September 2010 i.e. within a day of the date of onset of paralysis of the case.
  • The overall adjusted coverage verified by finger marking taking into account the factor of inaccessibility has been very low.  (Table 4).

Table 4:  Vaccination coverage verified by finger marking in less than 5 years children in Mohmand agency 2009 and 2010

Year SIAs  Month Type of SIAs Type of OPV Inaccessible children Coverage in children below 5 years in accessible areas (%) Adjusted finger marking coverage (%) Percentage of  Union Councils with below 90% coverage (among accessible areas)
No. %
2009 January NIDs tOPV 55,138 49 96 49 10
March NIDs tOPV 50,551 45 95 52 7
April SNIDs mOPV1 49,443 44 95 53 4
May NIDs tOPV 49,443 44 96 53 8
June SNIDs mOPV1 49,443 44 93 52 19
July NIDs tOPV 37,495 34 95 63 7
August SNIDs mOPV3 35,300 32 95 65 0
September Case response mOPV3 35,300 32 96 66 *
October NIDs tOPV 35,050 31 96 66 0
November NIDs tOPV 29,451 26 95 70 2
December SNIDs mOPV1 23,700 21 96 76 0
2010 January SNIDs mOPV1 22,768 20 94 75 0
February NIDs bOPV 20,310 18 91 74 0
March SNIDs bOPV 18,257 16 94 78 19
April NIDs tOPV 18,050 16 94 79 9
May SNIDs bOPV 18,200 16 94 78 7
July NIDs bOPV 16,802 15 94 80 14
August High Risk UCs campaign bOPV 4,927 3 94 92 0
September NIDs bOPV 17,530 16 Results awaited

* Data not available

Recommendations:

  • Urgent implementation of the decisions made by the Crisis Task Force for FATA.
  • Extra alertness in all accessible areas of the agency for ensuring high quality vaccination coverage and reporting of all paralyzed children.

Overall case count of 2010:

1      Total number of confirmed polio cases (as on 08th of October, 2010) =78

2      58 type-1 cases; one case each from Dir Upper, Swabi, Kohat and Charsadda; 2 cases from Lakki Marwat; three cases from Peshawar and 4 from Hangu district in Khyber-Pakhtunkhwa province; two cases from Orakzai, three cases from Mohmand, four from Kurram, five cases each from North Waziristan and Bajour and fourteen cases from Khyber agency in FATA; 1 case from Killa Abdullah district in Balochistan; 1 each from Muzaffargarh, Mianwali and 2 cases from DG Khan in Punjab; and 1 case each from Sanghar, Sukkur and Khairpur and 4 from Ghotki district in Sindh province.

3      20 type-3 cases; one case from South Waziristan, two from Bajour and five from Khyber agency in FATA; one each from Swat and Swabi and two from Peshawar in Khyber-Pakhtoonkhwa province; one from Karachi (Gulshan-e-Iqbal town) in Sindh; three from Quetta, two from Chaghai and one case from Killa Abdullah district in Balochistan; and one case from Rawalpindi in Punjab.

Dr. Altaf Bosan

National Program Manager EPI

08th October, 2010

Tables attached: –

1.    Table 1,2,3, 4:  Vaccination coverage of Mianwali, Ghotki, Sukkur districts and Mohmand agency respectively in 2009 and 2010.

2.    Table 5: Confirmed polio cases by month and year, 2001 – 2010

3.    Table 6: Confirmed polio cases by province, district and type of poliovirus in 2010

Table 5: Confirmed polio cases by month & by year, Pakistan (2001-2010£)

Month/Year 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
January 9 4 6 4 4 0 5 2 7 6
February 3 4 7 3 0 2 1 1 2 4
March 4 4 7 4 2 0 1 0 0 2
April 4 9 14 1 1 1 0 6 6 8
May 3 3 7 4 3 5 2 5 4 5
June 4 6 7 3 2 4 2 3 3 6
July 7 2 8 4 3 4 0 18 14 6
August 18 11 11 10 2 3 2 18 19 15
September 24 20 14 2 3 6 4 30 11 26
October 20 14 7 8 2 8 1 21 12
November 16 7 10 2 3 6 6 7 7
December 7 6 5 8 3 1 8 6 4
Total 119 90 103 53 28 40 32 117 89 78

£ As of 08th October, 2010
Table 6: Confirmed polio cases by province, district & by type in 2010
£

Province / Region District Name Type of Wild Poliovirus No. Cases No. infected  Districts Total Cases
Punjab DG Khan NSL1 2 4 5
Muzaffargarh NSL1 1
Mianwali* NSL1 1
Rawalpindi NSL3 1
Sindh Karachi-Gulshan-e-Iqbal NSL3 1 5 8
Sanghar NSL1 1
Sukkur* NSL1 1
Khairpur NSL1 1
Ghotki* NSL1 4
Khyber-Pakhtoonkhwa Peshawar NSL1 3 8 17
NSL3 2
Swat NSL3 1
Charsada NSL1 1
Lakki Marwat NSL1 2
Kohat* NSL1 1
Dir Upper NSL1 1
Swabi NSL3 1
NSL1 1
Hangu NSL1 4
FATA Bajour NSL1 5 7 41
NSL3 2
Khyber NSL1 14
NSL3 5
Kurram NSL1 4
Waziristan North NSL1 5
Waziristan South NSL3 1
Orakzai NSL1 2
Mohmand* NSL1 3
Balochistan Quetta NSL3 3 3 7
Chaghai NSL3 2
Kila Abdullah NSL1 1
NSL3 1
Pakistan 27 78

* New case; £ As of 08th October, 2010.