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Afghanistan


Status
: endemic

Most of Afghanistan is polio-free. The country has not yet interrupted transmission of wild poliovirus. However, poliovirus transmission ongoing in the Eastern Region of the country is largely due to poliovirus imported from neighbouring Pakistan.

Annual Report 2013 Polio Eradication Initiative, Afghanistan [pdf]

Financial resource requirements (2014-2016) for Afghanistan.

 



Polio this week in Afghanistan:

  
  • No new polio cases were reported in the past week. The most recent case had onset of paralysis on 05 May 2015 in Gulestan district, Farah. The total number of WPV1 cases for 2015 remains four.
  • The Technical Advisory Group met in early June and identified that southern and eastern Afghanistan remains at particular risk of polio. The group identified reasons for missed children, which to a great extent are due to remaining operational challenges during campaign implementation. The meeting put forward key recommendations to urgently address these remaining gaps.
  • National Immunization Days are scheduled on 16 to 18 August using bivalent oral polio vaccine. Since the most recent case on the 05 May, Farah has seen two supplementary immunization activities.
  

Strategy to eradicate polio in Afghanistan

Context

The Southern Region of Afghanistan and Farah province in the Western Region remain polio-endemic: in 2011, 85% of polio cases occurred in these areas. The other cases were reported in nine previously polio-free provinces, the result of importations from this endemic zone and from neighbouring Pakistan.

In the endemic zone, the immunization status of children was worse in 2011 than in 2008, uncovering a steady decline in the quality of Supplementary Immunization Activities. The 28 worst-performing districts have been identified in Hilmand, Kandahar and Uruzgan provinces in Southern Region and Farah province in Western Region.

In addition to problems accessing children in insecure areas, serious flaws in the management and accountability of the polio eradication programme persisted in 2011. Poor access and management were compounded by a failure to sufficiently communicate to parents and communities the importance of polio eradication.

Communication in Action: overview of community engagement

Strategic approach in Asia

In Asia, persistent poliovirus transmission is highly localized in a few districts. The approach in Asia therefore focuses on district- and sub-district-specific plans to achieve exceptionally high coverage with very frequent supplementary immunization activities to boost population immunity to >95% – the threshold required to stop transmission in Asia.

Engaging local political and administrative leaders to ensure the quality of supplementary immunization activities is also important.

Strategic approach in Afghanistan

Interrupting the remaining poliovirus transmission in Afghanistan has been declared an emergency by the World Health Assembly. In response, the National Polio Emergency Action Plan has been developed which recommends the following emergency approach.

  1. Resources focus on 28 worst-performing districts of endemic zone
  2. Engagement with local-level access negotiators and humanitarian organizations active in conflict areas
  3. New ‘permanent polio teams’: vaccination teams in place in worst-performing, security-compromised districts, able to circulate on a rolling basis to deliver additional OPV doses in between large-scale SIAs
  4. Scaling up Short Interval Additional Dose approach to more rapidly boost population immunity among populations living in hard-to-reach areas
  5. Strengthened capacity in worst-performing districts, through additional technical support and full-time district polio managers
  6. Strengthened accountability, through assessment and monitoring through provincial polio teams
  7. Refined post-SIA monitoring to obtain clearer picture of programmatic performance and enable corrective measures
  8. Sensitised micro-planning, and increased recruitment of local personnel for vaccination teams and supervision
  9. Assessment of community perceptions and targeted and scaled-up social mobilization efforts

Eradication targets

  • Coverage of >90% in high risk districts (HRDs) in at least 4 of the SIAs in a year

  • <5% inaccessible children in each high risk district
  • Awareness levels increased from 50% to 90% at the national level
  • Zero Dose AFP cases reduced by 50%4 
  • Among all the unvaccinated children, <10% missed due to “no team visit”
  • Reduction in total missed children and refusals by at least 50% in the country with special focus on 28 High Risk Districts.