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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:

  

  • One new case of wild poliovirus type 1 (WPV1) was reported in the past week, from Khost Province. The child is from a Pakistani family from polio-endemic North Waziristan who fled to Afghanistan to escape conflict at home. Already ill with fever when leaving Pakistan, the child developed paralysis on 16 June, 2014, in Khost province, one day after arrival from N. Waziristan. Including this most recent case, Afghanistan has reported eight polio cases to date in 2014, compared to three at this time in 2013.
  • Khost Province borders Pakistan, where communities displaced by military action have been leaving North Waziristan Agency. In preparation for the displacement of people – and possible movement of the virus – ahead of the Pakistan military’s actions in North Waziristan, health authorities in surrounding districts of Pakistan and across the border in Afghanistan have been vaccinating displaced children: more than 35,000 displaced children under the age of 10 are reported to have received a dose of bivalent oral polio vaccine (bOPV) as they entered the Afghan provinces of Paktyka and Khost.
  • No Supplementary Immunization Activities (SIAs) are planned during the holy month of Ramadan. The next SIAs are scheduled for 17-19 August, nationwide.
  

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.