Progress towards poliomyelitis eradication--Afghanistan, January 2019-July 2020/ Progres accomplis vers Teradication de la poliomyelite--Afghanistan, janvier 2019-juillet 2020.

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From: Weekly Epidemiological Record(Vol. 95, Issue 41)
Publisher: World Health Organization
Document Type: Article
Length: 5,074 words
Lexile Measure: 1810L

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Wild poliovirus type 1 (WPV1) is still being transmitted only in Afghanistan and Pakistan. (1) After decreases in the numbers of cases in Afghanistan during 2013-2016, the number increased each year during 2017-2020. This report describes polio eradication activities and progress in Afghanistan during January 2019-July 2020 and updates previous reports. (2, 3)

Since April 2018, insurgent groups (anti-government elements) have imposed bans on house-to-house vaccination. In September 2019, vaccination campaigns were restarted in areas under insurgency control only at health facilities. During March-June 2020, all campaigns were paused because of the COVID-19 pandemic.

The number of WPV1 cases reported increased from 21 in 2018 to 29 in 2019. Between January and July 2020 (as of 29 August), 41 WPV1 cases were reported, as compared with 15 during January-July 2019; in addition, 69 cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) and 1 case of ambiguous vaccine-derived poliovirus type 2 (aVDPV2) (with no evidence of person-to person transmission or from persons with no known immunodeficiency) were detected. Dialogue is under way with insurgency leaders to recommence house-to-house campaigns, which are essential to stopping WPV1 transmission in Afghanistan. To increase community demand for polio vaccination, other community health needs should be addressed and polio vaccination integrated with humanitarian services.

Vaccination activities

In September 2015, wild poliovirus type 2 was declared eradicated, and a single dose of injectable inactivated poliovirus vaccine (IPV, containing inactivated vaccine virus types 1, 2 and 3) was introduced into the routine immunization programme. In April 2016, type 2 oral polio vaccine (OPV) was withdrawn through a globally synchronized "switch" from trivalent OPV (containing Sabin-strain types 1, 2 and 3) to bivalent OPV (bOPV, containing types 1 and 3). WHO and the United Nations Children's Fund estimated that national routine vaccination coverage of children aged <12 months with the 3rd dose of bOPV was 73% in 2018 and 2019. Estimated coverage with one dose of IVP in 2019 was 66%. (4) In 2019, 69% of children aged 6-23 months with non-polio acute flaccid paralysis (NPAFP) nationwide had a history of receiving 3 OPV doses through routine immunization services, a proxy indicator of OPV3 coverage.

To reach every child with OPV, the polio programme conducts SIAs house-to-house whenever feasible. Children who are missed during campaigns are classified as inaccessible if they live in areas with security difficulties to access or where campaigns are banned. Children are considered missed but accessible when they are not vaccinated because of inadequate campaign quality. SIAs were banned in all areas controlled by the insurgency in April 2018. Since September 2019, vaccination has been permitted only at health facilities or insurgency-approved fixed posts.

The proportion of children with NPAFP who never received OPV through routine or supplementary immunization activities (SIAs) (5) was 1% nationally in 2019, with higher percentages in the southern provinces of Kandahar (9%) and Uruzgan (25%) and the eastern province of Kunar (7%). During January 2019-July 2020, SIAs targeted children aged <5 years for receipt of monovalent OPV type 1 (mOPV1,...

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Gale Document Number: GALE|A639544074