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Published Date: 2019-09-29 19:38:05
Subject: PRO/EDR> Poliomyelitis update (77): Pakistan (SD, PB, KP)
Archive Number: 20190929.6700783
POLIOMYELITIS UPDATE (77): PAKISTAN (SINDH, PUNJAB, KHYBER PAKHTUNKHWA)
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International Society for Infectious Diseases
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In this update:
[1] Pakistan (Sindh)
[2] Pakistan (Khyber Pakhtunkhwa, Sindh)
[3] Pakistan (Punjab)

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[1] Pakistan (Sindh)
Date: 28 Sep 2019
Source: Business Recorder [edited]
https://www.brecorder.com/2019/09/28/524918/sindh-reports-seventh-case-of-polio-for-the-year-2019/


Sindh reports 7th case of polio for the year 2019
--------------------------------
- Polio eradication has faced difficulties in 2019 with the total case count now standing at 69, with 52 cases from KP and KPTD, 7 cases from Sindh, 5 cases each from Balochsitan and Punjab.
- "We will ensure we turn the tide" said the spokesperson for the EoC in Sindh.
- This was said to be possible if only parents and caretakers take their children to any government EPI centre where these vaccines are available free of cost.

The Emergency Operation Centre for Polio in Sindh here on Saturday [28 Sep 2019] announced that a new case of polio has been reported from tehsil Kotri, district Jamshoro.

Abid Hasan, the spokesman of EoC Polio-Sindh sharing details said a 31-month-old boy has become the 7th polio victim in the province during the current year of 2019. Other affected districts are Hyderabad with 2 cases of polio and Larkana with 1 case and Karachi with 3 polio cases, which were reported earlier in the year [2019].

The latest victim of the crippling disease was said to be alright till he developed fever and chest congestion on [22 Aug 2019]; however, the very next [day] the child unfortunately also got hit by a water tanker while playing on the road, consequent to which, the child became irritable and was unable to move legs.

The child was said to be taken to nearby hospital, where he got medication; since his condition did not improve, he was further referred to Ziauddin Hospital in Karachi where he was suspected of acute flaccid paralysis (AFP). Upon testing, it was established the child had polio with reduced reflexes in both lower limbs.

Polio eradication has faced difficulties in 2019 with the total case count now standing at 69, with 52 cases from KP and KPTD, 7 cases from Sindh, 5 cases each from Balochsitan and Punjab.

"The child had a routine dose of polio, which we are verifying, and it is being investigated how many campaign doses were received," said Abid Hasan.

EoC-Sindh was said to have aggressive campaigns from November [2018] all the way to June [2019] with the aim to not only stop polio cases but eradicate polio from the environment. "We will ensure we turn the tide," said the spokesperson for the EoC in Sindh. As per forthcoming campaigns, he said OPV will be provided to the communities at their doorsteps, emphasizing that parents must also cooperate with EoC by not only accepting the vaccine but also ensuring that their children are not denied routine immunization. This was said to be possible only if parents and caretakers take their children to any government EPI centre where these vaccines are available free of cost.

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Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[The story of the child developing paralysis after trauma brought to mind the discussions on "provocation poliomyelitis". Through the years there have been observations and theories about "provocation poliomyelitis" where paralysis is "provoked" by trauma when an individual is infected with a poliovirus. A major concern was the receipt of intramuscular injections during the incubation period. Gromeirer and Wimmer studied this in an animal model and observed that "Skeletal muscle injury induces retrograde axonal transport of poliovirus and thereby facilitates viral invasion of the central nervous system and the progression of spinal cord damage". Strebel et al did a case control study of vaccine associated polio cases in Romania and demonstrated the same phenomenon was obserbed and associated with intramuscular injections within 30 days of receipt of oral poliovirus vaccine. In the case of this child, one always wonder which came first, did the injury provoke the AFP, or did the child already have AFP and bilateral lower limb weakness that prevented running away from imminent danger?

Refs.
1. Gromeier M, Wimmer E. Mechanism of injury-provoked poliomyelitis. J Virol. 1998 Jun;72(6):5056-60. full text available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC110068/.
2. Strebel PM, Ion-Nedelcu N, Baughman AL, Sutter RW, Cochi SL. N Engl J Med. 1995 Feb 23; 332(8):500-6. full text available at: https://www.nejm.org/doi/full/10.1056/NEJM199502233320804
-Mod.MPP]

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[2] Pakistan (Khyber Pakhtunkhwa, Sindh)
Date: 29 Sep 2019
Source: Sky Statement / Dawn [edited]
https://skystatement.com/tally-rises-to-69-as-three-more-polio-cases-reported/


3 more cases of polio have been reported in the country -- 2 in Khyber Pakhtunkhwa and 1 in Sindh -- taking the total number of such cases to 69.

An official at the Polio Virology Laboratory of the National Institute of Health (NIH) said on Saturday [28 Sep 2019] that the cases of Khyber Pakhtunkhwa were reported in Lakki Marwat and Bannu. The case of Sindh was reported in Jamshoro.

He said that in Lakki Marwat district, an 18-month-old girl had been paralysed due to the virus. The girl lives in the Zindhe Falak Sher village, in Serai Naurang tehsil. During investigations, it was revealed that she had never been administered polio drops, the official added.

The victim from Bannu -- a 2-year-old girl hailing from the Zalol Khel village of Wazir tehsil -- had been vaccinated against the crippling disease just once.

The emergency operation centre (EOC) for polio in Sindh said the 3rd case had been reported in the Kotri taluka of Jamshoro district. Officials said a 31-month-old boy had unfortunately become the province's 7th victim of the year [2019]. They said the child was well until [27 Aug 2019] when he suffered fever and chest congestion. "The next day, the child was hit by a water tanker while playing on the street, after which he turned irritable and found himself unable to move his legs. He was ultimately referred to a private hospital where it was established that he had polio," said an EOC official. An EOC spokesperson said the officials were investigating how many doses of polio drops he had been administered, if any at all. The NIH official said that although the boy's family had claimed that he had been administered 3 doses of polio drops, this had not been mentioned in the vaccination card.

Meanwhile, in order to ensure that important policymakers and stakeholders are informed at all times of the total number of polio cases in the country, the government has decided to install LCDs in key buildings, including the Presidency and the national and the provincial assemblies. The LCDs being installed on the directives of President Dr Arif Alvi would show how many cases had been reported and from where. Moreover, constituency-wise details of the environmental samples (showing presence of the virus in sewage) would also be displayed.

According to a document signed by the Prime Minister's Focal Person on Polio, Babar bin Atta, and addressed to the president, it has been decided that LCD screens displaying polio updates would be installed at various locations from World Polio Day, to be observed on [24 Oct 2019]. The LCDs would be installed in the lobby of the Presidency, the National Assembly of Pakistan, all the 6 provincial/constitutional assemblies, all 5 Chief Minister secretariats, and the Prime Minister's Secretariat.

Mr Atta said that during a meeting with the president, it had been proposed that the LCDs be put up at key locations so that parliamentarians and other decision-makers would remain aware of the issue. "Moreover, we have to take ownership of the programme in order to give a message to the masses that polio is our issue. On each LCD, constituency-wise performance would be displayed, due to which public representatives would be aware that their performance is being watched," he said.

A sample from sewage from an area is the basic parameter to determine whether the polio campaigns there are being conducted successfully or not. A polio case can be reported in any city because of frequent movement of people from one city to another, but if the virus is found in the sewage, it means that the polio campaign in that area did not achieve its targets.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

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[3] Pakistan (Punjab)
Date: 29 Sep 2019
Source: Samaa TV [edited]
https://www.samaa.tv/news/2019/09/two-year-old-diagnosed-with-polio-in-toba-tek-singh/


A 2-year-old girl has been diagnosed with polio in Toba Tek Singh, becoming the 1st case to be reported here this year [2019]. The child lives in a village near Toba Tek Singh. She has been referred to Faisalabad's Allied Hospital, according to the medical superintendent of the local DHQ Hospital. The child's father claims she was given polio drops.

This is the 1st polio case to be reported in Toba Tek Singh in 3 years.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Cases continue to be identified and reported in Pakistan. Since the last update, there are now 4 newly confirmed cases (the cases reported from KP are different from those in the previous report (Poliomyelitis update (74): Pakistan (KP) Philippines (Zambagoan Peninsula) susp. 20190924.6692404).

While the reports of the cases in Sindh and KP are reproduced in many media reports, the case from Punjab is only reported on the Samaa TV website. Unfortunately, End-Polio Pakistan has not been updated to reflect new cases in the past 2 weeks and is only showing a total of 64 cases instead of the 69 or 70 (if the Punjab case is confirmed). When officially confirmed, these will raise the global total of WPV associated cases with dates of onset since 1 Jan 2019 to 85 or 86.

There is a very thoughtful and well researched discussion on the reasons for the "anti-vaccination" movement in northern Pakistan in the Dawn newspaper, dated 29 Sep 2019 (Polio, what's behind the refusals? https://www.dawn.com/news/1507831). The focus of the discussion points at political protest on the part of disenfranchised communities with other more pressing health and social priorities. It is a very revealing discussion and worth reading.

A good map of Pakistan showing districts and provinces can be found at: https://reliefweb.int/sites/reliefweb.int/files/resources/pak215_pakistan_districts_v5_a0_20181203.pdf.

HealthMap/ProMED map of Pakistan: http://healthmap.org/promed/p/140. - Mod.MPP]

See Also

Poliomyelitis update (76): global (Pakistan, Angola, Myanmar), ARCC certif. 20190926.6696166
Poliomyelitis update (75): Philippines, WHO, no new confirmed cases 20190925.6694087
Poliomyelitis update (74): Pakistan (KP) Philippines (Zambagoan Peninsula) susp. 20190924.6692404
Poliomyelitis update (73): Philippines, Pakistan, global (Angola) 20190921.6685797
Poliomyelitis update (72): Afghanistan (OZ) Philippines (MM) VDPV environmental 20190903.6655037
Poliomyelitis update (71): Global (Pakistan, DR Congo) 20190901.6651501
Poliomyelitis update (70): Pakistan (KP, SD) 20190826.6641139
Poliomyelitis update (60): global WPV1, cVDPV2, cVDPV1 20190719.6577836
Poliomyelitis update (50): Afghanistan (OZ) 20190619.6528976
Poliomyelitis update (40): Central African Republic (MP,UK) cVDPV, WHO, RFI 20190529.6493464
Poliomyelitis update (30): (Afghanistan, Pakistan) social media 20190503.6454173
Poliomyelitis update (20): (Pakistan, Nigeria) isolates, real-time surveill. 20190315.6367838
Poliomyelitis update (10): (Afghanistan, Pakistan, Nigeria) positive environ. 20190131.6288339
Poliomyelitis update (01): global 20190104.6241814
2018
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Poliomyelitis update (62): (Nigeria, Niger) cVDPV2 20181228.6226490
Poliomyelitis update (01): global (Afghanistan) 20180105.5539242
2017
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Poliomyelitis update (47): Pakistan, global (Congo DR) 20171229.5526565
Poliomyelitis (01): Pakistan (GB), global, RFI 20170314.4898724
.................................................mpp/msp/mpp

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