Pakistan and Afghanistan must intensify efforts to halt spread of the crippling poliovirus, including better screening of travellers heading abroad, the World Health Organisation said on Monday.
Pakistan and Afghanistan – the only two countries where the poliovirus remains endemic – have reported 29 and seven cases, respectively, so far this year, against 108 and eight at this time in 2014, WHO spokesperson Sona Bari said.
The WHO emergency committee of experts in a statement, while recognising progress in Pakistan, said that its residents lacking documentation of recent polio vaccination should be restricted “at the point of departure”, whether travelling by road, air or sea.
The committee had convened a meeting on August 4, 2015, to review international spread of wild poliovirus during which the IHR States Parties submitted an update on the implementation of the temporary recommendations since the committee last met on 24 April 2015: Afghanistan and Pakistan.
While appreciating the strong progress made by Pakistan towards interruption of wild poliovirus transmission, implementation of temporary recommendations issued by the director-general, and overall decline in occurrence of international spread of wild poliovirus, it said that the virus was still prevalent in the country, accounting for 85% of all polio cases recorded worldwide.
However, while no export of the virus from Pakistan had been detected since October 21, 2014, several countries still require proof of polio vaccination from travellers out of Pakistan and Afghanistan at points of entry.
“The risk of new exportations from Pakistan remains, with ongoing transmission in the country during the low transmission season, and the commencement of the high transmission season in May.”
Two cases of poliovirus exported to Pakistan
The committee noted that the international spread of wild poliovirus has continued, with two new documented exportations from Afghanistan into Pakistan in 2015.
The poliovirus found in Pakistan were closely related to strains recently circulating in Afghanistan than to those currently found in Pakistan.
One of these cases occurred in Quetta, near the Afghanistan-Pakistan border. But worryingly the second case was found in a district of Sindh, an area that is quite far from the Afghan border.
This case, the committee said, underlines the risk of distant international spread from zones of poliovirus transmission.
The committee was concerned that the temporary recommendations for international travellers of all ages were not being implemented fully in Afghanistan – particularly at airports.
“The recent spread between the two countries is occurring from discrete zones of persistent transmission in each country. Strong programmatic action in such zones should interrupt such cross-border transmission,” it recommended.
Under the IHR, spread of poliovirus between two member states, i.e. Pakistan and Afghanistan, constitutes international spread.
The committee further recommended that coordination and quality of cross-border vaccination and surveillance activities should be further strengthened to reduce the risk of this international spread.