PESHAWAR: Khyber Pakhtunkhwa continues to report circulating vaccine-derived poliovirus type 2 (cVDPV2) cases as it has recorded 42 of the total 50 cases registered countrywide this year so far.

The virus thought to have been eradicated few years ago but last year a total of 22 cVDPV2 cases were recorded countrywide that included 16 from Khyber Pakhtunbkhwa, four from Gilgit-Baltistan, one each from Islamabad and Punjab.

Khyber Pakhtunkhwa has nine infected districts in 2019 with cVDPV2, which is now prevalent in 11 districts with 42 cases this year so far.

Khyber Pakhtunkhwa, which is in limelight due to detection of wild poliovirus (WPV) type 3 cases, has been the worst-affected province for vaccine cVDPV2 that is likely to infect more children due to poor polio eradication programme.

Pakistan tested 146 children positive for WPV type 3 in 2019 which included 92 from Khyber Pakhtunkhwa while it accounted for 21 cases of the total 56 recorded in 2020 so far.

The province has registered 42 cases of cVDPV2 this year

Last year, Gilgit-Baltistan and Kohistan reported cVDPV2 cases which have now spread all over the country. Khyber Pakhtunkhwa is the major contributor to national tally of both types of cases as more districts are becoming infected with the virus.

Pakistan has recorded a total of 108 polio cases, including 58 cVDPV2 and 50 WPV in 2020 that included 63 from Khyber Pakhtunkhwa. It means that the province accounts for 58 per cent of the nationwide case count.

The World Health Organisation withdrew vaccination for cVDPV2 as it was thought to have been eradicated in 1999. The last vaccination was carried out against cVDPV2 in April 2016. Polio has 3 strains -- 1, 2 and 3.

After cVDPV2 eradication, vaccination was switched from OPV, for three virus, to OPV (P1 and 3) in 2016. It was believed that the routine immunisation through injectable polio vaccine (IPV) would sustain the required immunity. However, entire attention was focused on polio and routine immunisation remained extremely weak.

The cVDPV2 cases were reported last year in August but WHO, which is responsible for monitoring and surveillance, didn’t notify the cases in time due to which prompt response was delayed. Experts say that both the virus would continue to haunt children due to poor polio vaccination.

Former Fata remained polio-free from 2016 till 2018 due to which Dr Nadeem Jan, technical lead person, was awarded Tamgha-i-Imtiaz by President of Pakistan for his excellent work but he was removed from the programme a few months ago.

The community-based vaccination (CBV) programme started in September 2015 in erstwhile Fata was wrapped up last month and an international consultancy firm McKinsey was hired to run polio eradicate programme there.

South Waziristan reported two WPV cases in 2019 and as many cVDPV2 cases in 2020. Khyber recorded 15 cVDPV2 in 2020 and one case in 2019.

Dr Rana Mohammad Safdar, coordinator of National Emergency Centre for Polio Eradication told, Dawn that they had identified 40 super high-risk union councils where the package of integrated service delivery including basic health services, routine immunisation, wash and nutrition was being implemented.

“One dose of IPV is already being administered at 14 weeks age. We have successfully negotiated with global alliance for vaccine and immunisation (GAVI) to introduce second dose in routine immunisation scheduled from early 2021. The initiative will hugely benefit Pakistan against the dual battle of WPV1 and cVDPV2,” he said.

Published in Dawn, July 20th, 2020