ISLAMABAD: A debate has broken out in Pakistan’s health circles over whether Pakistan can ever be declared ‘polio-free’ because of the high number of environmental sample collection sites in the country.

Although the number of polio cases has fallen in Pakistan, the presence of the poliovirus increased in environmental samples by 16pc during the last year.

Experts believe that even India would never have been declared polio free, had it had such a high number of environmental samples collection sites.

Health teams collect sewage samples from 53 sites every 15 days

Because of the security situation, it also seems impossible that the virus will be eradicated in Afghanistan, which would be another challenge for polio eradication in Pakistan, where the virus is transported from the neighbouring country.

Health teams collect sewage samples from 53 sites across the country every 15 days, which are then tested to see if they carry the poliovirus. The sample is called an environmental sample.

A health expert who asked not to be named told Dawn that this number of environmental sample collection sites was the largest in history.

“Although India has been declared a polio-free country, it would never have been declared polio free if it had such a huge sample size. The sample size was less than 10, despite the fact that India is five times bigger than Pakistan,” he said.

India is the latest country to have officially stopped the endemic transmission of polio, with its last reported case in 2011. The poliovirus is currently reported from just three countries: Pakistan, Afghanistan and Nigeria.

“Although polio cases have stopped in countries, it is very difficult to completely eradicate the virus and get 100pc clear environmental samples. Since international stakeholders have been focusing on environmental samples in Pakistan, it will be very difficult to completely eradicate polio from environmental samples,” he said.

During the last year, the detection of the virus has increased by up to 16pc in environmental samples because the poliovirus is being continuously transported from Afghanistan to Pakistan, he said. Meanwhile, because of the security situation in Afghanistan, it is impossible that the poliovirus will be eradicated there in the near future.

“In parts of Afghanistan adjacent to Pakistan, no polio vaccination campaign is being held because of security issues. So we should not be hopeful that the virus will ever be eradicated in Pakistan,” he added.

The head of the National Emergency Operation Centre on Polio, Dr Rana Safdar, said he looks at it differently.

“In 2016 Nigeria was performing positively and international stakeholders were very happy that it would be soon declared a polio-free country, as no case was detected for almost one and half years, but suddenly four cases were reported there. During investigations it was revealed that the virus was present in the environment and it paralysed children as soon as their immunity levels decreased,” he said.

“It is correct that there were only eight environmental sites in India while it was at the verge of eradicating the polio virus. We do not want to take any chances, so we are collecting environmental samples from 53 sites, across the country, and we have also introduced the Bag Mediated Filtration System (BMFS) with the collaboration of the University of Washington, due to which it has become possible to catch the virus even in a minute quantity.”

He added that because of detections of the poliovirus, it becomes possible to boost the immunity level of children in that area.

The detection of the virus is followed by genetic sequencing carried out at the National Institute of Health, to determine where the virus originated.

“In Pakistan there is very mobile population, because people frequently visit their native areas and their relatives. Moreover, people move from one area to another when crops are harvested. A large number of people move in the winter from the northern areas to other areas, which are called seasonal migrations, due to which the virus can be transported from one area to another,” Dr Safdar said.

“So we deliberately want to have more environmental sites and we are performing five times more [than] international standards require. Last year, only eight polio cases were reported in Pakistan. In India, as many as 43 cases were reported just a year before the year in which India totally eradicated the poliovirus,” he said.

In response to a question, he said there have not been any accessibility problems in Pakistan for two and a half years, but there was a significant problem in Afghanistan and the virus continues to be transported from Afghanistan to Pakistan.

“In fact, in four environmental samples from Rawalpindi, Lahore, Peshawar and Zhob, the virus originated from Nangarhar, a province of Afghanistan. But we have still been trying to eradicate the virus. Currently we have 24 sensitive union councils in Karachi and one tehsil – Gulistan in Killa Abdualla – which are being given special focus,” he said.

He said they would also hold three national polio vaccination campaigns in January, February and April, and two sub-national campaigns in March and May. “We have achieved over 95pc immunity levels in most parts of the country, and we have been expecting that we will completely eradicate the poliovirus this year,” he said.

Published in Dawn, January 22nd, 2018

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