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KARACHI, May 5: The health authorities have warned that a particular strain of poliovirus specific to Pakistan has travelled to other countries and caused outbreaks, which can become a major global issue with diplomatic and financial repercussions for Pakistan, it emerged on Friday.

“The spread can become a major global issue with diplomatic and financial repercussions for Pakistan. In part, because of this, Pakistanis going to Haj and Umrah are now required to have oral polio vaccination,” stated an official document, a copy of which is obtained by Dawn.

It cited that India also made polio vaccination compulsory for Pakistani children travelling to India and for Indian children travelling to Pakistan.

“If the situation does not improve, other nations may endorse travel restrictions upon citizens of Pakistan,” it warned.

Official reports stated that the poliovirus strain that was detected in Sukkur was also detected in Cairo in January and made Sukkur a dangerous destination.

Two sewage samples collected from Al Salam and Al Haggana areas of Cairo, when examined in a laboratory, had resemblance to the strain discovered in the sewage tested in Sukkur district.

This prompted the prime minister’s polio monitoring and coordination cell to order the establishment of polio vaccination counters inside international departure lounges at all airports across the country.

Although the virus did not infect any child in Egypt and the country has remained polio-free since 2004, the Egyptian ministry of health ordered immediate vaccination of all children less than five years old in the localities where the Pakistani-origin virus was discovered.

The Pakistani virus also caused outbreaks in China in 2011. The World Health Organisation then said that a genetic link had been confirmed between wild poliovirus type-1 (WPV1) detected in China and a strain circulating in Pakistan.

It said there had been seven confirmed cases involving the WPV1 strain detected in China’s Xinjiang province, which borders Pakistan.

The type-1 is more dangerous than type-3 because it is more likely to cause paralysis and spreads more easily. The type-2 poliovirus has been eradicated.

The global health body had then warned that countries should strengthen their disease surveillance systems and travellers to Pakistan should be vaccinated against polio.

The Pakistani virus travelled to Afghanistan as well, which is still ongoing.

High-risk sanctuaries in country

The official document highlights key challenges to polio eradication in the country, which includes: limited supervision and accountability of the lower government and administrative levels, access problems due to insecurity particularly in Karachi and Fata, failure to identify and focus on underserved population and mobile groups, operational and planning challenges to deliver vaccination door-to-door to more than 38 million children several times a year and achieving high coverage at union council level; and overall campaign fatigue in public, rumours and negative perception of oral polio vaccine in some communities.

It said that the polio vaccination coverage had remained low over the years in some parts of the country, especially in Gadap, Gulshan-i-Iqbal and Baldia Towns of Karachi, Balochistan’s Quetta, Pishin and Killah Abdullah districts, Khyber Pakhtunkhwa and Fata because of “highly mobile populations”.“These areas have been consistently infected with poliovirus, which has turned them into reservoirs where the virus breeds freely and spreads all over the country,” said the document.

“Such areas are high-risk and 80 per cent of all polio cases in Pakistan are attributed to them. Defeating polio there means ending polio almost all over the country.”

10 high-risk districts in Sindh

There are 10 ‘high-risk’ districts in Sindh, including Karachi, vis-à-vis the consistent presence of wild poliovirus, official reports show.

Most of the districts termed high-risk areas by the provincial health department authorities belong to northern Sindh. They are Khairpur, Sukkur, Ghotki, Kashmore, Shikarpur, Jacobabad, Kambar and Larkana.

The other two districts are Hyderabad and Karachi.

In Karachi, Baldia, Gadap and Gulshan-i-Iqbal towns have been stated to be high-risk zones.

Gadap Town’s volatile UC-4, where anti-polio campaign has been frequently interrupted because of several attacks on officials and vaccinators, has been dubbed a poliovirus sanctuary — a site of consistent presence of wild poliovirus.

The environmental samples taken during the last seven months show the presence of virus and are in the “Priority 1” areas.

In the “Priority 2” areas, which have reported at least one case in the past three years, are: Ghotki, Jacobabad, Kambar, Kashmore, Khairpur, Larkana, Mirpurkhas, Naushahro Feroze, Shikarpur, Sukkur and Gulberg, Liaquatabad and SITE areas of Karachi.

Official figures show that at least 314 polio cases have been reported in Sindh since 2000, including the two cases this year.