20 September 2011The risk of polio spreading from Pakistan is high, particularly given the expected mass travel for the upcoming Muslim pilgrimage to Mecca, the United Nations warned today, calling for full vigilance abroad and a scaling up of “inadequate” counter-efforts within the country. “It is important that countries across Asia and the Eastern Mediterranean strengthen disease surveillance for acute flaccid paralysis (AFP), in order to rapidly detect any poliovirus importations and facilitate a rapid response should importation occur,” the UN World Health Organization (WHO) said of the potentially fatal and paralyzing disease.The Hajj pilgrimage for Muslims is slated to take place in early November.In a global alert and response update, the agency reported that a wild poliovirus type 1 (WPV1) isolated in China was genetically linked to that currently circulating in Pakistan, where nationwide transmission has so far infected 84 people this year, compared to 48 for the same period of 2010.Pakistan, one of only four countries where polio remains endemic – the others are Afghanistan, India and Nigeria – has also seen the only wild poliovirus type 3 (WPV3) case in 2011, a strain that is on the verge of elimination in Asia, and WHO urged countries to continue to boost routine immunization coverage against all strains to minimize the impact of any introduction.“In 2011, supplementary immunization activities (SIAs) in Pakistan have been inadequate in quality in key high-risk areas,” it said, noting that more than 200,000 children have been regularly missed during SIAs conducted over the last two years in security-compromised parts of the Federally Administered Tribal Areas (FATA), in particular in Khyber agency.“In addition to challenges relating to reaching children in insecure areas of Khyber Pakhtunkhwa and FATA, significant operational challenges continue to mar the quality of SIAs in accessible areas of Khyber and in other key transmission areas of the country, notably in the provinces of Balochistan and Sindh,” it added, warning that undetected circulation also cannot be ruled out due to persistent sub-national surveillance gaps.WHO said the impact of a Pakistani Government emergency plan launched this year is not yet being seen at the critical programme implementation level, although further immunization days are planned.“However, key to success will be to overcome remaining operational challenges in fully-accessible areas and implemented special outreach strategies with full community participation to increase access to populations in security-compromised areas,” it added. “To achieve this, full and consistent engagement and accountability at provincial, district and union-council level is urgently needed.”Travellers to and from Pakistan should be fully protected by vaccination, with those who have in the past received three or more doses of oral vaccine offered another dose before departure, WHO reported.Unimmunized individuals should complete a full course while travellers from Pakistan should have a full course of vaccinations before leaving, with a minimum one dose of before departure. Some polio-free countries may also require travellers from Pakistan to be immunized against polio to obtain an entry visa, it added.Since the launch in 1988 of the Global Polio Eradication Initiative, spearheaded by WHO, the UN Children’s Fund (UNICEF), Rotary International and the United States Centers for Disease Control and Prevention, the incidence of polio has been reduced by more than 99 per cent. At the time, more than 350,000 children were paralyzed every year in more than 125 endemic countries. So far in 2011, some 325 cases have been reported worldwide.