Polio Situation in Afghanistan
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Polio Situation in Afghanistan MoPH, WHO, UNICEF Presentation Outline Polio virus epidemiology SIAs quality Measures taken to address the situation Challenges and the way forward Polio Virus Epidemiology Tajikistan Uzbekistan China Turkmenistan Iran Pakistan Dot=10 Persons/Sq Km

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Polio Situation in Afghanistan

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Polio Situation in Afghanistan

MoPH, WHO, UNICEF


Presentation Outline

  • Polio virus epidemiology

  • SIAs quality

  • Measures taken to address the situation

  • Challenges and the way forward


Polio Virus Epidemiology


Tajikistan

Uzbekistan

China

Turkmenistan

Iran

Pakistan

Dot=10 Persons/Sq Km

Population Density Map Afghanistan 2007


NSL1 isolate from 02

Healthy Children

September 13, 05

P1 & P3 Poliovirus Isolates Afghanistan 1999, 04-05

2004

1999

NSL1=02

NSL3=02

NSL1= 45

NSL3= 18

Widespread circulation in 1999

was localized to the Southern Region

Persistence of polio virus circulation threatens

to reverse past gains

2005

NSL1= 05

NSL3= 04

* Data up to 19 May, 2007


Last NSL1, Pulikhomri District of Baghlan Province, onset is 28 Nov, 06, Age 18 m, OPV doses 10

2006

NSL1=29

NSL3=02

Last NSL3, Kandahar city, Onset 17 Oct 06, OPV Doses 30, confirmed by contacts

Polio Virus Isolates Afghanistan 06-07

2007

NSL1=4

NSL3=5

Recent NSL1, Jalalabad District, in Nangarhar Province, Onset is 16 Jun, age 24m, OPV doses 10

NSL1

NSL3

Compatible

Recent NSL3, Kandahar District of Kandahar Province, Onset is 1 Aug, age 5m, 4 OPV doses

Date up to 15 Sep 2007


Social Characteristics of Confirmed Polio Cases 2006, Afghanistan

Average Distance from nearest Health Facility16Km (Range 1-50)

Average Duration of Nomadic Stay in the Areas 4.7 Months


Very High Risk Areas

High Risk Areas

Medium Risk Areas

Low Risk Area

NSL3=5

NSL1=4

Security Situation & Polio Cases in 2007 (Up to Sep, 13)


10 Jan Jacobabad

18 Jan Nowshera

24 Feb Nasirabad

27 Mar Nasirabad

13 May Jacobabad

30 Jun Nadali

10 Jul Panjwai

21 Jul Sangin

28 Jul Garmser

01 Aug Kandahar

Cluster B-1C

Afghanistan & Pakistan P3 isolatesby genetic cluster Jan-Aug 2007


12 Jan Karatchi B

10 Apr Kajaki

Cluster A-3C

16 Apr Maywand

05 Aug Karatchi B

30 Jan Khyber

14 May Nowshera

07 Aug Thatta

26 May Mihtrlam Laghman

Cluster B-4A

Cluster A-3D

18 Jun Jalalabad

24 Jun SWAT

27 Jun Peshawar

Afghanistan & Pakistan P1 isolatesby genetic cluster Jan-Aug 2007


NSL1

NSL3

Polio Virus Isolates By Type & Month, Afghanistan 05-07

2005

2007

2006

mOPV1+mOPV3

No P1 isolates since June

tOPV tOPV+mOPV1

tOPV tOPV+mOPV1 mOPV1

Data up to 15 Sep2007

NID

SNID or Mop Up


mOPV1 Area

mOPV3 Area

Proposed districts for the Mop Up Operation in Eastern, Southern and Western regions, Afghanistan September 2007


Supplemental Immunization Quality


Post NID Independent Coverage Assessment by District AFG 2007

Age group 0-59 months


NID Apr 22-24, 2007, Reported OPV coverage by district, AFG 2007

Overall 8% of the districts are having <85% coverage

Coverage range:

>95 %

86-95 %

76-85 %

51-75 %

25-50 %

Area Not covered


Districts >95%

District <95%

Areas not included

Post SIAs Independent Coverage Assessment by District , Southern Region. AFG 2007

Age group 0-59 months

Apr

Feb

Mar

May

Jun

Aug

Age group 0-11 months


Percentage of districts <95% coverage by month Southern Region-AFG 2006-2007


1-24%

25-49%

50-74%

75-100%

Comparison of Children not accessed by vaccination teams Analysis by District, Southern Region FR106 and FR107

August 2006

August 2007

Estimated number of children not accessed =75,000

Estimated number of children not accessed =110,000

% of missed children in the district


2007

NSL1=4

NSL3=5

Recent NSL1, Jalalabad District, in Nangarhar Province, Onset is 16 Jun, age 24m, OPV doses 10

Recent NSL3, Kandaahar District of Kandahar Province, Onset is 1 Aug, age 5m, 4 OPV doses

EPI routine- OPV 3 coverage status Jan-Jun, 07 & Polio Cases, 2007

?

78% of Polio confirmed cases are reported from the districts which have <50% OPV3 coverage in Routine vaccination


Vaccination Status: Infected & Non Infected Districts


Situation of the same Groups in 2007

Situation of all Southern region districts & Afghanistan in 2006

Vaccination status of NP AFP cases aged 6-35 month, Southern Region & Afghanistan year 06 & 07


Situation of the same Groups in 2007

Situation of Baghlan & Nangarhar & rest of AFG in 2006

Vaccination status of NP AFP cases aged 6-35 month, Nangarhar & Baghlan provinces & rest of Afghanistan year 06 & 07


Vaccination status of NP AFP cases aged 6-35 month, Nangarhar & Baghlan provinces and rest of Afghanistan excluding Southern Region year 06 & 07

Situation of the same districts in 2007

Situation of all Baghlan & Nangarhar & rest of AFG excluding South 2006


Intercountry movement

Intra-region movement

Cross border population movement

Nomads & other Cross Border Population Movement

  • Cross Border Pop Movement

  • Daily pop. Movement 8000, for business, treatment , skilled labor

  • Daily returnes/8-10 family

  • Bagriwal/100 families

Confirmed Nomad


Political Support

  • Personal involvement of his Excellency President Karzai in launching of SIAs

  • Constitution of Polio Action Groups (Health, Education, Information, Religious Affairs, Defense, ISAF/NATO/CF) at the national and provincial level.

  • Involving the Governor of Kandahar Province

    • Governor participation in the Geneva Consultation

    • Appointment of ‘Polio Officer’ in the office of governor – who is charged with authority to coordinate SIAs between health & other departments, and with district governors


Innovative Measures Taken

  • Use of mOPV1& mOPV3 in South, SE & Eastern regions as appropriate

  • Focused District Strategy (FDS)

    • One day operation, using village based vaccination teams leading to better Community involvement

  • Phased Approach in Hilmand & Kandahar

  • In conflict areas, using windows of opportunity to vaccinate children even after the regular campaign days

  • Using UN Peace Day as “Window of opportunity” to increase access in security compromised area

  • Vaccination of border population on both sides at the same time.

  • Conducted special social mobilization activities in the infected districts

  • Special focus during the trainings on how to reach young children

  • Combining the OPV with the Measles & MNT vaccination campaigns


Summary

  • Most of Afghanistan is polio free but large immunity gaps in young children allow continued polio virus transmission in the southern region.

  • Main cause of the problem is the conflict situation which impedes the access to children.

  • Immunity among the children in other regions looks satisfactory, not allowing the establishment of transmission.

  • Quality of campaign has deteriorated in the South mainly due to security reason and is not good enough to stop circulation.

  • Immunity gaps still persists & recent type 3 circulation poses risk of spread to adjacent areas

  • Interrupting virus transmission requires reaching all children through high quality vaccination rounds and to focus special attention on children in border areas and mobile populations.


Key Challenges

  • Deteriorating Security & Access Issue:

    • Active conflict / on going operations during the campaign days leading to an environment of fear for vaccination staff

    • Although reported coverage is 100% in most of districts, the coverage is less than 50-60% in the southern region ( >95% coverage required to interrupt polio virus transmission)

    • Difficult to supervise & monitor the campaign in security compromised areas

    • Weak management, misappropriation of funds and improper staff selection issues, sometime using security as smoke screen

  • Vaccinating moving populations (Seasonal, Nomads and Cross border )

  • More involvement & participation of community elders needed, particularly in unsecured area

  • Role & responsibility BPHS NGOs in NIDs need more clarity

  • Program Funding Gap of 30 million USD for 07-08


The Way Forward

Days of Tranquility (DOT)

No military operations during campaign days – so vaccinators can access all children and vaccinate safely. All parties in conflict need to agree on DOT

Commitment at higher level need to be transmitted at the provincial and district levels

Maintaining high population immunity in other parts of the country

Sustaining communications activities & its expansion to cross border activities

Improving routine immunization and optimizing experience of PEI

Fund raising to bridge the funding gap


Until Every Child is Protected...Every Child is at Risk

Thank you


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