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Pakistan: Karachi: Year’s first polio drive to start on Monday | The News International.

[February 8, 2020]

M. Waqar Bhatti writes:

As many as 2.3 million children would be vaccinated against the crippling disease of polio in Karachi during the upcoming National Immunisation Days (NIDs) or the countrywide polio eradication campaign starting on February 10, officials said on Friday.

“The Emergency Operation Centre for polio will be conducting a polio eradication campaign across Karachi from 10th to 17th February 2020, which will target approximately 2.3 million children under five years of age in all six districts of the city,” an official of the EOC Sindh said, adding that more than 13,000 workers and supervisors would take part in the campaign.

Officials said that over 5,000 police personnel would be providing security cover to teams, which would go door to door as well as to schools to provide children this vital vaccine.

After a difficult year for polio in 2019, the government aims to turn the tide with successive campaigns till June 2020, and the EOC had appealed to all parents to come forward and vaccinate their children to save them from this vaccine-preventable disease.

Apart from schools and door-to-door visits, more than 30 hospitals, 60 pediatric clinics and EPI centres across the city will also be administering the polio vaccine, and in order to reach the maximum number of children, evening vaccinations will also be offered at such premises.

In the lead up to the campaign, the EOC Sindh led meetings with all district staff of Karachi to identify the gaps and help fill them and motivate the staff to do their jobs in the best manner possible. In addition, special motivation workers were held in the super high-risk UCs of Karachi where high-performing workers and supervisors were appreciated and given certificates by EOC Coordinator Sindh Rehan Baloch and the EOC Core Team.

On the occasion, Rehan Iqbal Baloch told workers: “The time is from now till June. All of you must perform and leave no stone unturned so that we can save the future of our children. It is all of you that turned the situation around from when we had 306 polio cases in the country in 2014 to just 12 in 2018. I am counting on you to do your best to turn this around again.”

In addition to this, on the directives of the Sindh chief minister, the EOC Sindh had earlier held a grand session with all UC chairmen in Karachi, who pledged their support for polio eradication above any political allegiance. In the week leading up to the campaign, the UC chairmen came good on their promise and held sessions with district polio staff to identify areas where their support was needed, and they will now join teams on the ground to cover missed children and to further sensitise those that are resistant.

In 2019, the April incident and a subsequent long gap in the polio campaign led to an increase in cases. However, a successful December campaign and a case response in January forms a good foundation to turn to the tide and get back on track and the EOC is fully committed to conducting the upcoming campaigns with the same energy and commitment.

In addition to this, steps are also being taken to increase routine immunisation coverage across Sindh. Meanwhile, in the lead up to the campaign, free medical health camps are being provided by the district health officers in collaboration with the EOC Sindh in high-risk UCs of Karachi.

Polio Round NIDs will start on 10th February and runt till 16th February in Karachi Division and from 17th February to 23rd February in other divisions of Sindh. The total target (under five children) of Sindh is 9071978. The target for Karachi is 2,336,797.

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Pakistan: PMA report paints bleak picture of country’s healthcare system | DAWN.

[February 08, 2020] Faiza Ilyas writes:

KARACHI: Chronic neglect by successive governments towards fundamental human needs, primary healthcare and preventive healthcare strategies including infection control practices explains why Pakistan has failed miserably to show improvement in the health sector. In fact, matters have gone from bad to worse in areas lacking proper sanitation and refuse disposal mechanisms.

These points were raised at a press conference held at the PMA House on Friday for the launch of a report titled Health of the Nation.

The report highlights the country’s poor health indicators including its high maternal and infant mortality rates, slow progress on stunting and wasting, neglect towards mental health, weak healthcare system and a growing rise in the burden of diseases mainly due to lack of basic facilities, such as supply of clean drinking water, sanitation, primary healthcare services and environmental degradation.

Potable water not available to 90pc people.

The Health of the Nation report has suggested govt focus on preventive, primary healthcare.

“Clean drinking water is not available to 90 per cent of the population. This is the cause of many gastrointestinal infections, hepatitis A and hepatitis E, typhoid, polio (it can spread through drinking water if it’s contaminated with the stool of an infected person) and other diseases.

“Typhoid is now a big problem in Pakistan particularly in Sindh due to antibiotic resistance. This phenomenon is a looming disaster not just for developing countries but also for developed nations,” the report said.

The report looks into the factors contributing to antibiotic resistance in local settings and said that there were so many elements instrumental to this menace including quackery, irrational use of antibiotics, spurious drugs, availability of drugs over the counter without prescription, self-medication and the role of pharmaceutical industry offering lucrative deals to doctors against (specific) prescription.

The polio infection, according to the report, remains endemic despite over 100 rounds of vaccination being carried out in the past decade. Pakistan is one of the two remaining countries in the world where polio still exists, the other is Afghanistan.

“Our polio programme has deteriorated badly; during the year 2019 as many as 144 cases of polio have been reported as compared to 12 cases in 2018. Till now, seven cases have been reported in 2020,” the report said.

It also speaks about the “alarming increase” in the cases of dog bite and snake bite in the second half of 2019 in Sindh, causing loss of many lives because of non-availability of vaccines or inappropriate medical care.

Over 50,000 dengue cases reported in 2019.

The report also focused on dengue and said that more than 50,000 cases of this viral infection had been reported by the end of 2019 with death toll crossing 100.

“And these are only reported cases. We believe that an equal or more number of these cases had remained unreported. Such outbreaks have had been reported from other countries but they managed to overcome the challenge with the help of scientific guidelines. But, we persistently refuse to learn.”

Suggesting solutions, the report points to the fact that developed countries as well as many low-income countries had been able to eradicate many diseases by just putting in place effective vaccination and immunisation programmes.

“But, in Pakistan, our polio programme faces hardships mainly due to lack of political will, misconceptions and lack of awareness. To address this, it is important that (the government involve) each political and religious party along with civil society and the media in campaigns on vaccination and immunisation programme.”

The report recommends that the government invest more in disease prevention. “By just providing clean drinking water, we can prevent 60 per cent of diseases and if we could eliminate breeding grounds of mosquitoes, we can prevent all mosquito-borne diseases that currently constitute 40 per cent of our total disease burden.”

‘Restore PMDC’.

Speaking at the presser, PMA representatives including Dr Ikram Ahmed Tunio, Dr Qaiser Sajjad, Dr Qazi Mohammad Wasiq and Dr Abdul Ghafoor Shoro demanded that the government restore Pakistan Medical & Dental Council as an autonomous, democratic, transparent and vibrant body comprising elected and nominated members as per the 1962 ordinance.

“We also demand inclusion of stakeholders like PMA and Pakistan Dental Association and complete overhauling of medical education and training of doctors according to recent trends in the world. We need adequate health budgets with assurance that allocated amount will be spent with honesty,” they said.

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CIDRAP News Scan for Feb 07, 2020 | The Center for Infectious Disease Research and Policy at the University of Minnesota.

Measles outbreak in LA; Polio in five countries; Sewage-based AMR surveillance.

Measles outbreak reported in Los Angeles.

The Los Angeles County Department of Public Health this week confirmed a local outbreak of measles among five people—four of them county residents who were exposed to an unimmunized international visitor who was infectious with measles.

In a press release, department officials listed public places in Los Angeles and Santa Monica visited by the confirmed case-patient from Jan 26 to Feb 1, and warned that unimmunized people, or those with unknown immunization status, who were at these sites at the same time could be at risk for developing measles. They're urging people who were in those locations during the time period to review their immunization records and monitor themselves for illness.

As of Jan 31, according to an update this week from the US Centers for Disease Control and Prevention (CDC), there have been 5 confirmed measles cases in 5 states in 2020. A total of 1,282 cases were confirmed in 31 states in 2019—the greatest number of measles cases reported in the United States since 1992. Most were among people who had not been vaccinated.
Feb 5 LA County Department of Public Health press release
Feb 3 CDC measles update


Five countries report more polio cases.

In its latest weekly update, the Global Polio Eradication Initiative (GPEI) said five countries have reported new cases: Pakistan, the Democratic Republic of Congo (DRC), Somalia, Angola, and Burkina Faso.

Pakistan reported 8 wild polio virus type 1 (WPV1) cases, including 2 from Punjab province, 4 from Sindh province, and 1 each from Khyber Pakhtunkhwa and Balochistan. Some patients had illness onset in 2019, bringing the annual total for 2019 to 144. The number of cases for 2020 rose to 7.

In the DRC, 5 cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported, 1 each from Kwilu, Kongo Central, and Kinshasa provinces and 2 from Sankuru. GPEI says none of the newly-confirmed cases are new emergencies, but the fact that the virus has been detected in the mega-city of Kinshasa is of major concern. The total number of cases for 2019 rose to 82.

Elsewhere in Africa, Angola reported 8 cases of cVDPV2, including 4 from Brie province, 2 from Luanda, and 1 each from Malanje and Cuanza Norte provinces, raising the total for 2019 to 111. Burkina Faso reported 1 case of cVDPV2 from Centre-Est, with illness onset beginning in 2019. Somalia reported 1 cVDPV2-positive environmental sample from Banadir.
Feb 5 GPEI report


Paper touts benefits of global sewage-based AMR surveillance.

Implementation of a global sewage-based antimicrobial resistance (AMR) surveillance system based on metagenomics sequencing could yield substantial and rapid benefits and be implemented quickly and at minimal expense, according to a paper today in Science.

The paper, written by AMR experts at the Technical University of Denmark and the University of Edinburgh, argues that because current international AMR surveillance systems such as GLASS (the Global Antimicrobial Surveillance System) focus on surveillance of clinical isolates from hospitalized patients and resistance to last-resort antibiotics, they capture only one slice of the global AMR picture. Furthermore, this type of surveillance is based on small samples and is hard to implement in resource-poor settings. 

"This emphasis on clinical settings makes it difficult to determine the global spread of resistance to first-line drugs in the wider community, a large part of the global AMR burden," the authors write.

But global sewage-based surveillance using metagenomics sequencing, which can detect all known resistance genes, could complement clinical surveillance by generating pooled data from a large, non-hospital population that is not routinely assessed by conventional surveillance, the authors suggest. In addition, sewage-based surveillance is easy to implement, can be conducted in low-income settings using inexpensive equipment, and is not restricted to a limited set of bug-drug combinations.

"We therefore consider sewage-based surveillance to be a potentially valuable addition to current options for global AMR surveillance and monitoring," they write. "Though not a substitute for other surveillance methods, it can provide data that is otherwise hard to obtain and may sometimes be the easiest route to providing any information at all, especially in resource-poor settings."

The authors suggest an immediate working model could involve annual collection of sewage samples from across the globe and shipment to a central facility responsible for sequencing, bioinformatics, and reporting.
Feb 7 Science abstract

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Pakistan: Security lapse blamed for polio workers’ killing in Swabi | DAWN.

[February 07, 2020] Ashfaq Yusufzai writes:

PESHAWAR: A three-member committee, formed on the directives of chief minister to hold a fact-finding probe into the killing of two lady health workers in Swabi district last week, has said in its report that security lapse made the slain vaccinators a soft target.

The report submitted to the chief minister says that there were 17 polio vaccinating teams in Parmoli union council of Swabi but security arrangements were not up to the mark despite devising a plan for polio vaccinators 10 days ago.

There was no security for the teams in the rural area, which allowed the suspected militants to fire at the LHWs. One of them was killed instantly while the other died at the hospital.

On Thursday last, the home and tribal affairs department formed the fact-finding committee, including the special secretary of home department, Islam Zeb, DIG Kashif Alam of police department and Sharif Hussain, the additional secretary of home department, to identify security lapse during the incident and propose suitable action to avoid such mishaps in future.

Panel suggests provision of foolproof security to health workers in future.

Officials said that the police deployed 29,000 teams in every polio campaign to provide protection to polio workers in door-to-door drive but in Parmoli, where the latest incidence occurred, the vaccinators lacked security. The committee has recommended foolproof security for vaccinators in future to avoid such mishaps.

Pakistan is struggling to eradicate poliomyelitis as it recorded 140 cases, highest by any country in the world in 2019. Khyber Pakhtunkhwa recorded 92 polio cases that set alarm bells ringing for the government and partner agencies to speed up efforts to eradicate the virus and safeguard the children. In 2010, eight polio cases, including three from the province, have been reported.

The frontline workers, who knock every door in the campaign to administer oral polio vaccine (OPV) to children, have suffered casualties in Khyber Pakhtunkhwa but in none of the incidents the perpetrators have been brought to justice.

Since 2012, when militants began targeting polio teams, a total of 47 people have been killed in incidents linked to polio vaccination in Pakistan.

The dead included 36 polio workers and 11 security men. In Khyber Pakhtunkhwa 25 persons have been killed including 18 polio workers and seven policemen.

The panel has also found that the security situation gets lose when no incident occurs for long. The last incident where two workers were murdered happened two years ago. There was a firing incident in Dir some two months ago when the policemen were proceeding to join the teams and were away from the spot.

Health workers say that they have been taking part in the polio drives for which they are paid Rs700 per day. It means that they get Rs28,000 for working four days from dawn to dusk.

On the other hand, the people sitting in offices and making plans get millions in salaries from donor agencies while the workers, who are the real force, lack transport and other facilities.

The government as well as the donor organisations, including WHO, Unicef and others admit the sacrifices of the polio workers, policemen and paid volunteers during the campaigns but don’t bother to scale up their wages.

Most of the LHWs and health workers are not willing to take part in the campaigns and put their lives at the razor’s edge but they are forced by the respective department to be part of the drive.

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Polio this week as of 05 February 2020 | Global Polio Eradication Initiative via ReliefWeb.

[07 Feb 2020]

Published on 05 Feb 2020 —View Original

  • The WHO Executive Board is currently holding its 146th session at the WHO headquarters in Geneva. Among many others, polio is one of the topics of discussion, take a look at the report by the Director-General on polio eradication.

  • cVDPV2 confirmed in Kinshasa: a number of new cVDPV2s cases have been confirmed in DR Congo which may have significant implications on the current outbreak response activities. While none of the newly-confirmed cases are new emergences, the virus has now been detected in the mega-city of Kinshasa which is the first case in the city. See ‘DR Congo’ section below for more.

  • Summary of new viruses this week (AFP cases and environmental samples):

    • Pakistan: eight WPV1 cases
    • Democratic Republic of the Congo (DR Congo): five cVDPV2 cases
    • Somalia: one cVDPV2 positive environmental samples
    • Angola: eight cVDPV2 cases
    • Burkina Faso: one cVDPV2 case

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