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Polio Circumstance in Afghanistan

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  1. Polio Situation in Afghanistan MoPH, WHO, UNICEF

  2. Presentation Outline • Polio virus epidemiology • SIAs quality • Measures taken to address the situation • Challenges and the way forward

  3. Polio Virus Epidemiology

  4. Tajikistan Uzbekistan China Turkmenistan Iran Pakistan Dot=10 Persons/Sq Km Population Density Map Afghanistan 2007

  5. 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

  6. 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

  7. Social Characteristics of Confirmed Polio Cases 2006, Afghanistan Average Distance from nearest Health Facility 16Km (Range 1-50) Average Duration of Nomadic Stay in the Areas 4.7 Months

  8. 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)

  9. 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

  10. 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

  11. 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

  12. mOPV1 Area mOPV3 Area Proposed districts for the Mop Up Operation in Eastern, Southern and Western regions, Afghanistan September 2007

  13. Supplemental Immunization Quality

  14. Post NID Independent Coverage Assessment by District AFG 2007 Age group 0-59 months

  15. 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

  16. 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

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

  18. 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

  19. 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

  20. Vaccination Status: Infected & Non Infected Districts

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

  27. 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.

  28. 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

  29. 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

  30. Until Every Child is Protected...Every Child is at Risk Thank you