Seven wild poliovirus (WPV1) cases have been reported by the Regional Reference Laboratory (RRL) between 1 January and 31 March 2018. This brings the total number of WPV1 cases in Afghanistan to 7 in 2018.

12 positive environmental samples were reported

in the first quarter of 2018: seven from Nangarhar,

three from Kandahar and one each from

Helmand and Kabul.

POLIO TRANSMISSION:

January–March 2018

Afghanistan Polio Update

AT A GLANCE: Seven new wild

poliovirus (WPV1) cases

were reported by the

Regional Reference

Laboratory

in 2018. There were

14 cases in 2017.

84 environmental

samples from 20 sites

have been collected this

quarter.

12 environmental sam-

ples have been reported

positive for WPV in 2018.

Two Sub National Im-

munization Days (SNIDs)

targeting over 5.9 million

children under the age of

5 and one National Im-

munization Days (NIDs)

targeting over 9.9 million

children under the age of

5 have been organized

in the first quarter

of 2018.

41 cross-border teams at

15 cross-border vaccina-

tion points and 456

permanent transit teams

(PTTs) were operational

during this quarter.

Permanent transit teams

vaccinated 3,453,207

children under the age of

5 against polio during the

quarter while cross-

border teams vaccinated

200,668 children under

the age of 10.

Ph

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Data as of 31 March 2018

Polio Cases in 2018

Reducing Geographic Spread of Wild Poliovirus:

2015

Provinces: 8

WPV: 20

2016

Provinces: 4

WPV: 13

2017

Provinces: 5

WPV: 14

2018

Provinces: 3

WPV: 7

IMMUNIZATION ACTIVITIES

Afghanistan Polio Update

Two Sub National Immunization Days (SNIDs) targeted over 5.9 million children under the age of 5 and one National Immunization Days (NIDs) targeted over 9.9 million children under the age of 5 in the first quarter of the year 2018.

IPV-OPV Campaigns

Complementary Vaccination Activities

62,723 children were vaccinated with IPV in Loya Wala and Manzalbagh in Kandahar city of Kandahar Province in South 14-19th January.

A total of 41 cross-border teams at 15 cross-border vaccination points and 456 permanent transit teams (PTTs) were operational across Afghanistan during this quarter. There were no permanent polio teams (PPTs).

Permanent transit teams vaccinated 3,453,207 children under the age of 5 against polio during the quarter while cross-border teams vaccinated 200,668 children under the age of 10.

During the reporting period, over 3,511 children were vaccinated with OPV by teams at UNHCR and IOM sites receiving returnees from Pakistan and Iran. In 2018, a total of 3,511 returnee children have been vaccinated with OPV and 2,555 with IPV at these sites.

In compliance with International Health Regulations (IHR), 114,836 international travelers were vaccinated against polio between January-March 2018.

Supplementary Immunization Activities (SIAs)

Data as of 31 March 2018

These

children

were

vaccinated in

the

Iran-

Afghanistan

border in

March.

Photos: Tuuli

Hongisto

Supplementary Immunization Activities (SIAs)

Campaign Children

Targeted

% Failed Lots

in LQAS PCA Coverage

Jan SNID 2018 5.9 Million 94.7% 6.3%

Feb SNID 2018 5.9 Million 95.0% 1.1%

Mar NID 2018 9.9 Million 95.9% 7.1%

Case Response

Province District Transmission Response SIAs

22 provinces in 7 regions 181 districts

Confirmed polio case in Kama

(date of onset: 1/1/ 2018)

1-(29 Jan-2 Feb SNID)

22 provinces in 7 regions 182 districts 2-(12 -16 Feb SNID)

32 provinces 352 districts 3-(12 -16 Mar NID)

22 provinces in 7 regions 181 districts

Confirmed polio case in Shahwal-ikot (date of onset: 5/1/ 2018)

1-(29 Jan-2 Feb SNID)

22 provinces in 7 regions 182 districts 2-(12 -16 Feb SNID)

32 provinces 352 districts 3-(12 -16 Mar NID)

22 provinces in 7 regions 181 districts

Confirmed polio case in Spin-boldak (date of onset: 6/1/ 2018)

1-(29 Jan-2 Feb SNID)

22 provinces in 7 regions 182 districts 2-(12 -16 Feb SNID)

32 provinces 352 districts 3-(12 -16 Mar NID)

22 provinces in 7 regions 182 districts Confirmed polio case in Gha-ziabad (date of onset: 14/2/

2018)

1-(12 -16 Feb SNID)

32 provinces 352 districts 2-(12 -16 Mar NID)

22 provinces in 7 regions 188 districts 3-(9 -13 Apr SNID)

32 provinces 352 districts Confirmed polio case in Shahwal-ikot (date of onset: 19/2/ 2018)

1-(12 -16 Mar NID)

22 provinces in 7 regions 188 districts 2-(9 -13 Apr SNID)

32 provinces 352 districts Confirmed polio case in Khakrez

(date of onset: 25/2/2018)

1-(12 -16 Mar NID)

22 provinces in 7 regions 188 districts 2-(9 -13 Apr SNID)

32 provinces 352 districts Confirmed polio case in Gha-ziabad (date of onset: 3/3/ 2018)

1-(12 -16 Mar NID)

22 provinces in 7 regions 188 districts 2-(9 -13 Apr SNID)

ACCESS FOR SUPPLEMENTARY IMMUNIZATION ACTIVITIES

Afghanistan Polio Update

QUALITY OF SUPPLEMENTARY IMMUNIZATION ACTIVITIES

LQAS Results in 2016-18—National Level Lot Quality Assessment Sampling (LQAS) data shows

improvement in the quality of supplementary

immunization activities over the past quarter. The

proportion of failed lots decreased from 12% in March

2016 to 7% in March 2018.

Inaccessible Children: March 2017 - March 2018

Data as of 31 March 2018

Accepted at 90% Accepted at 80% Rejected at 80%

Region Mar NID

Apr SNID

May NID November SNID

December SNID

Jan SNID Feb SNID Mar NID

East 21,002 34,528 26,734 31,470 20,463 23,084 21,504 45,879

North 23,458

North-eastern 4,350 300 87,367 300 300 576

South 40,989 42,793 35,705 13,249 17,641 16,288 26,934 22,358

South-Eastern 24,051 23,075 14,040 2,229 9,734

3,195 10,872 9,609

West 12,970 70 70 695 195 10,655 476 8,711

Central

Total 99,012 100,466 80,899 47,943 135,400 53,522 60,086 110,591

Local

kindergarden

children in Herat

were among the

first to be

vaccinated in

the March NID.

Photo: Tuuli

Hongisto

January SNID February SNID March NID

Afghanistan Polio Update

SURVEILLANCE

Environmental Surveillance:

84 environmental samples from 20 sites located in 9 provinces in the 07 regions have been collected and sent to the laboratory

in good condition during this quarter.

Of the total 84 samples collected, laboratory results have been received for 62 samples — 12 WPV1 positive environmental sam-

ple was reported in the 1st qyuarter of 2018.

AFP Surveillance:

In 1st quarter of 2018, non-polio AFP rate is 16, stool adequacy above 96 %, and non-polio enterovirus rate above 9 % at the na-

tional level. In all regions non-polio AFP rate is above 10, stool adequacy above 93%, and non-polio enterovirus rate is ranging

from 5-15%.

In 2018, 831 AFP cases have been reported (463 males/368 females), of which 632 have been discarded as “non-polio AFP” and

192 AFP cases are pending classification.

Extensive AFP reporting network in Afghanistan consists of 733 AFP focal points who are medical doctors in the district/s which

are closely linked with more than 28,000 reporting volunteers.

The Ministry of Public Health, WHO and UNICEF continue to vaccinate children crossing the border to Afghanistan from Pakistan and Iran to ensure all children are immunized and protected from polio. There are currently 41 cross-border teams vaccinating children at 16 vaccination points. Between January and March 2018, 200,668 children were given the oral polio vaccine (OPV) by cross border teams. In 2017, a total of 48 teams vaccinated 834,997 children in 17 sites. In addition, returnee children are vaccinated by special returnee teams which are supported by IOM and UNHCR. Between January and March 2018, over 3,500 returnee refugee children were vaccinated with OPV and over 2,550 with inactivated polio vaccine (IPV) at the IOM/UNHCR sites. In 2017 in total, over 50,000 children were given OPV and over 25,600 at the IOM/UNHCR sites.

AFP Surveillance: Quality Key Indicators

Vaccination of returnees and refugees continues

at border areas

Abdul Sahat’s daughter was

vaccinated at Islam Qala

border crossing in March.

Photo Tuuli Hongisto

Data as of 31 March 2018

OPV Coverage of UNHCR Repatriation Centres

and IOM Zero Point 2016-18

Afghanistan Polio Update

Community Engagement

Data as of 31 March 2018

Campaign awareness:

In ICN districts awareness of campaigns has remained at

around 72-78% in the last three campaigns, while in the

non-ICN districts the awareness level is lower. (Table 1)

Reducing missed children after campaign:

The efforts of social mobilizers through catch-up of missed

children after campaigns resulted in the vaccination of

118,230 missed children in between the last three

campaigns—about 60% of children missed due to being

absent were recovered. (Table 2)

Convincing and vaccinating children missed due to

refusals after campaigns:

During catch-up activities after SIAs, social mobilizers were

successful in convincing refusal families and vaccinating

7857, 7723, and 6,956 children missed due to refusals

respectively in January, February and March. (Table 3)

Monitoring of ICN:

For accountability, two tiers for monitoring of frontline

workers continued to be utilized in the quarter through

internal ICN monitoring and third party Monitoring.

The monitoring results are regularly shared using smart

phones via Open Data Kit (ODK) by both tiers of monitoring.

(Graph: Number of social mobilizers monitored in the field)

Keeping track of HRMPs:

ICN plays a key role in keeping track of high-risk mobile

populations (HRMPs) that include returnees and refugees

from Pakistan, internally displaced persons and visitors in

very high-risk areas of the country. In the last quarter,

ICN conducted survey in ICN districts to track HRMPs.

Data will feed into microplan review in second quarter.

Immunization Communication Network (ICN)

Campaign

Total regis-tered

missed

Total vaccinated

by ICN

% Vaccinat-ed

by ICN

Total remain-

ing

Jan NID

81,195 40,753 50% 40,442

Feb SNID

80770 37,524 46% 43,246

March NID 83,621 39,953 48% 43,668

Table 3: Vaccinated children missed due to refusal (Source: ICN Catch-Up)

(Source: UNICEF ODK data)

1157

10031063

1314 1343

1035

0

200

400

600

800

1000

1200

1400

1600

January February March

Social mobilisers monitoredSource: UNICEF ODK data

Monitored by TPM Monitored by ICN

Campaign Vaccinated refusals Remaining refusals

Jan SNID 7,857 17,581

Feb SNID 7,723 19,762

March NID 6,956 19,250

Table 2: Missed children vaccinated by ICN

between campaigns (Source: ICN Catch-Up)

Table 1: Campaign awareness (Source: PCM)

Campaign ICN districts Non-ICN districts

Jan'18 SNID 78.4% 41.5%

Feb'18 SNID 72.8% 40.2%

Mar'18 NID 77.3% 51.1%

Alternative Approaches:

Engaging Influencers in refusal resolution:

In January and February 2018, almost 50% (about 1500

children) of chronic refusals that could not be resolved after

campaigns by ICN were resolved and vaccinated by mobile

mullahs and cluster level resolution committees comprising

of local influencers in the focus districts of Spinboldak,

Panjwai, and Zhari. Only 20% (about 4o0) of such ”hard’

refusals visited were resolved through the same approaches

in Kandahar city.

Mobile religious scholars and community elders known as ‘Mobile Mullahs’ visit religious scholars, community elders, Madrasas, schools and families that refuse the polio vaccine. The team has been very successful and effective in addressing refusals throughout Kandahar province. In February, the team conducted 15 meetings with elders, teachers and students in five districts of Kandahar. They addressed 32 refusal families, two refusing Madrasas and, as a result, vaccinated 99 refusal children.

Page 6

January–March 2018

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Asadullah was three years old when he was told he would never walk again. He was born during intense fighting, and polio workers were unable to deliver the polio vaccine. Now an #endpolio advocate, Asadullah vaccinates other children. He supports vaccination teams by focusing on families that refuse the vaccine. “When you are paralysed, you don’t exist. I am half a man; half a person. I can’t even do simple things, and I must be carried by my friends, it is humiliating. Imagine how it feels to be someone’s luggage,” he said. Asadullah is now 19 years old, and represents the po-lio programme on Afghan TV and radio, encouraging parents to “give their child the life he wished he had.”

Asadullah supports the polio programme

A Family Affair

Malik Mohammad Nazir, his daughter Spogmai, and his son Mashal all work to-gether. But they are not working for themselves, they are working to eradicate polio. Zangoee is an indigent village with a diverse community in the eastern Af-ghan province of Nangarhar, close to the border with Pakistan. In Zangoee, the Nazir family are well-known. Each month, they knock on doors giving free polio vaccines and educating their community about the virus. Read the full story here: https://www.unicef.org/afghanistan/stories/family-affair

Contact:

WHO: Dr Hemant Shukla - shuklah@who.int

UNICEF: Melissa Corkum - mcorkum@unicef.org

Find us on Facebook: World Health Organization Afghanistan | UNICEF Afghanistan

Twitter: @UNICEFAfg @WHOAfghanistan Web: www.unicef.org/afghanistan | www.emro.who.int/afg

Special thanks to: Bill & Melinda Gates Foundation, The Department of Foreign Affairs, Trade and Development (DFATD) of Canada, USAID, UK Department for Interna-

tional Development (DfID), Rotary International, KfW Development Bank, the Government of Japan and US Centres for Disease Control and Prevention

Mobile Mullahs

UNICEF Afghanistan/Jim Huylebroek

Thus, no one in his community has rejected the vaccine. It frustrates him that he has lost his legs because of a virus that could have been prevented, “I wasn’t part of the war, I didn’t fight. My friends lost their legs due to the war, but I wasn’t involved, so why did I deserve this?” Despite Asadullah’s hardship, giving other children a life he never had brings him comfort.

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