Outbreak Investigation of Two Human Wild Polio Cases: District Dera Ghazi Khan, Punjab, Pakistan, January-2020

Since the inception of environmental site in DG Khan, intermittently Wild Polio Virus (WPV) was isolated but since 2018 it is observed that though still intermittent, but the frequency of positive isolates has been raised as compared with past. Now 02 Human Wild Polio Virus type-1 (WPV1) cases are confirmed by Regional Reference Laboratory. Sample collected on 12 Sept, 2018 was positive for WPV1. Objectives of the study were to find out that whether the recently emerged situation is due to the WPV circulation in various regions of Pakistan especially against backdrop that some areas among them are now heavily flooded with virus or there are some programmatic and/or performance gaps responsible for it. The assessment was conducted from 10-13 January 2020. Activities conducted were EPI desk review supplemented with quick 30 HH cluster surveys in selected UCs of Tehsil DG Khan, verification of HR&MP registration, Zero Reporting and AFP case validation, retrospective active case search in selected health to detect and timely report AFP cases using traditional RRU assessment Tools. It was found that WPV1 introduction to DG Khan might have been through high presence of semi to permanently settled HR&MP (High Risk Migrant& Mobile Population) but traveling and returning originally from Districts with ongoing/intermittent WPV1 circulation. Vanished herd immunity due to long time with no Campaign and worsened by deteriorating of RI service delivery and specially missed opportunities to provide high number of due OPV doses in 2019 played incremental role to widen the gap. It was concluded that Emergency Immunization activities should be carried out in terms of quality Crash Programs with regular frequencies of 1 every 2.5 months from January 2020 onward till minimum of 1-year period in all priority UCs. All NEAP (National Emergency Action Plan) areas of work (Surveillance, SIAs and EI) as related to HR&MP to be strengthened in HR&MP priority UC.