Study of polio in Pakistan shows insecurity a barrier to eradication

January 30, 2018 by Bob Yirka, Medical Xpress report
Credit: CC0 Public Domain

A team of researchers from Canada, the U.S. and the U.K. has found that insecurity in a country or region can be a barrier to eradication of a disease such as polio. In their paper published in Proceedings of the National Academy of Sciences, the team describes their study and what they found about the relationship between social insecurity and polio incidence in northwest Pakistan.

Polio is a crippling viral disease transmitted through feces, generally under unsanitary conditions. It has been nearly eradicated due to an effective vaccine developed in the 1950s. Today, the disease exists in just three countries, Pakistan, Afghanistan and Nigeria—all of which have populations living with due to violence from militants. Despite health worker efforts, the disease has persisted. In this new effort, the researchers sought to find if it truly was insecurity preventing the eradication of in Pakistan by comparing eradication campaigns with military casualty records and polio infections rates in northwest Pakistan—militants there have been waging a war against government soldiers since 2004.

The team compiled polio infection rates on a district-by-district basis for the years 2007 to 2014, and eradication campaign data for the years 2007 to 2009. They compared what they found against reports of armed violence in the for roughly the same time periods. They found that when eradication campaigns were carried out during times of higher insecurity (due to military conflict), vaccination rates declined by 5.3 percent on average, which resulted in an increase in polio rates of 73 percent. The team noted that in many cases, eradication teams continued with their efforts in spite of the danger, though there were times when the danger was too great, resulting in cancellation of efforts. The team estimates that up to 250,000 children in the region have missed out on being vaccinated due to insecurity. They note also that there is room for error in their statistics due to the tendency of some eradication officials to falsify records to improve their apparent results.

The researchers conclude that insecurity does, indeed, appear to be a factor in preventing the eradication of polio in Pakistan, which suggests the will not be eradicated until armed conflict in the region ends.

Explore further: Polio incidence hits 15-year high in Pakistan

More information: Amol A. Verma et al. Insecurity, polio vaccination rates, and polio incidence in northwest Pakistan, Proceedings of the National Academy of Sciences (2018). DOI: 10.1073/pnas.1711923115

Pakistan is one of three countries in which endemic transmission of poliovirus has never been stopped. Insecurity is often cited but poorly studied as a barrier to eradicating polio. We analyzed routinely collected health data from 32 districts of northwest Pakistan and constructed an index of insecurity based on journalistic reports of the monthly number of deaths and injuries resulting from conflict-related security incidents. The primary outcomes were the monthly incidence of paralytic polio cases within each district between 2007 and 2014 and the polio vaccination percentage from 666 district-level vaccination campaigns between 2007 and 2009, targeting ∼5.7 million children. Multilevel Poisson regression controlling for time and district fixed effects was used to model the association between insecurity, vaccinator access, vaccination rates, and polio incidence. The number of children inaccessible to vaccinators was 19.7% greater (95% CI: 19.2–20.2%), and vaccination rates were 5.3% lower (95% CI: 5.2–5.3%) in "high-insecurity" campaigns compared with "secure" campaigns. The unadjusted mean vaccination rate was 96.3% (SD = 8.6) in secure campaigns and 88.3% (SD = 19.2) in high-insecurity campaigns. Polio incidence was 73.0% greater (95% CI: 30–131%) during high-insecurity months (unadjusted mean = 0.13 cases per million people, SD = 0.71) compared with secure months (unadjusted mean = 1.23 cases per million people, SD = 4.28). Thus, insecurity was associated with reduced vaccinator access, reduced polio vaccination, and increased polio incidence in northwest Pakistan. These findings demonstrate that insecurity is an important obstacle to global polio eradication.

Related Stories

Polio incidence hits 15-year high in Pakistan

November 5, 2014
The incidence of polio in Pakistan hit a 15-year high on Wednesday, as the prime minister vowed to rid the country of the crippling disease in the next six months despite a Taliban campaign to kill workers distributing vaccines ...

Pakistan records 72 polio cases in 2013: WHO

December 4, 2013
Pakistan recorded 72 cases of polio this year compared to 58 for all of 2012, a World Health Organisation (WHO)official said on Wednesday.

Polio nearly vanquished: CDC

October 24, 2016
(HealthDay)—Polio is almost a thing of the past, but it still exists in small pockets on the planet, U.S. health officials reported Monday.

Second child contracts polio in Pakistan's Waziristan

May 23, 2013
A second child has contracted polio in a restive Pakistani tribal region near the Afghan border after the Taliban banned vaccinations there nearly a year ago, a UN official said Thursday.

Polio vaccination: Paper highlights final steps to polio eradication

April 2, 2015
April 12th 2015 marks the 60th anniversary of the publication of Jonas Salk's landmark polio vaccine trial results, which confirmed that the first vaccine against polio was safe and effective. A new review, which was published ...

Recommended for you

Lung-on-a-chip simulates pulmonary fibrosis

May 25, 2018
Developing new medicines to treat pulmonary fibrosis, one of the most common and serious forms of lung disease, is not easy.

Reconstructing Zika's spread

May 24, 2018
The urgent threat from Zika virus, which dominated news headlines in the spring and summer of 2016, has passed for now. But research into how Zika and other mosquito-borne infections spread and cause epidemics is still very ...

Tick bite protection: New CDC study adds to the promise of permethrin-treated clothing

May 24, 2018
The case for permethrin-treated clothing to prevent tick bites keeps getting stronger.

Molecular network boosts drug resistance and virulence in hospital-acquired bacterium

May 24, 2018
In response to antibiotics, a gene regulation network found in the bacterium Acinetobacter baumannii acts to boost both virulence and antibiotic resistance. Edward Geisinger of Tufts University School of Medicine and colleagues ...

Past use of disinfectants and PPE for Ebola could inform future outbreaks

May 24, 2018
Data from the 2014 Ebola virus outbreak at two Sierra Leone facilities reveal daily usage rates for disinfectant and personal protective equipment, informing future outbreaks, according to a study published May 24, 2018 in ...

Early lactate measurements appear to improve results for septic patients

May 24, 2018
On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a bundle of recommendations defining optimal treatment of patients suffering from sepsis, a life-threatening response to infection ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.