This installment has some recent, encouraging information out of Afghanistan.  The first piece of good news is that, on January 17, 2022, UNICEF reported that the first national polio immunization campaign for 2022 began across Afghanistan.  The campaign aimed to immunize 9.9 million children under the age of five. The World Health Organization’s (WHO) representative in Afghanistan, Dr. Dapeng Luo, stated that WHO has an additional five national immunization campaigns planned for the country in 2022.1
In addition to the commencement of polio immunizations in Afghanistan for 2022, on January 21, 2022, the U.S. Centers for Disease Control and Prevention (CDC) published a report on the progress of polio eradication in Afghanistan from January 2020 to November 2021.2  The report summarized the significant strides toward eradicating polio that took place during that time frame and reflected cautious optimism of continued progress.
During the year 2020, there were 56 cases of wild poliovirus type 1 (WPV1) reported in Afghanistan but this number dropped to just four cases during 2021.  Cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) (Note: this is paralytic polio that arises from mutations of the live, weakened poliovirus in the oral polio vaccine.  This topic will be discussed in greater detail in the next installment of this blog) decreased from 308 in 2020 to 43 in 2021.
The numbers of reported polio cases are not the only indicators that health professionals use to monitor the extent of poliovirus transmission in a region.  Environmental surveillance, in the form of systematic testing for the virus in sewage is also used for tracking.  Sampling is regularly conducted at 25 sites in 13 provinces within Afghanistan.  In 2020, 17% of the environmental samples taken had detectable WPV1 but in 2021 this reduced to just 0.3% of all samples, indicating greatly reduced transmission of the virus.
These reductions in the numbers of people infected with polio and levels of virus within the environment took place despite the fact that fewer children were able to be contacted to be immunized during that time.  This was due to some combination of conflict and restricted access by the Taliban.  It was estimated that 28% of children under the age of 5 were inaccessible for vaccination during a January 2020 national immunization day (NID) but this percentage increased to 34% in October 2020 and 40% in June 2021.  While NIDs took place in November and December of 2021, estimates of the percentage of inaccessible children were not readily available.
Given all of this, it was very encouraging to see these multiple indicators of positive progress towards the eradication of polio being made in the Afghanistan/Pakistan region.  Hopefully these focused efforts will continue during this year and we look forward to more reports of sustained immunization campaigns leading ultimately to the elimination of this disease from our planet!
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Notable Person Stricken With Polio: Tenley Albright (b. 1935); Figure skater and surgeon.  Silver medalist in ladies singles figure skating at the 1952 Oslo Winter Olympics and gold medal winner at the 1956 Winter Olympics at Cortina d'Ampezzo, Italy.  Graduated from Harvard Medical School and practiced surgery for over 20 years.  Diagnosed with polio at age 10 and spent several months in the hospital, as the disease impacted her legs, neck, and back.3
 2Sadigh KS, Akbar IE, Wadood MZ, et al. Progress Toward Poliomyelitis Eradication ― Afghanistan, January 2020–November 2021. MMWR Morb Mortal Wkly Rep 2022;71:85–89. DOI: