Progress Toward Poliomyelitis Eradication — Afghanistan, January 2012–September 2013

Since 2012, transmission of indigenous wild poliovirus (WPV) has been limited to three countries: Afghanistan, Pakistan, and Nigeria. This report describes polio eradication activities and progress in Afghanistan during January 2012-September 2013 and updates previous reports. During 2012, 37 WPV type 1 (WPV1) cases were confirmed in Afghanistan, compared with 80 cases in 2011; nine WPV1 cases were confirmed during January-September, 2013, compared with 26 WPV1 cases during the same period in 2012. Since November 2012, no WPV1 cases have been reported from the Southern Region, previously the main WPV reservoir in Afghanistan; all nine polio cases in 2013 were in the Eastern Region and caused by WPV1 that originated in Pakistan. From October 2012 to March 2013, 14 polio cases caused by circulating vaccine-derived poliovirus type 2 (cVDPV2) were detected in the Southern Region. During 2012-2013, strategies to improve supplemental immunization activity (SIA)§ effectiveness in 11 low-performing districts (LPDs) in the Southern Region included increasing staff and supervisory training, implementing short-interval-additional-dose (SIAD) campaigns, placing transit vaccination teams at the borders of districts inaccessible because of insecurity, and establishing permanent polio vaccination teams to vaccinate children quarterly. From March 2012 to August 2013, the percentage of children unreached during SIAs declined by 43% in the Southern Region but increased by 122% in the Eastern Region. Despite ongoing challenges, the government of Afghanistan continues to expand the application of innovative solutions to reach unvaccinated children in accessible and inaccessible districts.