​AKU helps Pakistan become first country to integrate polio tracking system

  • ​Targets immuno-deficient children excreting polio into environment

  • ​Hands over system and network for inclusion in national polio program

​​Pakistan is extremely close to eradiating polio, but even if it does, there is one way the virus could return: through children with weak immunity who will keep excreting the virus into their neighbourhoods.

Pakistan and Afghanistan are the two countries left in the world with active cases of poliovirus. According to Federal Polio Surveillance coordinator Dr Abdul Aziz Awan, in 2022 Pakistan had 20 new cases all reported from Khyber Pakhtunkhwa (17 from North Waziristan, one from South Waziristan and two from Lakki Marwat).

In 2023, six cases were reported (3 Bannu, 1 Orakzai and 2 from Karachi East).

The good news is that people such as Ahmed Soghaier of the National Poliovirus Eradication Program believe it could be completely eradicated from Pakistan by mid-2024. This is a possibility because it has been reduced to specific geographical areas and is thus easy to get rid of.

There is, however, one last crucial weak link that will need closing: the surveillance of immunodeficient children who excrete poliovirus in the environment. On Tuesday, the WHO Pakistan and National Emergency Operation Center met in Islamabad to announce that this final component was being added to the national poliovirus eradication program.

This is considered an important step because as poliovirus is eradicated from Pakistan there are two ways it could return. It could be leaked from a laboratory but Pakistan has a containment plan run by the National Institute of Health (NIH) and there is a low chance of this option.

The second way polio could return to Pakistan is from what scientists call chronic excretors. These are children who have weak immune systems, which is why the virus stays alive in their gut, mutates and, when they go to the toilet, it gets flushed into their neighbourhood.

Chronic excretion happens in primary immunodeficient (PID) bodies because they do not have the immunity to fight poliovirus or support antibodies. So, when a PID takes the poliovirus vaccine, the antibodies do not help them. Instead it multiplies in the gut and turns into the wild poliovirus. The wild poliovirus can cause acute flaccid paralysis.

The WHO's Federal Surveillance Officer Dr Aasiya Bano said excretion can run up to six months normally in such children, which is much longer than a healthy excretor.

In 2018 AKU's Vice Chair of Clinical Services at the Department of Paediatrics and Child Health, Dr Ali Faisal Saleem, created a network of doctors working across hospitals and clinics in Pakistan. Through them the AKU team tracked over 650 primary immune-deficient children in four years. They built a network and system of informing each other and keeping details on the patients.

Now the government is ready to take this network and system and make it a part of the national surveillance network that keeps an eye on polio in Pakistan.

The National Emergency Operation Center and WHO Pakistan have built a phone app where the doctors can add information on any suspected PID child. They will assess this by using the 10 Jeffery Modell signs. Some of these signs are two or more bouts of Pneumonia, two or more sinus infections in one year, a failure to gain weight or grow normally.

The app is called NEOC. It has multiple forms for screening, blood tests and stool samples which are updated at each step.

The WHO Pakistan will lead this program, the NIH will help it with the blood tests and the Armed Forces Institute of Pathology will help with stool sampling and testing.

The event was attended by WHO representative OIC in Pakistan Ellen Thom, Brigadier (r) Kamal Soomro, Dr Rana Muhammad Safdar, Brig (r) Abdul Hasan and NEOC coordinator Dr Shehzad Baig​. 

Text and reporting by Rahim Sajwani, December 6, 2023.