1. Polio Eradication Afghanistan Poliovirus Epidemiology and Interventions Afghanistan Meeting Technical Advisory Group March 24-25, 2011 Islamabad

3. Map of Afghanistan by province and population density Dot = 20,000 Pop Northeast Northern Western Southern Southeast Central Eastern Regions - 7 Province - 34 Districts – 329 Target <5 years-7.8 mil Pakistan Uzbakistan Turkmanistan Iran Tajikistan China

4. Comparison of AFP Cases by Classification 2009-2011 Afghanistan Compared to 2009, there is reduction in number of confirmed cases by 34% Data up to 16 Mar 2011 Classification 2009 2010 2011 Reported AFP cases 1477 1572 278 Confirmed 38 25 1 Compatible 11 5 0 cVDPV2 1 5 1 Discarded 1427 1537 203 Pending - - 73

5. Distribution of polio cases 2009-2011 Afghanistan 2009 2010 2011 Data up to 16 Mar 2011 Polio virus Circulation is localized, mainly in high districts of Kandahar and Helmand Province Although sporadic cases detected from East and N.East but no evidence of established circulation Region Confirmed cases 2009 2010 2011 Central 1 0 0 East 2 3 0 South east 0 0 0 South 34 19 01 North 0 0 0 Northeast 0 1 0 West 1 2 0 Country 38 25 01 P1 P3

6. Distribution of confirmed cases in Afghanistan 2008-11 and Area of 13 High Risk Districts Despite number of rounds poliovirus is isolated at regular intervals indicating continued circulation with a shift from P3 to P1 type in 2010 -11 Almost 80-90% of the confirmed cases reported from the 13 High Priority Districts. Target Population of these districts is 54% of the region and 9% of the Country .

7. AFP Cases with isolation of cVDPV2 reported during 2010-11 Southern Region Afghanistan Data up to 16 Mar 2011 Five cVDPV2 cases reported during Jun-Dec 2010 and one in 2011 Nad Ali Dist Helmand Almost 30-50 % of the target remain inaccessible in most of the rounds. SIAs coverage also ranged between 18-60% Routine vaccination coverage among AFP cases <24 months is 9% tOPV used in July SNIDs only in NadAli. An additional round with tOPV in 4 districts followed by tOPV in November NIDs. 3 rounds of accelerated routine EPI are planned in 2011. First round completed and 7700 children below 1 year vaccinated with tOPV. Guidance from TAG is requested Nimroz 2010 cVDPV2 2011 cVDPV2 Hilmand Kandahar Urozgan Zabul

11. Out of the house (FM) Surveys ( Transmission , Non Transmission &High risk Zones ) Feb 2010 to Jan 2011

12. PCA- Proportion of clusters by Transmission, High risk and non-transmission zone by FM, Afghanistan 2010-2011 Data up to 16 Mar 2011 Transmission Zone High Risk Zone Non-Transmission Zone

13. Routine Vaccination of AFP cases 6-23 Months by Region, 2007-Mar 2011 Afghanistan Data up to 16 Mar 2011 South+Farah Southeast East Central West North Northeast Badakhshan

17. Overall trend of inaccessible children in number and %age Southern region 2009 & 2011 2009 2010-2011 Month Target # inaccessible % Month Target # inaccessible % Jan 1249321 235794 19 Feb 1298495 126748 10 March 1249321 182786 15 March 1298495 90233 7 April 1249321 187442 15 May 1298495 82782 6 May 1249321 212784 17 June 1298495 80510 6 June 1249321 95078 8 July 1298495 82500 6 Jul 1249321 62912 5 Oct 1298495 109563 8 sep 663290 30788 5 Nov 1298495 92763 7 Oct 1249321 147325 12 Dec 1298495 96986 7 Nov 1249321 105449 8 Jan ,2011 1330742 72423 5.4 Dec 1249321 153220 12

19. Trend of Vaccination from May -2010 to Jan-2011 SIAs in 13 high risk districts of Southern Region, 2010, Afghanistan (Coverage Adjusted for Inaccessible children)

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