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Since its launch in 1988, the Global Polio Eradication Initiative (GPEI) has made substantial progress towards eradication of wild poliovirus (WPV), including eradicating 2 of the 3 serotypes and reducing the number of countries with ongoing endemic transmission of WPV type 1 (WPV1) to Afghanistan and Pakistan. The two countries are considered a single epidemiological block. Despite the occurrence of only a single confirmed WPV1 case during the first half of 2023, Pakistan experienced widespread circulation of WPV1 during the subsequent 12 months, specifically in the historical reservoirs of the cities of Quetta, Karachi and Peshawar. As of 30 June 2024, 8 WPV1 cases had been reported in Pakistan, as compared with 6 reported during all of 2023. These cases, and >300 WPV1-positive environmental surveillance (sewage) samples reported during 2023-2024, indicate that Pakistan is not on track to interrupt WPV1 transmission. The country's complex sociopolitical and security environment continues to pose formidable challenges to poliovirus elimination. To interrupt WPV1 transmission, sustained political commitment to polio eradication, including increased accountability at all levels is necessary. Systematic tracking and vaccination of children who are continually missed during polio vaccination activities should be enhanced by better addressing operational issues and the underlying reasons for community resistance to vaccination and vaccine hesitancy. Depuis le lancement de l'Initiative mondiale pour l'eradication de la poliomyelite (IMEP) en 1988, des progres substantiels ont ete accomplis vers l'eradication des poliovirus sauvage (PVS). Ainsi, 2 des 3 serotypes sont desormais eradiques et seuls l'Afghanistan et le Pakistan enregistrent encore une transmission endemique du PVS de type 1 (PVS1). Ces deux pays forment un bloc epidemiologique unique. Bien qu'ayant observe un seul cas confirme de poliomyelite due au PVS1 au premier semestre 2023, le Pakistan a connu une circulation a grande echelle du PVS1 au cours des 12 mois suivants, en particulier dans les villes de Quetta, Karachi et Peshawar, qui constituent des reservoirs traditionnels du virus. Au 30 juin 2024, 8 cas de PVS1 avaient ete signales au Pakistan depuis le debut de l'annee, contre 6 notifies sur l'ensemble de l'annee 2023. Ces cas, ainsi que les >300 echantillons de surveillance environnementale (eaux usees) positifs pour le PVS1 qui ont ete recenses en 20232024, indiquent que le Pakistan n'est pas en voie d'interrompre la transmission du PVS1. Le contexte sociopolitique et securitaire complexe du pays demeure un obstacle majeur a l'elimination des poliovirus. Pour interrompre la transmission du PVS1, un engagement politique durable en faveur de l'eradication de la poliomyelite, assorti d'une responsabilisation accrue a tous les niveaux, est indispensable. Des efforts plus soutenus doivent etre deployes pour suivre et vacciner de maniere systematique les enfants qui continuent d'echapper aux activites de vaccination antipoliomyelitique, ce qui implique d'apporter de meilleures solutions aux problemes operationnels existants, ainsi qu'aux facteurs qui sous-tendent la reticence a la vaccination et la resistance des communautes., Introduction Although the GPEI has achieved substantial progress since its establishment in 1988, the goal of polio eradication has remained elusive. Indigenous WPV1 circulation has never been interrupted in Pakistan, [...]

Pakistan reported a single case of polio associated with wild poliovirus type 1 (WPV1) in 2021 but reported 14 cases between 1 April and 31 July 2022. Afghanistan and Pakistan [...]

When the Global Polio Eradication Initiative (GPEI) began in 1988, wild poliovirus (WPV) was being transmitted in 125 countries; currently, transmission of WPV type 1 (WPV1) continues in only 2 [...]

Since October 2016, Afghanistan and Pakistan have been the only 2 countries to report cases of polio due to wild poliovirus type 1 (WPV1). (1) In Afghanistan, although the number [...]

Widespread use of live, attenuated (Sabin) oral poliovirus vaccine (OPV) has resulted in marked progress towards global poliomyelitis eradication. (1) In under-immunized populations, however, extensive person-to-person transmission of Sabin poliovirus [...]

After declaration of the eradication of wild poliovirus type 2 in 2015, all countries that were using oral poliovirus vaccine (OPV) switched from trivalent OPV (tOPV) (containing types 1, 2 [...]

Afghanistan, Nigeria and Pakistan remain the only countries in which transmission of endemic wild poliovirus type 1 (WPV1) continues. (1) This report describes polio eradication activities and progress in and [...]

In 1988, the World Health Assembly launched the Global Polio Eradication Initiative. Of the 3 wild poliovirus serotypes, only wild poliovirus type 1 (WPV1) has been detected since 2012. Since [...]

Afghanistan, Pakistan and Nigeria remain the only countries where the transmission of endemic wild poliovirus type 1 (WPV1) continues. (1) This report describes the activities, challenges, and progress towards polio [...]

Only 74 cases of wild poliovirus type 1 (WPV1) were reported globally in 2015, a number lower than at any time previously. (1) WPV1 detection in Afghanistan also declined in [...]

Despite recent progress towards global polio eradication, endemic transmission of wild poliovirus type 1 (WPV1) continues in Afghanistan and Pakistan. (1,2) The Afghanistan programme will need to overcome many challenges [...]

Streptococcus pneumoniae, or pneumococcus, causes an estimated 4 million illnesses in the United States annually (1). Pneumococcal disease outbreaks often occur in closed settings such as childcare facilities and hospitals. [...]

Background Despite insecurity challenges in Somalia, key indicators for acute flaccid paralysis (AFP) surveillance have met recommended targets. However, recent outbreaks of vaccine-derived polioviruses have raised concerns about possible gaps. We analyzed nonpolio enterovirus (NPEV) and Sabin poliovirus isolation rates to investigate whether comparing these rates can inform about the integrity of stool specimens from inaccessible areas and the likelihood of detecting circulating polioviruses. Methods Using logistic regression, we analyzed case-based AFP surveillance data for 1348 cases with onset during 2014−2017. We assessed the adjusted impacts of variables including age, accessibility, and Sabin-like virus isolation on NPEV detection. Results NPEVs were more likely to be isolated from AFP case patients reported from inaccessible areas than accessible areas (23% vs 15%; P =.01). In a multivariable model, inaccessibility and detection of Sabin-like virus were positively associated with NPEV detection (adjusted odds ratio [AOR], 1.75; 95% confidence interval [CI], 1.14–2.65; and AOR, 1.79; 95% CI, 1.07–2.90; respectively), while being aged ≥5 years was negatively associated (AOR, 0.42; 95% CI, 0.20–0.85). Conclusions Rates of NPEV and Sabin poliovirus detection in inaccessible areas suggest that the integrity of fecal specimens tested for AFP surveillance in Somalia can generate useful AFP data, but uncertainties remain about surveillance system quality. [ABSTRACT FROM AUTHOR]

Background. During 2009 and 2010, 2 clusters of organ transplant-transmitted Balamuthia mandrillaris, a free-living ameba, were detected by recognition of severe unexpected illness in multiple recipients from the same donor. Methods. We investigated all recipients and the 2 donors through interview, medical record review, and testing of available specimens retrospectively. Surviving recipients were tested and treated prospectively. Results. In the 2009 cluster of illness, 2 kidney recipients were infected and 1 died. The donor had Balamuthia encephalitis confirmed on autopsy. In the 2010 cluster, the liver and kidney-pancreas recipients developed Balamuthia encephalitis and died. The donor had a clinical syndrome consistent with Balamuthia infection and serologic evidence of infection. In both clusters, the 2 asymptomatic recipients were treated expectantly and survived; 1 asymptomatic recipient in each cluster had serologic evidence of exposure that decreased over time. Both donors had been presumptively diagnosed with other neurologic diseases prior to organ procurement. Conclusions. Balamuthia can be transmitted through organ transplantation with an observed incubation time of 17-24 days. Clinicians should be aware of Balamuthia as a cause of encephalitis with high rate of fatality, and should notify public health departments and evaluate transplant recipients from donors with signs of possible encephalitis to facilitate early diagnosis and targeted treatment. Organ procurement organizations and transplant centers should be aware of the potential for Balamuthia infection in donors with possible encephalitis and also assess donors carefully for signs of neurologic infection that may have been misdiagnosed as stroke or as noninfectious forms of encephalitis. [ABSTRACT FROM AUTHOR]

Since its launch in 1988, the Global Polio Eradication Initiative has made substantial progress toward the eradication of wild poliovirus (WPV), including eradicating two of the three serotypes, and reducing the countries with ongoing endemic transmission of WPV type 1 (WPV1) to just Afghanistan and Pakistan. Both countries are considered a single epidemiologic block. Despite the occurrence of only a single confirmed WPV1 case during the first half of 2023, Pakistan experienced widespread circulation of WPV1 over the subsequent 12 months, specifically in the historical reservoirs of the cities of Karachi, Peshawar, and Quetta. As of June 30, 2024, eight WPV1 cases had been reported in Pakistan in 2024, compared with six reported during all of 2023. These cases, along with more than 300 WPV1-positive environmental surveillance (sewage) samples reported during 2023-2024, indicate that Pakistan is not on track to interrupt WPV1 transmission. The country's complex sociopolitical and security environment continues to pose formidable challenges to poliovirus elimination. To interrupt WPV1 transmission, sustained political commitment to polio eradication, including increased accountability at all levels, would be vital for the polio program. Efforts to systematically track and vaccinate children who are continually missed during polio vaccination activities should be enhanced by better addressing operational issues and the underlying reasons for community resistance to vaccination and vaccine hesitancy., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

After reporting a single wild poliovirus (WPV) type 1 (WPV1) case in 2021, Pakistan reported 14 cases during April 1-July 31, 2022. Pakistan and Afghanistan are the only countries where endemic WPV transmission has never been interrupted (1). In its current 5-year strategic plan, the Global Polio Eradication Initiative (GPEI) has set a goal of interrupting all WPV1 transmission by the end of 2023 (1-3). The reemergence of WPV cases in Pakistan after 14 months with no case detection has uncovered transmission in southern Khyber Pakhtunkhwa province, the most historically challenging area. This report describes Pakistan's progress toward polio eradication during January 2021-July 2022 and updates previous reports (4,5). As of August 20, 2022, all but one of the 14 WPV1 cases in Pakistan during 2022 have been reported from North Waziristan district in Khyber Pakhtunkhwa. In underimmunized populations, excretion of vaccine virus can, during a period of 12-18 months, lead to reversion to neurovirulence, resulting in circulating vaccine-derived polioviruses (cVDPVs), which can cause paralysis and outbreaks. An outbreak of cVDPV type 2 (cVDPV2), which began in Pakistan in 2019, has been successfully contained; the last case occurred in April 2021 (1,6). Despite program improvements, 400,000-500,000 children continue to be missed during nationwide polio supplementary immunization activities (SIAs),* and recent isolation of poliovirus from sewage samples collected in other provinces suggests wider WPV1 circulation during the ongoing high transmission season. Although vaccination efforts have been recently complicated by months of flooding during the summer of 2022, to successfully interrupt WPV1 transmission in the core reservoirs in southern Khyber Pakhtunkhwa and reach the GPEI goal, emphasis should be placed on further improving microplanning and supervision of SIAs and on systematic tracking and vaccination of persistently missed children in these reservoir areas of Pakistan., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.