MMWR Morb Mortal Wkly Rep. 2010 Mar 12;59(9):268-72.
Afghanistan, Pakistan, India, and Nigeria are the four remaining countries where indigenous wild poliovirus (WPV) transmission has never been interrupted. This report updates previous reports and describes polio eradication activities in Afghanistan and Pakistan during January-December 2009 and proposed activities in 2010 to address challenges. During 2009, both countries continued to conduct coordinated supplemental immunization activities (SIAs) and used multiple strategies to reach previously unreached children. These strategies included 1) use of short interval additional dose (SIAD) SIAs to administer a dose of oral poliovirus vaccine (OPV) within 1-2 weeks after a prior dose during negotiated periods of security; 2) systematic engagement of local leaders; 3) negotiations with conflict parties; and 4) increased engagement of nongovernmental organizations delivering basic health services. However, security problems continued to limit access by vaccination teams to large numbers of children. In Afghanistan, poliovirus transmission during 2009 predominantly occurred in 12 high-risk districts in the conflict-affected South Region; 38 WPV cases were confirmed in 2009, compared with 31 in 2008. In Pakistan, 89 WPV cases were confirmed in 2009, compared with 118 in 2008, but transmission persisted both in security-compromised areas and in accessible areas, where managerial and operational problems continued to affect immunization coverage. Continued efforts to enhance safe access of vaccination teams in insecure areas will be required for further progress toward interruption of WPV transmission in Afghanistan and Pakistan. In addition, substantial improvements in subnational accountability and oversight are needed to improve immunization activities in Pakistan.
阿富汗、巴基斯坦、印度和尼日利亚是四个仍存在本土野生脊灰病毒（WPV）传播未被中断的国家。本报告更新了以往的报告，描述了 2009 年 1 月至 12 月期间在阿富汗和巴基斯坦的脊灰消除活动以及 2010 年应对挑战的拟议活动。2009 年，两国继续开展协调补充免疫活动（SIAs），并采用多种策略来覆盖以往未覆盖的儿童。这些策略包括：1）利用短间隔补充剂量（SIAD）SIA，在经过协商的安全期间内，在上次剂量后 1-2 周内为儿童接种一剂口服脊髓灰质炎疫苗（OPV）；2）系统地争取当地领导人的支持；3）与冲突各方进行谈判；4）增加提供基本卫生服务的非政府组织的参与。然而，安全问题持续限制了接种小组为大量儿童提供服务的机会。2009 年，阿富汗脊灰病毒传播主要发生在受冲突影响的南部地区的 12 个高风险地区；2009 年确认了 38 例 WPV 病例，而 2008 年为 31 例。2009 年，巴基斯坦确认了 89 例 WPV 病例，而 2008 年为 118 例，但在安全受到影响的地区和可及地区仍持续存在传播，管理和运营问题继续影响免疫覆盖率。为了在阿富汗和巴基斯坦进一步中断 WPV 传播，需要继续努力加强接种小组在不安全地区的安全通行。此外，需要在国家以下各级大幅度加强问责制和监督，以改善巴基斯坦的免疫接种活动。
