Polio Surveillance in Pakistan

• How the Programme Tracks the Virus
• To stop polio, Pakistan doesn't just wait for children to get sick. They use a smart, modern system called **Environmental Surveillance** to find and track the poliovirus even when no one has symptoms.

1. The Main Tool: Sewage Testing The programme collects sewage (wastewater) samples from major cities across the country. These samples are sent to special polio laboratories.

If the polio virus is found in the sewage, it means the virus is silently spreading in the community, even if no sick children have been reported.

2. Laboratory Analysis Pakistan has two top-level polio labs certified by the World Health Organization (WHO).

These labs can identify exactly which type of poliovirus is spreading (Wild Polio Type 1, orcVDPV1,cVDPV2, etc.).

3. Where Samples Are Collected Pakistan has established 115 sampling sites (collection points) in 53 cities across all four provinces, plus Gilgit-Baltistan, and Azad Jammu & Kashmir.

4. Key Cities Monitored Based on the surveillance data, the programme identified **18 high-risk cities** where the virus is most likely to spread. These "core reservoir" cities are the highest priority targets for vaccination campaigns:

Gilgit-Baltistan: Skardu

AJK: Muzaffarabad

Khyber Pakhtunkhwa (KP): Peshawar, Mardan, Bannu, D.I. Khan, Swabi, Kohat, Abbottabad

Punjab: Rawalpindi, Lahore

Balochistan: Quetta, Pishin, Killa Abdullah, Loralai, Sibi

Sindh: Karachi, Hyderabad

5. How This Helps Strategy By monitoring these 18 cities, the programme can see exactly where the virus is active.

This allows them to focus vaccination teams and resources ("laser focus") on those specific areas to stop the virus before it spreads to other parts of the country.

• Why This Matters:
• The surveillance system acts as an early warning system. It tells health officials which communities need immediate help, allowing them to launch targeted vaccination campaigns quickly and effectively.