The leadership of EOC Sindh has failed to curb the spread of the virus, with Karachi now emerging as a global epicenter, raising alarms on international health concerns
By Aziz Khatri
KARACHI: The district Larkana has reported its first polio case in nearly five years, signaling a worrying setback in the fight against debilitating disease. A 54-month-old girl from the UC Bhamas area in Tehsil Ratodero, Larkana, developed symptoms of acute flaccid paralysis (AFP) on February 6, 2025. The case was promptly reported on February 7 by a polio surveillance team during a National Immunization Drive (NID), and the virus was later isolated from the child’s stool samples. As of 2025, Pakistan has confirmed a total of three wild poliovirus type 1 (WPV1) cases, all of which are linked to Larkana.
This new case marks a disturbing break in the district’s recent history, as the last reported polio case in Larkana occurred in May 2020. The virus’ re-emergence highlights the ongoing challenges faced by the health authorities in the battle against the debilitating disease. The incumbent leadership of EOC Sindh has so far completely failed to deliver, and the entire Sindh, especially Karachi, has become an epicenter of the virus, attracting international attention due to growing concerns.
The young girl, a member of the Kharos caste and Baloch tribe, was examined by the polio team after her family noticed a sudden weakness in her left leg on February 6. On clinical examination, the child was found to have hypotonus (low muscle tone) in her left lower limb, with a strength rating of 4/5. Despite this, her deep tendon reflexes were normal, and sensations remained intact. The family’s vaccination history has been partially verified, with three doses of routine immunization (RI) and seven rounds of supplementary immunization activities (SIA) recorded, though further verification of the record is pending as some polio workers are accused of fake finger marking.
Interestingly, the family had recently hosted guests from UC M Panah Odho, an area in the neighbouring district of Shikarpur, approximately 20 days before the onset of paralysis. This could point to potential cross-district transmission, as polio continues to lurk in various regions and due to proper strategy and planning by the EOC Sindh, it is hard to counter virus circulation.
Meanwhile, 84 environmental samples (ES) are isolated so far this year. Larkana itself, having been an ES site since the early phases of the immunization campaign, recorded two significant ES isolates: one in November 2024 and another in January 2025. These isolates were linked to different areas, with one connected to Karachi East and the other to Pishin in Balochistan, demonstrating the mobility of the virus within the region.
In light of this new case, the genetic analysis of the polio strain is awaited to determine its source and potential links to other outbreaks in the country. Notably, the polio virus isolated from the child’s stool is a concerning reminder that the eradication campaign must address the possibility of cross-border transmission, as highlighted by the family’s recent connection with Shikarpur.
Polio eradication efforts rely heavily on surveillance teams that work to track potential cases and ensure that children who have been affected receive timely care and vaccination. In this instance, the prompt investigation and response by the polio team helped to quickly confirm the case, with stool samples sent for lab testing within a day of the initial reporting. The child’s second stool sample was collected just two days later, further accelerating the investigation into the outbreak.
Despite these rapid measures, the recurrence of cases in Larkana underscores the importance of strengthening surveillance networks and ensuring that vaccination coverage remains high. The National Immunization Days (NIDs) continue to be a crucial tool in combating polio, but they must be complemented by consistent follow-up vaccination efforts in areas identified as high-risk.
Although the child in question had received routine immunization and participated in several rounds of supplementary immunization, there are indications that challenges persist in reaching every child, especially in remote and underserved areas. The verification of vaccination records is ongoing, but such cases highlight the critical importance of ensuring that all children, especially in high-risk districts, are consistently immunized against polio.
Larkana’s re-emergence as a site for polio transmission further underscores the need for comprehensive immunization campaigns that not only focus on routine immunization but also intensify efforts in areas with historical vulnerabilities. The growing number of ES isolates, which are detected from environmental samples, emphasizes that the virus remains present in the environment, posing a threat to innocent children.
