Experts urge EOC Sindh to act swiftly, demanding strategic planning, merit-based leadership, and robust field monitoring to avert looming catastrophe
By our correspondent
KARACHI: The Regional Reference Laboratory for Polio Eradication at the National Institute of Health has confirmed a polio case reported from District Thatta, Sindh. This marks the fourth case from Sindh out of the six detected in Pakistan so far in 2025. The latest case, a six-month-old boy from Tehsil Ghora Bari, underscores the continued threat of poliovirus transmission in the province.
The child, belonging to the Chandio caste and Sindhi tribe, developed fever in early January, which lasted for nearly two weeks. His mother noticed weakness in both lower limbs on January 13, but he was kept at home for a month with home remedies before being taken to a healthcare provider. By the time he was assessed on February 11 and classified as an acute flaccid paralysis (AFP) case, crucial intervention had already been delayed.
While, investigations began the next day, with stool samples collected on February 14 and 18 and subsequently sent for laboratory analysis on February 19. Clinical examination revealed hypotonia in both lower limbs, though deep tendon reflexes were normal, and sensations remained intact. The child’s immunization history indicates three routine immunization doses and four supplementary immunization doses, though verification is still pending, hopefully will remain pending.
However, the virus was also detected in a stool sample from one of the child’s three contacts—a three-year-old cousin (during contact sampling)—indicating ongoing community transmission. Thatta remains without environmental surveillance (ES) sites, a major gap in polio detection. The only ES sample collected in December 2024—linked to Multan’s ES network—had already tested positive for WPV1, raising concerns about undetected circulation in Sindh.
With the latest case, Pakistan’s polio burden for 2025 has now reached six, with four cases in Sindh leading the race, one in Punjab, and one in Khyber Pakhtunkhwa. In 2024, Sindh accounted for 33 percent of the country’s total polio cases, standing second to Balochistan—a region plagued by conflict—as Sindh reported 23 out of country’s 74 cases.
It is important to note that the actual numbers are likely far higher than those officially acknowledged. Reliable sources, speaking on condition of anonymity, have confirmed that many cases go unreported or are deliberately shifted from affected areas to avoid drawing unwanted attention from the authorities. If this is indeed the case, it raises serious concerns about the effectiveness of the surveillance and sample collection mechanisms in place for identifying Acute Flaccid Paralysis (AFP) or Environmental Samples (ES).
Managed by WHO’s District Surveillance Officers (DSOs), these systems seem to be operating with alarming inertia, further complicating the task of addressing the crisis at hand. The persistence of WPV1 in Sindh poses questions about the province’s polio eradication efforts. Delayed case detection, gaps in surveillance, and inadequate community engagement continue to undermine progress. The latest case in Thatta highlights not just the vulnerabilities in vaccination coverage but also the ongoing risk posed by undetected transmission in areas where surveillance remains weak.
As Sindh faces yet another polio resurgence, the Thatta case is a stark reminder that eradication efforts require urgent recalibration. Without immediate action to strengthen surveillance, expand vaccination outreach, and address healthcare access challenges, the province risks further setbacks in its long-standing battle against polio.
