{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T06:36:12Z","timestamp":1776926172625,"version":"3.51.2"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Implementation of supplementary immunization activities (SIAs) delivering oral poliovirus vaccine (OPV) to children under 5\u202fyears of age is a key strategy for interruption of poliovirus transmission. Quetta block (Quetta, Pishin, Chaman, and Killa Abdullah districts), which has the largest number of children under 5\u202fyears in Balochistan province, is a core reservoir for wild poliovirus type 1 (WPV1) in Pakistan. This study examined the quality of polio SIAs and trends in WPV1 cases in Quetta block during 2020\u20132024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted descriptive analysis of administrative coverage, lot quality assurance sampling (LQAS) surveys and post-campaign monitoring (PCM) data for polio SIAs implemented during 2020\u20132024. Data on WPV1 cases and environmental isolates for the same period were obtained from the acute flaccid paralysis (AFP) and environmental surveillance databases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 33 SIAs planned in Quetta block during 2020\u20132024, only 24 (73%) were fully implemented. Due to the COVID-19 pandemic, all polio SIAs in Pakistan were paused in the first half of 2020 but resumed by July 2020. The quality of SIAs in Quetta block declined during the period under review, with the proportion of LQAS lots that achieved the threshold for acceptable performance (\u226595%) reducing from 90% in 2020 to 70% in 2023. WPV1 cases re-emerged in 2024 in Quetta block after a three-year absence and a 28-month period without WPV1 isolations from environmental samples. The 14 WPV1 cases that were reported in Quetta block accounted for 19% of all 74 cases in Pakistan and 98% of environmental samples within the block tested positive for WPV1 in 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Quetta block in Balochistan province experienced a significant reduction in the quality of polio SIAs during 2020\u20132024, which likely contributed to a resurgence in WPV1 cases in 2024. Factors influencing the decline in SIA quality included COVID-19 disruptions of immunization activities, security incidents, community boycotts, and vaccine hesitancy. To enhance the prospects of poliovirus elimination in Balochistan, stronger government commitment and greater community engagement will help to improve vaccine access and acceptance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1817720","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T05:36:56Z","timestamp":1776922616000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Contributing factors to declining vaccination campaign quality and resurgence of polio cases in Quetta block, Pakistan: a five-year analysis (2020\u20132024)"],"prefix":"10.3389","volume":"14","author":[{"given":"Ehsan","family":"Larik","sequence":"first","affiliation":[{"name":"National Stop Transmission of Polio (NSTOP) Program","place":["Islamabad, Pakistan"]},{"name":"Expanded Programme on Immunization","place":["Balochistan, Pakistan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aftab","family":"Kakar","sequence":"additional","affiliation":[{"name":"National Stop Transmission of Polio (NSTOP) Program","place":["Islamabad, Pakistan"]},{"name":"Expanded Programme on Immunization","place":["Balochistan, Pakistan"]},{"name":"Provincial Emergency Operation Centre (EOC), Polio Eradication Initiative","place":["Balochistan, Pakistan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kifayat","family":"Ullah","sequence":"additional","affiliation":[{"name":"National Stop Transmission of Polio (NSTOP) Program","place":["Islamabad, Pakistan"]},{"name":"Integral Global Health, Federal Directorate of Immunization","place":["Islamabad, Pakistan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamkeen","family":"Ghafoor","sequence":"additional","affiliation":[{"name":"National Stop Transmission of Polio (NSTOP) Program","place":["Islamabad, Pakistan"]},{"name":"Integral Global Health, Federal Directorate of Immunization","place":["Islamabad, Pakistan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul Sami","family":"Khan","sequence":"additional","affiliation":[{"name":"National Stop Transmission of Polio (NSTOP) Program","place":["Islamabad, Pakistan"]},{"name":"Provincial Emergency Operation Centre (EOC), Polio Eradication Initiative","place":["Balochistan, Pakistan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gohar Ali","family":"Shahbaz","sequence":"additional","affiliation":[{"name":"Provincial Emergency Operation Centre (EOC), Polio Eradication Initiative","place":["Balochistan, Pakistan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul","family":"Raziq","sequence":"additional","affiliation":[{"name":"National Stop Transmission of Polio (NSTOP) Program","place":["Islamabad, Pakistan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chukwuma","family":"Mbaeyi","sequence":"additional","affiliation":[{"name":"Global Immunization Division, Centers for Disease Control and Prevention","place":["Atlanta, GA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e1862","DOI":"10.1002\/hsr2.1862","article-title":"Re-emergence of polio in Pakistan: can the nation achieve the WPV1 eradication goal?","volume":"7","author":"Faizan","year":"2024","journal-title":"Health Sci Rep"},{"key":"ref2","volume-title":"Polio Eradication Strategy 2022\u20132026: Delivering on a Promise","year":"2021"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/3-540-36583-4_11","article-title":"Mass vaccination campaigns for polio eradication: an essential strategy for success","volume":"304","author":"Sutter","year":"2006","journal-title":"Curr Top Microbiol Immunol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"880","DOI":"10.15585\/mmwr.mm7233a1","article-title":"Progress toward poliomyelitis eradication \u2014 Pakistan, January 2022\u2013June 2023","volume":"72","author":"Mbaeyi","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref5","year":"2024"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/vaccines12010001","article-title":"A holistic strategy of mother and child health care to improve the coverage of routine and polio immunization in Pakistan: results from a demonstration project","volume":"12","author":"Habib","year":"2024","journal-title":"Vaccines (Basel)"},{"key":"ref7","year":"2023"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"179","DOI":"10.26719\/emhj.22.052","article-title":"Polio vaccination in Balochistan: issues and challenges","volume":"38","author":"Khan","year":"2018","journal-title":"Balochistan Rev"},{"key":"ref9","author":"Bashir Soofi","year":"2023"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"S176","DOI":"10.1093\/infdis\/jix178","article-title":"Lessons from the polio endgame: overcoming the failure to vaccinate and the role of subpopulations in maintaining transmission","volume":"216","author":"Thompson","year":"2017","journal-title":"J Infect Dis"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e0212049","DOI":"10.1371\/journal.pone.0212049","article-title":"The impact of supplementary immunization activities on routine vaccination coverage: an instrumental variable analysis in five low-income countries","volume":"14","author":"Chakrabarti","year":"2019","journal-title":"PLoS One"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1575319","DOI":"10.3389\/fpubh.2025.1575319","article-title":"Creating cohesive communities: using conditional\u2013collective\u2013community-based incentives to change social norms on polio immunization in Pakistan","volume":"13","author":"Tabassum","year":"2025","journal-title":"Front Public Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"105022","DOI":"10.1016\/j.idnow.2025.105022","article-title":"WPV1 resurgence in Pakistan: endangering the global polio eradication goal","volume":"55","author":"Syed","year":"2025","journal-title":"Infect Dis Now"},{"key":"ref14","year":"2026"},{"key":"ref15","volume-title":"Best Practice for Monitoring the Quality of polio Eradication Campaign Performance","year":"2018"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s13690-020-00418-0","article-title":"Vaccine coverage within the first year of life and associated factors with incomplete immunization in a Brazilian birth cohort","volume":"78","author":"Buffarini","year":"2020","journal-title":"Arch Public Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2467","DOI":"10.1186\/s12889-024-12467-3","article-title":"Exploring the reasons for defaulting from childhood immunization: a qualitative study in Pakistan","volume":"24","author":"Ullah","year":"2024","journal-title":"BMC Public Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"A2","DOI":"10.1016\/j.vaccine.2021.10.028","article-title":"The immediate impact of the COVID-19 pandemic on polio immunization and surveillance activities","volume":"41","author":"Burkholder","year":"2023","journal-title":"Vaccine"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.puhe.2020.10.003","article-title":"Delays in polio vaccination programs due to COVID-19 in Pakistan: a major threat to Pakistan\u2019s long war against poliovirus","volume":"189","author":"Din","year":"2020","journal-title":"Public Health"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.5339\/avi.2022.11","article-title":"Effects of the COVID-19 pandemic on the uptake of routine immunization vaccines in Swat District in Pakistan","volume":"2022","author":"Ullah","year":"2022","journal-title":"Avicenna"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"446","DOI":"10.4269\/ajtmh.20-1438","article-title":"Polio amidst COVID-19 in Pakistan: what are the efforts being made and challenges at hand?","volume":"104","author":"Ahmad","year":"2020","journal-title":"Am J Trop Med Hyg"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2153513","DOI":"10.1080\/21645515.2022.2153513","article-title":"Unveiling and addressing implementation barriers of vaccination communication strategy: perspectives from government officials at national and provincial levels","volume":"18","author":"Aslam","year":"2022","journal-title":"Hum Vaccin Immunother"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.3390\/vaccines11071132","article-title":"Exploring knowledge and perceptions of polio disease and its immunization in polio high-risk areas of Pakistan","volume":"11","author":"Habib","year":"2023","journal-title":"Vaccines (Basel)"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2237390","DOI":"10.1080\/21645515.2023.2237390","article-title":"Polio vaccination activities in conflict-affected areas","volume":"19","author":"Mbaeyi","year":"2023","journal-title":"Hum Vaccin Immunother"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"109","DOI":"10.60141\/AJID\/V.2.I.2\/12","article-title":"Polio eradication in Afghanistan: challenges and solutions","volume":"1","author":"Hayat","year":"2024","journal-title":"Afghan J Infect Dis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e006002","DOI":"10.1136\/bmjgh-2021-006002","article-title":"30 years of polio campaigns in Ethiopia, India and Nigeria: the impacts of campaign design on vaccine hesitancy and health worker motivation","volume":"6","author":"Neel","year":"2021","journal-title":"BMJ Glob Health"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"S250","DOI":"10.1093\/infdis\/jix047","article-title":"Experiences and lessons from polio eradication applied to immunization in 10 focus countries of the polio endgame strategic plan","volume":"216","author":"van den Ent","year":"2017","journal-title":"J Infect Dis"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1914","DOI":"10.1186\/s12889-020-09945-3","article-title":"Lessons learned from the polio eradication initiative in the Democratic Republic of Congo and Ethiopia: analysis of implementation barriers and strategies","volume":"20","author":"Deressa","year":"2020","journal-title":"BMC Public Health"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e438","DOI":"10.1093\/infdis\/jiae129","article-title":"Progress in access and oral polio vaccine coverage among children aged <5 years in polio campaigns after the political change in Afghanistan","volume":"231","author":"Sabawoon","year":"2024","journal-title":"J Infect Dis"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e076607","DOI":"10.1136\/bmjopen-2023-076607","article-title":"COVID-19 related disruption and resilience in immunisation activities in LMICs: a rapid review","volume":"14","author":"Hartner","year":"2024","journal-title":"BMJ Open"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"S181","DOI":"10.1093\/infdis\/jiu230","article-title":"Polio outbreak investigation and response in Somalia, 2013","volume":"210","author":"Kamadjeu","year":"2014","journal-title":"J Infect Dis"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.29245\/2688-6673\/2021\/5.1176","article-title":"Efforts towards polio eradication in Madagascar: 1997 to 2017","volume":"5","author":"Mengouo Nimpa","year":"2021","journal-title":"J Immunol Sci"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1817720\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T05:36:59Z","timestamp":1776922619000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1817720\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,23]]},"references-count":32,"alternative-id":["10.3389\/fpubh.2026.1817720"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1817720","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,23]]},"article-number":"1817720"}}