Morbidity and Mortality Weekly Report
Weekly / Vol. 71 / No. 49 December 9, 2022
INSIDE
1547 Human Rabies — Texas, 2021
1550 Chronic Obstructive Pulmonary Disease Mortality
by Industry and Occupation — United States, 2020
1555 Safety Monitoring of JYNNEOS Vaccine During the
2022 Mpox Outbreak — United States,
May 22–October 21, 2022
1560 Reduced Risk for Mpox After Receipt of 1 or
2 Doses of JYNNEOS Vaccine Compared with Risk
Among Unvaccinated Persons — 43 U.S.
Jurisdictions, July 31–October 1, 2022
1565 QuickStats
Continuing Education examination available at
https://www.cdc.gov/mmwr/mmwr_continuingEducation.html
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Progress Toward Poliomyelitis Eradication Afghanistan,
January 2021–September 2022
Abdinoor Mohamed, MD
1
; Irfan Elahi Akbar, MBBS
2
; Sumangala Chaudhury, MBBS
2
; Mufti Zubair Wadood, MBBS
3
; Fazal Ather, MBBS
4
;
Jaume Jorba, PhD
5
; Maureen Martinez, MPH
1
Afghanistan and Pakistan are the two remaining countries
with endemic wild poliovirus type 1 (WPV1) transmission
(1). During 2019–2020, these countries reported their highest
numbers of WPV1 cases since 2014 and experienced outbreaks
of type 2 circulating vaccine-derived poliovirus (cVDPV2)
(2–4).* In Afghanistan, the number of WPV1 cases nearly
doubled, from 29 in 2019 to 56 in 2020; 308 cVDPV2 cases
were reported during 2020. After years of active conflict, the
Afghanistan government was fully replaced by the Taliban
de facto government on August 15, 2021. This report describes
activities and progress toward polio eradication in Afghanistan
during January 2021–September 2022 and updates previous
reports (3,4). During January–December 2021, four WPV1
and 43 cVDPV2 cases were detected, representing decreases
of 93% from 56 cases and 86% from 308 cases, respectively,
during 2020. During January–September 2022 (reported as of
October 20), two WPV1 cases and zero cVDPV2 cases were
detected. Although no supplementary immunization activities
(SIAs)
†
occurred during July–October 2021, SIAs resumed
during November 2021 in all districts after the political transi-
tion, and 3.5–4.5 million previously unreachable persons have
been vaccinated since. However, restrictions on how SIAs are
conducted are still in place in the critical South Region prov-
inces of Kandahar, Helmand, and Uruzgan. If efforts to vac-
cinate all children are enhanced and expanded, Afghanistan has
an opportunity to interrupt WPV1 transmission during 2023.
* Vaccine-derived polio viruses can emerge when attenuated oral polio vaccine
(OPV) virus reverts to neurovirulence as a result of transmission in areas with
low immunization coverage. cVDPV2s are genetically linked VDPV2 isolates
for which there is evidence of person-to-person transmission in the community.
†
SIAs are mass immunization campaigns intended to supplement the routine
immunization systems and target children aged <5 years with OPV, regardless
of their vaccination history. In Afghanistan, SIAs are conducted using a variety
of methods such as house-to-house, mosque-to-mosque, or site-to-site.
Immunization Activities
The World Health Organization (WHO) and UNICEF
estimate of national 2021 immunization coverage with
3 doses of oral poliovirus vaccine (OPV3) among children
aged 12–23 months was 71% compared with 75% in 2020.
The estimated 1-dose coverage with injectable inactivated
poliovirus vaccine was 67% in 2021 compared with 62% in
2020 (5). However, these national estimates obscure substantial
subnational coverage gaps.
Because of the low quality of routine immunization (RI)
data, caregiver recall dose history from investigations of acute
flaccid paralysis (AFP) in children who do not have laboratory
evidence of poliovirus infection (nonpolio AFP [NPAFP]) is
used as a proxy for RI coverage. Among the 2,567 infants and
children aged 6–59 months with NPAFP in 2021, 68% had
received ≥3 RI OPV doses nationwide; 17% had not received
