Muhammed Muheisen/AP - Pakistani health worker Naela Emanuel, 18, left, gives a polio vaccine to child in a Christian neighborhood in Islamabad, Pakistan on July 17, 2012. Only Pakistan, Afghanistan and Nigeria are on the World Health Organization's list of countries where polio is endemic.
LAHORE, Pakistan — They gathered in a small room in one of this city’s worst slums, a dozen mothers sitting cross-legged with toddlers and newborns on their laps, listening to advice about polio prevention.
“Keep your children from playing in garbage cans and sewer drains,” said Saddaf Malik, a brightly dressed young woman from UNICEF.
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Simple enough, but then came the questions, spiked with suspicion and indicative of why Pakistan remains one of three countries in the world where the paralyzing disease still thrives despite constant campaigns in recent years to defeat it.
Why, some mothers wondered, were the vaccination teams coming back once a month, instead of every three months, as they used to? Were the repeated doses meant to induce sterility in Muslims?
The polio fighters looked crestfallen. They thought this dangerous myth was dead in Lahore — a sprawling city with an estimated 1.5 million young children that logged just one polio case a year ago and none since.
“This is really alarming,” the district’s chief health officer, Muhammad Saeed Akhtar Ghumman, said in his office later when a UNICEF staffer reported the women’s concerns to him.
Troubling, too, was the confirmation of the polio virus in 16 of 28 sewage samples taken so far this year in Lahore, a marked increase over 2011. And three successive positive samples — in July, August and September — have raised worries about the virus’s “silent circulation,” as World Health Organization officials call it.
“We take it very seriously if there is even one positive sample,” said Ni’ma Abid, a WHO senior medical officer. “It means you have polio in the community.”
Still, overall trends in Pakistan, where nearly 30 million children have been vaccinated in recent years, are encouraging. In 1994, when the nation began to fully engage the scourge, polio killed or paralyzed at least 1,500 children, by conservative estimates.
Last year’s cases numbered 198 nationwide. This year’s tally is 54.
But the intractability of other social ills, including insurgency, poverty, illiteracy and inadequate sanitation, have conspired to ensure that the country remains years away from meeting its goal of polio eradication by the dawn of 2013.
Last week, a new setback emerged in Baluchistan, where doctors reported five cases of polio-crippled children in the restive province, which had seen only four cases this year.
The new cases are significant because they resulted from the vaccine itself. WHO officials called this extremely rare, but it can happen in places where the level of immunization is exceedingly low and the sanitation poor.
Polio drops contain a weakened polio virus that provides immunity. Once excreted, it has a slim potential to mutate into a strain that can cause paralysis.
The five cases of “vaccine-derived polio” — the first seen in Pakistan — could give skeptical parents another reason to refuse to vaccinate their children, some officials fear.
While refusals have been dropping nationwide, rumors abound that the drops contain religiously proscribed (“non-halal”) ingredients or are part of a Western plot to spread infertility and limit Muslim population growth.
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