Evolution and transmission dynamics of wild poliovirus in Pakistan and Afghanistan (2012-2023)

David Jorgensen (), Margarita Pons-Salort, Muhammad Salman, Adnan Khurshid, Yasir Arshad, Nayab Mahmood, Darlan Silva Candido, Steve Kroiss, Hil Lyons, Nicholas C. Grassly and Muhammad Masroor Alam
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David Jorgensen: Imperial College London
Margarita Pons-Salort: Imperial College London
Muhammad Salman: National Institute of Health
Adnan Khurshid: National Institute of Health
Yasir Arshad: National Institute of Health
Nayab Mahmood: National Institute of Health
Darlan Silva Candido: Imperial College London
Steve Kroiss: Gates Foundation
Hil Lyons: Gates Foundation
Nicholas C. Grassly: Imperial College London
Muhammad Masroor Alam: National Institute of Health

Nature Communications, 2025, vol. 16, issue 1, 1-11

Abstract: Abstract Despite concerted global vaccination efforts, wild poliovirus remains endemic in two countries in 2024, Pakistan and Afghanistan. This study uses phylogeographic analysis of poliovirus genetic and epidemiological data from clinical and wastewater surveillance to identify the causes of poliovirus persistence and routes of spread over the last decade (2012 to 2023). Poliovirus genetic diversity declined after 2020, with one of two major genetic clusters dying out, and recent detections are now closely related genetically. High-risk and hard-to-access regions have sustained polio transmission over the past decade, even when interrupted elsewhere. Karachi, one of the most densely populated cities globally, has acted as a hub for the amplification and spread of poliovirus to other regions, many of which we show to be dead-end for onwards transmission despite frequent virus detection. Phylogenetic analysis has long been central to the polio surveillance network, and advancing the approaches used can provide critical epidemiological insights to accelerate eradication efforts.

Date: 2025
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DOI: 10.1038/s41467-025-60432-x

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