UNITED NATIONS - The risk of polio spreading from Pakistan is high, particularly given the expected mass travel for the upcoming pilgrimage to Makkah, the United Nations warned on Tuesday, calling for full vigilance abroad and a scaling up of 'inadequate counter-efforts within the country. 'It is important that countries across Asia and the Eastern Mediterranean strengthen disease surveillance for acute flaccid paralysis (AFP), in order to rapidly detect any poliovirus importations and facilitate a rapid response should importation occur, the UN World Health Organisation (WHO) said of the potentially fatal and paralyzing disease. The Haj pilgrimage will take place in early November. In a global alert and response update, the agency reported that a wild poliovirus type 1 (WPV1) isolated in China was genetically linked to that currently circulating in Pakistan, where nationwide transmission has so far infected 84 people this year, compared to 48 for the same period of 2010. Pakistan, one of only four countries where polio remains endemic the others are Afghanistan, India and Nigeria has also seen the only wild poliovirus type 3 (WPV3) case in 2011, a strain that is on the verge of elimination in Asia, and WHO urged countries to continue to boost routine immunisation coverage against all strains to minimise the impact of any introduction. 'In 2011, Supplementary Immunisation Activities (SIAs) in Pakistan have been inadequate in quality in key high-risk areas, it said, noting that more than 200,000 children have been regularly missed during SIAs conducted over the last two years in security-compromised parts of the Federally Administered Tribal Areas (FATA), in particular in Khyber agency. 'In addition to challenges relating to reaching children in insecure areas of Khyber Pakhtunkhwa and FATA, significant operational challenges continue to mar the quality of SIAs in accessible areas of Khyber and in other key transmission areas of the country, notably in the provinces of Balochistan and Sindh, it added, warning that undetected circulation also cannot be ruled out due to persistent sub-national surveillance gaps. WHO said the impact of a Pakistani govt emergency plan launched this year is not yet being seen at the critical programme implementation level, although further immunisation days are planned. 'However, key to success will be to overcome remaining operational challenges in fully-accessible areas and implemented special outreach strategies with full community participation to increase access to population in security-compromised areas, it added. 'To achieve this, full and consistent engagement and accountability at provincial, district and union-council level is urgently needed. Travellers to and from Pakistan should be fully protected by vaccination, with those who have in the past received three or more doses of oral vaccine offered another dose before departure, WHO reported. Since the launch in 1988 of the Global Polio Eradication Initiative, spearheaded by WHO, the UN Childrens Fund (UNICEF), Rotary International and the United States Centers for Disease Control and Prevention, the incidence of polio has been reduced by more than 99 per cent. At the time, more than 350,000 children were paralysed every year in more than 125 endemic countries. So far in 2011, some 325 cases have been reported worldwide.