children is a factor in lowered resistance to disabling diseases and reduced efficacy of the polio vaccine. in 2019 there were allegedly 'a dozen' cases of the most dangerous p2 strain from vaccine mismanagement. impact of polio in pakistan polio has had drastic effects on the health of the population of pakistan and on the nation's healthcare infrastructure and economy. the who estimates that 65–75% of polio cases in developing countries occur in children under 3 years of age, with 95% of all cases occurring in children under 5 years of age. researchers at the school of public health at johns hopkins university quantified the disease burden of various diseases in pakistan; in the year 1990, a pakistani person with polio averaged a loss of 1.13 healthy life years to the disease. the duration of disability of polio, averaged over 1000 people, was 81.84 years, the equivalent of diseases including diphtheria, childhood meningitis, and measles. there has been limited research into the impacts of polio in pakistan in recent years, but a 1988 health survey found that the most common handicaps among individuals with polio were associated with mobility, occupation, and social integration. the survey found differences in participants based on whether they lived in a village or a slum area: there was a higher rate of disability in the village population, and higher frequencies of infectious, respiratory, and digestive diseases in the slum area. both areas saw individuals with polio have a higher incidence of musculoskeletal system diseases, as well as infections of the ear, and respiratory tract. given 1–2 years with occupational therapists, 80% of patients with handicaps showed improvement in function.