After Years of Decline, Afghan Polio Cases Rise KABUL, Afghanistan - It has often been called the polio cease-fire. In a country where insurgents have for years attacked and killed people working for the government or the international community, a small army of vaccination teams connected to both have, year after year, fanned out through some of Afghanistan's most dangerous areas, quietly and mostly safely. Appointed by the government, paid for by international agencies, and given free passage by the Taliban in one of the last three countries in the world where polio is endemic, the Global Polio Eradication Initiative's 65,000 volunteers and workers had seemed to have nearly wiped out the disease - until recently. After years of steady decline, only 25 polio cases were reported in the country in 2010, prompting one international health care official to declare, "the Afghans are heroes." But last year, the number tripled to 76, the Afghan Ministry of Public Health said. While the total remains small, polio is highly contagious and health experts say that each detected case is an indicator of hundreds of "silent" ones, mainly children with mild infections who become carriers. Health workers are alarmed at the reversal of what has been both a local and a worldwide trend - particularly since some of the cases erupted far outside the disease's traditional areas in Afghanistan. "This is a national tragedy to end up with a major polio outbreak, especially with all the effort they have put into it," said Dr. Bruce Aylward, the World Health Organization's polio coordinator. It increases the risk to neighboring countries and is both a local and national, and international, concern. President Hamid Karzai issued a statement through his office on Tuesday, in effect blaming the Taliban. "Those who stand in the way of vaccination are the true enemies of our children's future," Mr. Karzai said, calling on "the armed opposition to allow the vaccination teams to help save children against the lifetime paralysis." Health care officials said they had experienced no change in the militants" tolerance for the vaccination efforts, and the Taliban reacted indignantly. "It is not for Karzai to ask us to attack or not to attack someone," said the Taliban's southern Afghanistan spokesman, Qari Yousaf Ahmadi . He insisted there had been no change in Taliban policy toward polio vaccination teams, saying, "We have never attacked medical teams, as long as they coordinate with us when they enter areas under our control." After decades of worldwide immunization efforts, polio is now considered endemic only to Afghanistan and neighboring Pakistan - where cases also increased dramatically last year - and in northern Nigeria. India, long an center of the disease, last week celebrated its first full year with no new cases, the World Health Organization reported. "It has been a huge achievement," said Vidhya Ganesh, Unicef's deputy representative in Afghanistan. Unicef and the World Health Organization oversee the $32 million eradication campaign in Afghanistan. "If polio were to be eradicated, it would be only the second disease ever," she said. The last case of smallpox, the first human disease believed to be successfully eradicated, was diagnosed in 1977. "At only 25 cases you could almost smell the victory," said Ahmad Azadi, a spokesman for the World Health Organization here. Peter Crowley, Unicef's country representative in Afghanistan, said that security was a factor in the rising number of cases, "but it is not the only factor." "In general," he said, "eradication is one of the areas where work has been more possible to continue to implement, in spite of the security situation." In Afghanistan polio has traditionally been concentrated in the Pashtun belt across southern Afghanistan - some of the most dangerous areas in the country, where the conflict has been concentrated. In 2011, however, cases emerged in northern, central and eastern parts of Afghanistan as well - apparently spread by travelers or refugees from endemic areas in Pakistan. One of Pakistan's major polio areas is found in Pashtun tribal areas contiguous with Afghanistan's. Just as a porous, rugged border has allowed infiltration of insurgents, it has also provided pathways for the spread of polio. New polio cases in Pakistan went to 192 in 2011 from 80 in 2010, said Muhammed Taufiq Mashal, the director general of preventive medicine in the Afghan Ministry of Public Health. He blames much of the polio increase in his country on infiltration from Pakistan, which World Health Organization scientists say is confirmed by gene sequencing of the virus in victims. "We have never experienced something like this," he said, noting that polio has declined steadily every year since 2002 in Afghanistan. While in Pakistan and Nigeria some extremist Muslim leaders have denounced vaccination programs as a Western conspiracy, that has not been the case with the Taliban in Afghanistan. Many polio vaccination teams carry a letter bearing the signature of the Taliban leader Mullah Muhammad Omar, approving of their work. Those who saw Mr. Karzai's statement as politicizing the issue were sharply critical. "I was very shocked when I read the president's statement," said an international health official, who spoke on the condition of anonymity because of his agency's rules about criticizing a host country government. Politicizing this issue is alarming. Health is not a political thing. Another Western official, also speaking anonymously for the same reason, said, "the reason polio vaccination teams have been able to operate is because they're allowed to operate - interfering with the campaign has been off limits in Afghanistan." "This health issue is nonpolitical, nonmilitary," said Naqibullah Faieq, who heads the health committee in the Afghan Parliament. We want both the government and the Taliban to not use the issue of vaccination in their speeches. Internationally, authorities are deeply concerned about the polio increase - not only in Afghanistan and Pakistan, but also in Nigeria. The World Health Organization is expected later this week to declare those increases a "global public health emergency," Dr. Aylward said. He cautioned that the eradication program in Afghanistan remained effective, and authorities on all sides seemed determined to make it work. Still, he said, "Anytime you see a three-fold increase in an epidemic-prone disease, you've got to be concerned about it." Donald G. McNeil Jr. contributed reporting from New York, and Sharifullah Sahak from Kabul.