International Measures to Stop Spread of Wild Poliovirus (Update 5)

The seventh meeting of the Emergency Committee under the International Health Regulations (IHR) (2015) regarding the international spread of wild poliovirus in 2014-2015 was convened by the WHO Director General on 10 November 2015.

In their last report in August 2015, the Emergency Committee expressed concerns regarding circulating vaccine-derived polioviruses (cVDPV) and it was decided that this seventh meeting would broaden its approach to also consider outbreaks of cVDPV. As a result the Committee have revised their criteria to include countries reporting cVDPV.

The Committee noted that the international spread of wild poliovirus continues and that there were two new documented exportations from Pakistan into Afghanistan during July and August 2015.

The Committee agreed that the situation still constitutes a Public Health Emergency of International Concern (PHEIC) and recommended the extension of the Temporary Recommendations for a further three months to the following countries:

Countries currently exporting wild poliovirus or cVDPV:

Afghanistan (last exportation 6 June 2015) and Pakistan (last exportation 27 August 2015).

Countries infected with wild poliovirus or cVDPV detected in the last 6 months but not currently exporting:

Nigeria, Guinea, Madagascar, Ukraine and Laos People's Democratic Republic.

In addition, all travellers to Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia, South Sudan and Syria should ensure they have had a full primary course of poliomyelitis vaccine and be offered a booster if it has been more than 10 years since their last dose.

(these countries are no longer infected with wild poliovirus or cVDPV but remain vulnerable to international spread or to the emergence and circulation of cVDPV)

Advice for Travellers

Travellers should be encouraged to take strict precautions with food, water and personal hygiene.

In addition, in order to comply with the WHO and ECDC recommendations and also to avoid travellers being vaccinated in the polio-infected country, authorities in the UK have made the following vaccination recommendations.

In Scotland, Health Protection Scotland (HPS) advise:

• Travellers should receive a booster dose of a polio-containing vaccine if they have not had one in the past 12 months and are visiting one of the polio-infected or exporting countries (listed above) for longer than 4 weeks (this advice supersedes the current advice in the Green Book).
• Travellers should acquire this additional dose within 12 months of the date they plan to leave the polio-infected country.
• Travellers visiting one of these countries for less than 4 weeks should ensure they are up-to-date with routine polio vaccination, including 10 yearly boosters.
• Travellers should carry proof of vaccination. In particular, for Pakistan and Afghanistan, this should be documented on the standard International Certificate of Vaccination or Prophylaxis (ICVP). The ICVP is the 'Yellow Card' normally used for yellow fever vaccination.
• In Scotland, paper ICVP’s can be obtained from HPS by contacting TRAVAX administration, email your FULL NAME and FULL POSTAL ADDRESS to: NSS.HPSTravax@nhs.net electronic copies can be downloaded from WHO

In addition, all travellers to Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia, South Sudan and Syria should ensure they have had a full primary course of poliomyelitis vaccine and be offered a booster if it has been more than 10 years since their last dose.

(these countries are no longer infected with wild poliovirus or cVDPV but remain vulnerable to international spread or to the emergence and circulation of cVDPV)

In England, Public Health England and NaTHNaC have issued advice which is different to that in Scotland (please look at Travel Health Pro Clinical updates for full details).