International Measures to Stop Spread of Wild Poliovirus (Update 1)

In May 2014, WHO (World Health Organization) declared spread of wild polio virus a Public Health Emergency of International Concern (PHEIC). As part of the response, WHO requires the polio-infected countries to ensure or encourage that people leaving these countries have been vaccinated against polio in the previous 12 months.

As of week commencing 2 July 2014, Equatorial Guinea has been added to the list of “virus-exporting countries” which should implement a set of Temporary Recommendations recently issued by the Director-General of the WHO under the International Health Regulations (2005).

From 1 June 2014, the Pakistan Government began to implement the WHO temporary recommendations and require all departing travellers who have spent more than 4 weeks in Pakistan to produce a valid vaccination certificate at the time of their departure. They are providing oral polio vaccine at various departure points, including Islamabad, Karachi, Lahore and Peshawar airports. Recipients are issued a polio certificate and then allowed to depart.

In support of the international effort, and in order to avoid the possibility of being vaccinated on the border when leaving a polio-infected country, the European Centre for Disease Prevention and Control (ECDC) has made temporary vaccination recommendations for EU travellers to the ten polio infected countries:

• 4 polio-exporting countries - Pakistan, Cameroon, Syria and Equatorial Guinea.
• 6 polio-infected countries - Afghanistan, Ethiopia, Iraq, Israel, Somalia and Nigeria.

In the UK, polio vaccine is included as part of the routine childhood immunisation schedule in combination with several other vaccine components. In adults this is most commonly given in combination with diphtheria and tetanus (Revaxis®), in children there are a variety of combined vaccines available. There is no oral or individual injectable polio vaccine available for use in the UK.

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 10 polio-infected 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.
• Travellersshould carry proof of vaccination. In particular, for Pakistan, Cameroon, Syria and Equatorial Guinea 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 England, Public Health England and NaTHNaC have issued interim advice which is slightly different to that in Scotland (please look at NaTHNaC Clinical updates for full details):

• Travellers should have a booster dose of a polio-containing vaccine if they had not received vaccination in the past 12 months and they are travelling to settings with extremely poor hygiene (e.g. refugee camps), or likely to be in close proximity with cases (e.g. healthcare workers), and/or visiting for 6 months or more.
• Other shorter term travellers to these countries should ensure that they are up to date with polio immunisation, including a booster if none has been received for 10 years.
• Immunosuppressed and pregnant travellers are strongly advised to have inactivated polio vaccine within 1 year before planned departure from Pakistan and ensure this is recorded on an ICVP.
• In England, Wales and Northern Ireland the ICVP’s should be obtained from NaTHNaC online shop or WHO.

A series of Polio FAQ’s are being posted on TRAVAX to help clarify some of the issues arising as a result of these temporary recommendations, including how to correctly fill in the ICVP and what if a booster has recently been given?

We will continue to monitor the situation as it evolves and post further updates as necessary.

Information can also be found on TRAVAX country-specific pages.