13 May 2015

Polio: exportations from Afghanistan

Afghanistan: evidence of polio spread to Pakistan and polio vaccine recommendations for travellers

On 5 May 2015, the World Health Organization (WHO) issued a statement advising that the international spread of wild poliovirus (WPV) continues to constitute a Public Health Emergency of International Concern and confirmed Afghanistan as a state currently exporting WPV.

WHO also recommended an extension of the Temporary Recommendations, as revised, for a further three months [1].

Whilst progress has been made, the international spread of WPV has continued, with three new documented exportations from Afghanistan to Pakistan in late 2014. The continued risk of international WPV spread from Afghanistan and Pakistan remains a concern [1].

The current recommendations for travellers from England, Wales and Northern Ireland for those travelling to countries currently exporting WPV can be seen on the relevant country pages for Afghanistan and Pakistan.

In response to WHO emergency recommendations regarding spread of WPV, the governments of Afghanistan and Pakistan may require all departing travellers who have spent more than four weeks in Afghanistan or Pakistan to produce a valid vaccination certificate at the time of their departure. This certificate should show that either oral polio vaccine (OPV) or inactivated polio vaccine (IPV) has been administered between four weeks and 12 months before departure [1]. Vaccine certificates should be completed in the same format and on the same document as the ICVP for yellow fever. The certificate booklets are available from the online shop or WHO.

Although protection from a booster dose of polio vaccine following a primary course is expected to last 10 years [2], a booster dose of IPV or OPV within four weeks to 12 months of travel, boosts intestinal mucosal immunity and reduces the risk of poliovirus shedding [3].

International requirements for polio vaccination are reviewed regularly and this advice is subject to change. Health professionals and travellers should refer to Country Information pages for country specific polio vaccine recommendations and requirements.

Oral polio vaccine (OPV) information

OPV is not available in the UK. IPV is available, as a combined polio vaccine with tetanus and diphtheria (Revaxis®) in the UK and is also contained in some childhood vaccines.

OPV contains live attenuated poliovirus strains. In general, it is well tolerated. However, in very rare cases, administration of OPV results in vaccine-associated paralytic poliomyelitis, associated with a reversion of the vaccine strains to the more neurovirulent profile of wild poliovirus [3, 4].

OPV is contraindicated in individuals who are immunosuppressed. Although non-teratogenic, OPV is not recommended for pregnant women in the UK, as an alternative inactivated vaccine (Revaxis®) is available [2-3].

Advice for travellers

Polio is a virus transmitted through faecally-contaminated food and water. Travellers to areas with ongoing polio transmission should practise strict food and water hygiene. More information on polio can be found in Polio Factsheet.

Advice for health professionals

Clinicians should maintain awareness for suspect cases of poliomyelitis in travellers and migrants arriving from affected areas. Acute poliomyelitis is a notifiable disease. All suspected cases must be notified to the Proper Officer, normally the Consultant in Communicable Disease Control in the Health Protection Team of the local PHE Centre, which are then reported to Centre for Infectious Disease Surveillance and Control.

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