16 May 2018

Polio: Public Health Emergency of International Concern

An update on the polio Public Health Emergency of International Concern (PHEIC) Polio: Public Health Emergency of International Concern

The seventeenth meeting of the Emergency Committee (EC) under International Health Regulations (IHR) 2005 was convened on 30 April 2018, to review the data on wild poliovirus (WPV) and circulating vaccine derived polioviruses (cVDPV). The EC agreed that the risk of international spread of poliovirus continues to constitute a Public Health Emergency of International Concern (PHEIC). Temporary Recommendations (IHR 2005) to reduce the risk of international spread of poliovirus were extended for a further three months, effective from 7 May 2018 [1].

The Statement details progress made towards stopping transmission of Wild Polio Virus (WPV). Since the last report (14 February 2018) [2] the number of cases of WPV globally remains low; there has been no international spread of WPV since November 2017 [1].

Afghanistan and Pakistan are commended for their high level of commitment, cooperation and coordination in targeting high risk populations crossing the shared border between the two countries. In Nigeria, the number of inaccessible children has been significantly reduced, but routine immunisation coverage is low, particularly in high-risk northern areas. The substantial risk of international spread from Nigeria to the Lake Chad basin countries (Cameroon, Chad, Central African Republic and Niger) and beyond remains of concern [1].

Rarely, where a population is under-immunised, the live virus present in oral polio vaccine can mutate and spread, causing outbreaks of circulating vaccine derived poliovirus (cVDPV), which pose a risk for international spread [3]. Ongoing circulation of cVDPV continues to be a concern. The outbreak in Democratic Republic of Congo has been declared a public health emergency; in addition to cases reported in previously affected provinces, a case has been reported in a new area (Haut Katanga). Syria has not reported any new cases of cVDPV for six months, but low-level transmission cannot be ruled out. Nigeria has reported new outbreaks of cVDPV in Jigawa [2].

The detection of the same strain of cVDPV2 in environmental samples in Mogadishu (Somalia) and Nairobi (Kenya) indicating international spread [3], is a major concern; in addition, cVDPV3 has been detected in environmental samples in Somalia. It is unclear how long the viruses might have been circulating and this, together with the challenges of reaching inaccessible populations, makes an effective response difficult.

The full Statement of the Seventeenth IHR Emergency Committee is available from the World Health Organization is available from the World Health Organization.

IHR Temporary Recommendation categories

(please refer to Country Information pages)

States infected with WPV1, cVDPV1 or cVDPV3 with the potential risk of international spread:

  • Afghanistan
  • Nigeria
  • Pakistan
  • Somalia

These countries have a certificate requirement for polio vaccination under IHR (2005).

States infected with cVDPV2, with potential risk of international spread:

  • DR Congo*
  • Kenya*
  • Nigeria
  • Syria*
  • Somalia
*There is no certificate requirement under IHR (2005) for these countries. Travellers are, however, encouraged to carry proof of polio vaccination.

States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV:

  • Cameroon
  • Central African Republic
  • Chad
  • Niger


In addition to the countries detailed in this report, the Global Polio Eradication Initiative highlight the following countries to be no longer polio-virus infected, but at high risk of outbreaks [4]:

  • Ethiopia
  • Equatorial Guinea
  • Guinea
  • Iraq
  • Laos
  • Liberia
  • Madagascar
  • Myanmar
  • Sierra Leone
  • South Sudan
  • Ukraine

For these countries, NaTHNaC recommends a booster dose of a polio-containing vaccine for those who have not received a dose within the previous 10 years travelling to these countries see our Country Information pages.

The polio status of countries is reviewed by WHO on a regular basis and polio vaccination recommendations are subject to change.

Advice for travellers

Polio is transmitted via the faecal-oral route, either by exposure to water contaminated by infected human faeces, or by person to person contact. You should practise strict food, water and personal hygiene. Independent of your destination, you should complete a primary vaccination course for polio according to the UK schedule. Travellers are encouraged to carry documentary evidence of their polio vaccination status. An International Certificate of Vaccination or Prophylaxis is required by some countries see our Country Information pages for country specific information.

Advice for health professionals

All travellers regardless of destination should be up to date with routine vaccination courses and boosters as recommended in the UK. See our Country Information pages for country specific recommendations and certificate requirements.

For specific outbreak information, check our Outbreak Surveillance. The polio status of countries is reviewed by WHO on a regular basis and polio vaccination recommendations are subject to change.


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