31 May 2019

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 twenty-first meeting of the Emergency Committee (EC) under International Health Regulations (IHR) 2005 was convened on 21 May 2019 to review the data on wild poliovirus (WPV) and circulating vaccine derived polioviruses (cVDPV) and progress made towards stopping transmission since the last report (1 March 2019) [1].

A further rise in number of WPV1 cases globally during 2019 (particularly in Pakistan where, as of 21 May, 17 cases have already been reported during 2019) [2], and multiple outbreaks of cVDPV in Africa, continue to cause concern; 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 21 May 2019 [1].

IHR Temporary Recommendation categories

(countries with a change in status since the last EC meeting are in bold. Please refer to Country Information pages for further information)

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

  • Afghanistan - WPV1
  • Nigeria - WPV1
  • Pakistan – WPV1
  • Indonesia – cVDPV1
  • Papua New Guinea – cVDPV1
  • Somalia -cVDPV3

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

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

  • DR Congo*
  • Mozambique*
  • Niger*
  • Nigeria
  • 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 (note: on 24 May 2019, two cases of Vaccine Derived Poliovirus (VDPV) were reported to WHO; investigations are ongoing and further information will be posted when available) [3].
  • Chad
  • Kenya
  • Syria 

Other

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.

WPV1 was recently detected in sewage in Iran in an area close to the border with Pakistan. There is no evidence of virus transmission in Iran, which has high polio immunisation coverage. The virus found appears to be closely linked to poliovirus found recently in Karachi, Pakistan. The situation is being closely monitored [1]; further information will be posted when available.

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

Advice for travellers

You can become infected with the Polio virus through contact with the infected human faeces and/or respiratory secretions of an infected person. The virus can also be found in food or water contaminated with infected faeces. You should practise strict food, water and personal hygiene

Wherever you are travelling to, you should make sure you have completed a primary vaccination course for polio according to the UK schedule. Vaccines used in the UK schedule contain inactivated polio vaccine (IPV) and provide protection against types 1, 2 and 3 polioviruses. The bivalent oral polio vaccine (bOPV) used in some other countries, does not protect against type 2 poliovirus. You should check with your doctor or nurse that you are protected against all types of poliovirus.

You are encouraged to carry documentary evidence of your polio vaccinations. 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.

Resources

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