10 Oct 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-second meeting of the Emergency Committee (EC) under International Health Regulations (IHR) 2005 was convened on 16 September 2019 to review the data on wild polio virus (WPV) and circulating vaccine derived polio viruses (cVDPV) and progress made towards stopping transmission since the last report (14 May 2019) [1].

The number of cases of Wild Polio Virus (type 1) (WPV1) has increased globally with 73 cases reported in 2019 to date compared to 15 during the same period in 2018; most of the increase is attributed to the ongoing outbreaks in Pakistan where surveillance and environmental sampling indicate transmission to be widespread. Community and individual resistance to vaccination continues to be a serious problem [1].

There are serious concerns too about the multiple outbreaks of cVDPV, particularly in Africa but also in parts of Asia.

Earlier in 2019, the first exportation of WPV1 since 2014 from Pakistan was reported; an environmental sample of WPV1 in sewage in Iran was identified through routine surveillance, close to the international border with Pakistan. The virus was closely linked to those found in Karachi, Pakistan [2]. Iran has good polio vaccination coverage and there was no onward transmission of polio virus, nevertheless this importation is of concern and highlights the global challenge to polio eradication [1].

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 25 September 2019 [1].

The statement from the EC, which provides the background to the emergency and detail on the current situation, is available here: Statement of the Twenty-Second IHR Emergency Committee Regarding the International Spread of Poliovirus.

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; these countries have a certificate requirement for polio vaccination under IHR (2005):

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

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

  • Angola*
  • Benin*
  • Cameroon* (environmental only)
  • CAR*
  • China*
  • DR Congo*
  • Ethiopia*
  • Ghana*
  • Mozambique*
  • Niger*
  • Nigeria
  • Philippines*
  • 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:

  • 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 [3]:

  • Equatorial Guinea
  • Guinea
  • Iran (environmental sample detected 9 May 2019)
  • Iraq
  • Laos
  • Liberia
  • Madagascar
  • 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

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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Ebola virus disease (EVD): Democratic Republic of Congo- update

The meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease (EVD) in DRC took place on 18 October 2019 Read more

‘Current aspects of travel health’ course March 2020

A single day update for health professionals will be held on 26 March in London Read more

Chad, Togo and Zambia: updated recommendations for polio vaccination

Circulating vaccine derived poliovirus type 2 has been confirmed by the World Health Organization in these African countries Read more

Measles reminder

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