Travel advice: New recommendations for residents and visitors to polio-infected countries
26 May 2014
These are temporary recommendations to EU travellers to polio-infected countries, upon request from the European Commission. These are based on the temporary recommendations from the World Health Organisation (WHO) who declared a Public Health Emergency of International Concern on polio on 5 May 2014.
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Most residents in the EU are likely to have received a full course of polio vaccination according to the national immunisation schedule where they live. For people fully vaccinated against polio, the previous advice was to have one additional dose of polio vaccine before travelling to a polio-infected area.
The national recommendations for the interval between such booster doses vary between countries from one life-time additional dose to a fully vaccinated person, to one additional dose every 10 years.
In view of the new temporary recommendations issued by WHO, which requires the polio-infected countries to ensure or encourage that people leaving these countries have been vaccinated against polio in the last 12 months, there may be practical reasons for EU Member States to revise their advice to travellers to polio-infected countries. In order to avoid the possibility of being required to be vaccinated on the border when leaving a polio-infected country, travellers to polio-infected countries are advised to comply with the WHO recommendations before visiting a polio-infected country. People who are residents in polio-infected countries are advised to comply with the WHO vaccination recommendations before travelling out of the country.
Travellers from the EU who are fully vaccinated against polio according to the national immunisation schedule where they live and plan to travel to any of the 10 polio-infected countries should receive an additional dose of IPV. In order to comply with the WHO recommendations and avoid having to be vaccinated in the polio-infected country, it is important that travellers to polio-infected countries time this additional IPV dose so that it is given within 12 months of the date when they plan to leave the polio-infected country.
Everyone who lives in or has stayed more than four weeks in a polio-infected country and plans to travel out of that country, should receive one additional dose of polio vaccine (IPV or OPV) not later than four weeks before and within 12 months of the date of departure from the polio-infected country.
If someone who has stayed more than four weeks in a polio-infected country has to urgently travel out of that country (i.e. within four weeks), that person should receive a dose of polio vaccine at the latest by the time of departure unless he or she already received a dose within the last 12 months.
- Travellers should carry proof of their vaccination against polio using the WHO International Certificate of Vaccination or Prophylaxis document (‘Yellow Card’) when travelling to and from polio-infected countries.
- EU residents who have not been vaccinated against polio at all, or have not received a complete course of polio vaccinations, or are unsure about their vaccination status, should consult with their physician, a vaccination clinic or a travel health clinic for advice and vaccination. This advice is both for travellers to polio-infected countries and for all EU residents and citizens regardless of travel plans.
- The vaccination advice above applies to both adults and children under the age of 18 years. Because polio vaccine is administered to children as part of combination vaccines (one injection with several vaccine components) in the routine vaccination schedule, it is important to consult a physician or vaccination clinic for advice on the timing and choice of vaccine for children.
- The risk of coming into contact with poliovirus in a polio-infected country can be reduced by applying strict hand hygiene (washing hands with soap before preparing food and eating, and after going to the toilet) and by washing and peeling raw fruit and vegetables immediately before eating them.
WHO recommends that countries currently exporting wild poliovirus (Pakistan, Cameroon, and Syria) ensure that:
- all residents and long-term visitors (i.e. more than four weeks) receive a dose of OPV or IPV between four weeks and 12 months prior to international travel;
- those undertaking urgent travel (i.e. within four weeks), who have not received a dose of OPV or IPV in the previous 12 months, receive a dose of polio vaccine at the latest by the time of departure;
- such travellers are provided with an International Certificate of Vaccination or Prophylaxis in the form specified in Annex 6 of the International Health Regulations (2005) to record their polio vaccination and serve as proof of vaccination.
WHO recommends that countries that are infected with wild poliovirus but not currently exporting the virus encourage their residents and visitors to follow the same vaccination advice as for the exporting countries.
The new recommendations from the World Health Organisation (WHO) are temporary and apply to people who visit or live in countries where poliovirus is still circulating. Travellers to these countries should consult national travel advice in their home countries and in the country that they plan to visit, in addition to the WHO recommendations. The purpose of the WHO recommendations is to stop poliovirus from being transported out of a polio-infected country to a country that has been cleared of polio. Vaccinated people can become infected with poliovirus in the gut for a short period without experiencing symptoms. The infection does not cause any harm or symptoms, and will clear after a few weeks. But the infected person can carry the virus to polio-free areas where it can cause outbreaks. The risk of carrying poliovirus diminishes after a person has received an additional dose of polio vaccine (booster) and then slowly increases as time passes from the last vaccination. This is why WHO now recommends residents of and visitors to polio-infected countries to get an additional dose of polio vaccine within 12 months before travelling out of the polio-infected country.
Exportation of polio virus from a polio-infected country to a polio-free country with poor vaccination uptake could result in large outbreaks that would jeopardise the polio eradication goal.
To prevent this, WHO has declared the international spread of polio to be a public health emergency of international concern, and issued temporary recommendations for the 10 countries in which poliovirus is still circulating.
The 10 polio-infected countries are Afghanistan, Cameroon, Ethiopia, Equatorial Guinea, Iraq, Israel, Nigeria, Pakistan, Somalia and Syria. Poliovirus was detected in sewage in Israel in 2013 but no one in Israel has developed paralytic poliomyelitis. The other nine countries have reported cases of paralytic polio in recent years.
WHO divides the ten polio-infected countries into two groups:
- three polio-exporting countries: Pakistan, Cameroon and Syria, where cases of polio are reported and from which poliovirus has been exported in the recent past, and;
- seven polio-infected countries: Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Nigeria, which are infected with wild poliovirus but currently not exporting wild poliovirus to other countries.