International spread of wild poliovirus continues to be of international concern, risk to Europe unchanged

​The fourth meeting of the International Health Regulations Emergency Committee regarding the international spread of wild poliovirus convened on 17 February 2015. The Committee concluded that, although the risk of international spread from the infected countries, with the exception of Pakistan, appears to have declined, the situation still constitutes a Public Health Emergency of International Concern (PHEIC). The Committee recommended the extension of the Temporary Recommendations for a further three months to the ten wild poliovirus-affected areas: four ‘currently exporting countries’ (Cameroon, Equatorial Guinea, Pakistan and the Syrian Arabic Republic) and the remaining ‘affected but currently not exporting’ countries (Afghanistan, Ethiopia, Iraq, Israel, Somalia and Nigeria).

The Committee noted that Ethiopia, Israel and Iraq will meet the criteria for a newly added category ‘countries no longer infected by wild poliovirus, but remaining vulnerable to international spread’ by 16 March, 28 April and 19 May respectively, if no further detection of wild poliovirus occurs up to these dates. Syria will belong to this risk category from 17 March, should no further exportations or cases of wild poliovirus occur.

Furthermore, it was noted that by 11 March and 4 April, 12 months would have elapsed since any documented exportation from Cameroon and Equatorial Guinea, respectively. After each of those dates, these countries will meet the criteria as ‘affected but not currently exporting countries’, should no further exportations of wild poliovirus occur. If this is the case then Pakistan would be the only currently exporting country.

The Committee assessed that the expansion of conflict-affected areas, particularly in the Middle East and Central Africa, has worsened the global polio threat following a decline in health services leading to deterioration of immunisation delivery systems.Recognising the escalating wild poliovirus transmission in Pakistan, with more reported cases than at any time in the past 14 years, further measures were proposed by the Committee:

• Pakistan should restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination. These recommendations apply to international travellers from all points of departure, irrespective of the means of conveyance (e.g. road, air, sea);
• Pakistan should note that the recommendation stated previously for urgent travel remains valid (i.e. those undertaking urgent travel who have not received appropriate polio vaccination must receive a dose of polio vaccine at least by the time of departure and be provided with appropriate documentation of that dose);
• Pakistan should continue to provide to the Director-General a report on the implementation by month of the Temporary Recommendations on international travel, including the number of residents whose travel was restricted and the number of travellers who were vaccinated and provided appropriate documentation at the point of departure.
• Recognising that the movement of people across the border with Afghanistan continues to facilitate exportation of wild poliovirus, Pakistan should intensify cross border efforts by improving coordination with Afghanistan to substantially increase vaccination coverage of travellers crossing the border and of high risk cross-border populations.

Risk to Europe

The conclusions of the International Health Regulations Emergency Committee do not change the ECDC risk assessment for Europe. The continuing circulation of wild poliovirus in ten countries shows that there is a continued risk for the disease being imported into the EU/EEA. ECDC previously concluded that in the event of importation of wild-type poliovirus resulting in the re-establishment of virus circulation in the EU, the overall risk to EU residents would be:

• very low in OPV-vaccinated populations for both poliovirus infection and disease;
• moderate in IPV-only cohorts for poliovirus infection and very low for disease; and
• high in low- or unvaccinated groups for poliovirus infection and moderate for disease.

 

ECDC endorses the temporary recommendation of WHO and suggests the following options for intervention to EU/EEA Member States:• Revise polio vaccination advice to EU travellers and residents to the ten affected countries, and in particular to Pakistan.

• Advise travellers to, and EU residents in, polio-affected countries to have an additional IPV dose within 12 months from planned travel to polio-affected countries.
• Prioritise assessment of polio vaccination uptake at the national, subnational and local levels, and the identification of vulnerable and under-vaccinated populations; efforts should be increased to improve vaccination coverage to 90 per cent in accordance with national or regional immunisation recommendations.
• Assess the vaccination status of refugees and migrants from polio-affected countries at the time of entry into the EU/EEA; people not vaccinated against polio or other diseases should be offered age-appropriate vaccinations and in accordance with the host country’s vaccination schedule.

ECDC continues to support the EU-wide response to the threat of poliovirus spreading across Europe and will, upon request, support individual EU Member States in all areas related to their preparedness, e.g. the detection and control of poliovirus importations.

 

Read more:

• Updated ECDC polio risk assessment, June 2014