Rapid risk assessment: International spread of wild-type poliovirus in 2014 declared a Public Health Emergency of International Concern under the International Health Regulations (IHR) – May 2014

Risk assessment
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European Centre for Disease Prevention and Control. International spread of wild-type poliovirus in 2014 declared a Public Health Emergency of International Concern under the International Health Regulations (IHR) – 28 May 2014. Stockholm: ECDC; 2014

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ECDC acknowledges that the recent spread of wild-type polio virus threatens the eradication of poliomyelitis and welcomes the declaration of a Public Health Emergency of International Concern (PHEIC) by the World Health Organization.

WHO issued temporary recommendations for reducing and controlling the spread (i.e. importation) of wild polioviruses from polio-infected countries. This Rapid Risk Assessment examines the implications of the temporary recommendations for EU Member States and assesses whether the developments leading to the declaration of a PHEIC represent an increased risk of WPV importation to Member States of the European Union. It also considers practical suggestions for implementing the WHO recommendations in the EU.

Executive summary

Following the announcement of a Public Health Emergency of International Concern (PHEIC) by the World Health Organization recently, ECDC examines the risk of importing polio to Europe and implications of the temporary recommendations on polio vaccination to Member States.

On risk of importing wild-poliovirus to the EU

Previous assessments on the risk of poliovirus importation and re-introduction of polio transmission in the EU following WPV circulation in Israel and Syria (link to previous RA) do not need to be changed in light of the declaration of a PHEIC and the WHO temporary recommendations.

Temporary polio vaccination recommendations

ECDC recognises that the declaration of a PHEIC may require Member States to revise their advice to travellers to polio-infected countries. ECDC suggests the following actions to EU/EEA Member States:
 

  • Revise  polio vaccination advice to EU travellers and residents, in particular in the ten countries that reported infections. Travellers to polio-affected countries should have an additional IPV dose 12 months before planned departure from polio-infected countries. 
  • Prioritise assessment of polio vaccination uptake at the national, subnational and local levels, and the identification of vulnerable and undervaccinated populations; efforts should be increased to improve vaccination coverage to 90 per cent in accordance with national or regional immunisation recommendations.
  • Based on a review of available evidence and expert opinion, Member States are strongly advised to 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.

 

WHO issued temporary recommendations for reducing and controlling the spread (i.e. importation) of wild polioviruses from polio-infected countries. These recommendations apply to people who visit or live in countries where poliovirus is still circulating and have direct and immediate consequences for EU travellers and EU residents.
 
There are 10 polio-affected countries according to WHO:
 

  • Three ‘currently exporting countries’ (Pakistan, Cameroon and Syria) from which the virus has been carried to other countries in 2014. 
  • Seven countries (Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Nigeria) which are affected but are currently not exporting poliovirus.

 
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.