Interim CDC Guidance for Polio Vaccination for Travel to and From Countries Affected by Wild Poliovirus

Gregory S. Wallace, MD; Jane F. Seward, MBBS; Mark A. Pallansch, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2014;63(27):591-594. 

In This Article

Introduction

In the prevaccine era, infection with wild poliovirus (WPV) was common worldwide, with seasonal peaks and epidemics in the summer and fall in temperate areas. The incidence of poliomyelitis in the United States declined rapidly after the licensure of inactivated polio vaccine (IPV) in 1955 and live oral polio vaccine (OPV) in the 1960s.[1] The last cases of indigenously acquired WPV in the United States occurred in 1979, the last WPV case in a U.S. resident traveling abroad occurred in 1986, and the last WPV imported case was in 1993.[2,3] Since 2000, the United States has exclusively used IPV, resulting in prevention of 8–10 vaccine-associated paralytic poliomyelitis cases annually. In 2005, an unvaccinated U.S. adult traveling abroad acquired vaccine-associated paralytic poliomyelitis after contact with an infant recently vaccinated with OPV.[4]

The Global Polio Eradication Initiative has made great progress in eradicating WPV, reducing the number of reported polio cases worldwide by >99% since the late 1980s. Only three countries remain in which WPV circulation has never been interrupted: Afghanistan, Nigeria, and Pakistan. However, polio could be brought into the United States from countries where WPV is circulating. During the last 6 months, 10 countries have had active transmission of WPV, and four of these countries have exported WPV to other countries. In the last 10 years, at least 40 polio-free countries have been affected through international travel.[5]

In 2012, the completion of polio eradication was declared a programmatic emergency by the World Health Assembly.[6] On May 5, 2014, the director-general of the World Health Organization (WHO) declared the international spread of polio to be a public health emergency of international concern under the authority of the International Health Regulations[7] and issued temporary vaccination recommendations for travelers from countries with active WPV transmission to prevent further spread of the disease.[8] On June 2, 2014, CDC issued a health alert providing guidance to U.S. clinicians regarding new WHO polio vaccination requirements for travel by residents of and long-term visitors to countries with active poliovirus transmission.[9] This report provides an update on CDC policy for polio vaccination of travelers for health protection. It also provides additional interim guidance for physicians whose U.S. resident patients will travel to or reside in affected countries for >4 weeks, to ensure those patients will have evidence of administration of polio vaccine (IPV or OPV) within 12 months of travel that might be required when they depart from countries with active poliovirus transmission. This interim guidance is to ensure compliance with WHO International Health Regulations temporary recommendations for countries designated as "polio-infected" to reduce the risk for exportation of WPV from those countries.

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