COMMENTARY

CDC Interim Guidance: Polio Vaccine Requirements for Travelers Abroad

Mark Pallansch, PhD

Disclosures

December 15, 2014

Editorial Collaboration

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Hello. I'm Dr Mark Pallansch, a polio expert at the Centers for Disease Control and Prevention (CDC). I'm speaking with you as part of CDC's Expert Video Commentary Series on Medscape.

The Global Polio Eradication Initiative has made great progress toward eliminating polio, reducing the number of cases reported worldwide by more than 99% since the late 1980s. In only three countries has poliovirus transmission never been interrupted, and the affected areas in these countries have shrunk in recent years. However, during the first six months of 2014, seven countries that were previously polio-free have reported wild poliovirus transmission. And from January through April 2014, months normally considered to be the low-transmission season for poliovirus, travelers from four of the polio-infected countries exported the virus at a rate that the World Health Organization (WHO) considers a public health risk to other countries.

The high-transmission season for poliovirus has already begun, and WHO is concerned that cases could multiply considerably if the spread from polio-infected countries continues. These events prompted WHO on May 5 to declare the international spread of polio to be a public health emergency of international concern.

Under the authority of the International Health Regulations, WHO issued temporary vaccination recommendations for long-term visitors and residents traveling from countries with active poliovirus transmission. WHO is urging a coordinated international response to prevent further spread of poliovirus, and CDC recently released interim guidance to help ensure traveler compliance.

Today I will discuss CDC's interim guidance, which includes an update on the agency's policy for polio vaccination of travelers, and remind you of the importance of discussing polio vaccine with your patients. First I will give some background about polio in the United States. Thanks to effective vaccination, wild poliovirus hasn't circulated in this country since 1979. But we continue to vaccinate American children to protect them, knowing that an infected traveler could import poliovirus from another country at any moment, as has happened elsewhere in the world. This hasn't happened in the United States since 1993, but with the recent increase in international poliovirus transmission, it is as important as ever that people are up-to-date on their polio vaccination, especially before they embark on international travel.

CDC and the Advisory Committee on Immunization Practices (ACIP) routinely recommend that anyone planning travel to a country with wild poliovirus circulation be fully vaccinated with inactivated polio vaccine (IPV) based on the complete vaccination schedule available in CDC's Yellow Book. Adults who as children were fully vaccinated against polio should receive a single lifetime booster dose of IPV before traveling to any polio-affected country. For additional information on vaccine recommendations and countries with wild poliovirus circulation, consult CDC's Travelers' Health website and the Global Polio Eradication Initiative's up-to-date list of polio-infected countries.

As of May 5, people of all ages traveling or residing for more than 4 weeks in any polio-infected country may be required by the government of that country to show proof of polio vaccination before being permitted to leave the country.These requirements, if implemented, include having documented receipt of one dose of polio vaccine within 4 weeks to 12 months before the date of departure from that polio-infected country.

To help patients avoid travel delays from a polio-infected country because of vaccine requirements, US healthcare professionals should be fully aware of these possible requirements and make every effort to always ask patients about planned international travel. If travel is planned, you should explain the new polio vaccine requirements if they pertain, and ensure that the patient will be compliant at the time he or she plans to depart the polio-infected country. For guidance on interpreting ad hoc doses in relation to an individual's routine vaccine schedule, please consult the new CDC MMWR about polio vaccination for travelers.

In addition, on an International Certificate of Vaccination or Prophylaxis (ICVP, often referred to as the "WHO yellow card"), healthcare professionals should document all polio vaccine doses administered to patients. Information about where to order ICVPs and instructions about how to fill them out are available on CDC's Traveler's Health website. You should remind patients to always have their WHO yellow card with them while traveling.

To conclude, the recent increase in wild poliovirus spread and the WHO emergency declaration do not minimize the worldwide progress toward polio eradication. Rather, it focuses us on the role that everyone in the global community can play in preventing the spread of poliovirus from the last remaining countries with active poliovirus transmission and ensure that we get to the finish line for good.

Web Resources

Wallace GS, Seward JF, Pallansch MA. Interim CDC guidance for polio vaccination for travel to and from countries affected by wild poliovirus. MMWR Morb Mortal Wkly Rep. 2014;63:591-594.

World Health Organization. World--polio vaccination for travellers. June 12, 2014.

CDC Travelers' Health - Poliomyelitis

Centers for Disease Control and Prevention. Guidance to US clinicians regarding new WHO polio vaccination requirements for travel by residents of and long-term visitors to countries with active polio transmission. June 12, 2014.

Global Polio Eradication Initiative: Up-to-date list of countries where poliovirus is still circulating

CDC: Global Health--Polio

Mark A. Pallansch, PhD, is Director, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). He joined CDC in 1984 following completion of his PhD in biochemistry at the University of Wisconsin-Madison and postdoctoral work in Virology at Rockefeller University. He has been both consummate scientist and consequential public health leader during this tenure, with his virologic research efforts focusing on characterization and molecular epidemiology of polio and other viruses, development and evaluation of new diagnostic methods, and technology transfer to state and international public health laboratories. His public health leadership has been devoted to advancing the global polio eradication initiative, improving surveillance through establishing and nurturing global laboratory networks, and contributing to many of CDC's public health investigations of new or previously unrecognized infectious diseases.

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