# 8811
Two months ago (May 5th) the World Health Organization - after convening a meeting of their Emergency Committee on the recent spike in polio cases in the Middle East and parts of Africa- Declared Polio Spread A Public Health Emergency Of International Concern (PHEIC).
A month later, the CDC published a HAN (Health Alert Network) Advisory with New Vaccination Requirements For Travel To Countries With Active Polio.
Yesterday the MMWR fleshed out these new vaccine requirements in an early release called:
Interim CDC Guidance for Polio Vaccination for Travel to and from Countries Affected by Wild Poliovirus
Early Release
July 7, 2014 / 63(Early Release);1-4Gregory S. Wallace, MD1, Jane F. Seward, MBBS1, Mark A. Pallansch, PhD1 (Author affiliations at end of text)
(Excerpt)
Vaccine Recommendations and Requirements
Advisory Committee on Immunization Practices (ACIP) and CDC recommendations are evidence-based and provide public health recommendations to the general public on the basis of the best available epidemiological and scientific data to prevent poliovirus infection. This includes recommendations for travelers visiting countries with WPV circulation in the last 12 months or countries and provinces where they will be in situations with a high risk for exposure to persons with imported poliovirus infection.
Three countries are still endemic for polio (Afghanistan, Nigeria, and Pakistan). Countries where WPV has circulated during the previous 12 months include those endemic countries and those with polio outbreaks or environmental evidence of active WPV circulation during this time (Cameroon, Ethiopia, Equatorial Guinea, Iraq, Israel, Somalia, and Syria). Travelers working in health-care settings, refugee camps, or other humanitarian aid settings in these and neighboring countries might be at particular risk for exposure to WPV.
Recommendations for vaccination under the International Health Regulations differ from ACIP and CDC recommendations and include exit requirements for proof of polio vaccination when leaving the country at borders or through airports. If implemented by a country, these requirements could be mandatory and are intended to prevent exportation of WPV.
Vaccine Recommendations for Travelers to Countries with WPV Circulation
Persons at greatest risk for acquiring polio are unvaccinated persons. In the United States, infants and children should be vaccinated against polio as part of a routine immunization series. Before traveling to areas with WPV circulation, all travelers should ensure that they have completed the recommended age-appropriate polio vaccine series and have received a booster dose, if necessary.*
Infants and Children
In the United States, all infants and children should receive 4 doses of IPV at ages 2, 4, and 6–18 months and 4–6 years (10). The final dose should be administered at age ≥4 years, regardless of the number of previous doses, and should be given ≥6 months after the previous dose. A fourth dose in the routine IPV series is not necessary if the third dose was administered at age ≥4 years and ≥6 months after the previous dose (11). Infants and children traveling to areas where there has been WPV circulation in the last 12 months should be vaccinated according to the routine schedule. If the routine series cannot be administered within the recommended intervals before protection is needed, an accelerated schedule can be used as follows: 1) the first dose should be given to infants aged ≥6 weeks, 2) the second and third doses should be administered ≥4 weeks after the previous doses, and 3) the minimum interval between the third and fourth doses is 6 months.
If the age-appropriate series is not completed before departure, the remaining IPV doses to complete a full series should be administered when feasible, at the intervals recommended for the accelerated schedule. If doses are needed while residing in the affected country, the polio vaccine that is available (IPV or OPV) may be administered.
Adults
Adults, who are traveling to areas where there has been WPV circulation in the last 12 months and who are unvaccinated, incompletely vaccinated, or whose vaccination status is unknown should receive a series of 3 doses: 2 doses of IPV administered at an interval of 4–8 weeks; a third dose should be administered 6–12 months after the second. If 3 doses of IPV cannot be administered within the recommended intervals before protection is needed, the following alternatives are recommended:
- If >8 weeks are available before protection is needed, 3 doses of IPV should be administered ≥4 weeks apart.
- If <8 weeks but >4 weeks are available before protection is needed, 2 doses of IPV should be administered ≥4 weeks apart.
- If <4 weeks are available before protection is needed, a single dose of IPV is recommended.
If <3 doses are administered, the remaining IPV doses to complete a 3-dose series should be administered when feasible, at appropriate intervals, if the person remains at increased risk for poliovirus exposure. If doses are needed while residing in the affected country, the polio vaccine that is available (IPV or OPV) may be administered.
Adults who have completed a routine series of polio vaccine are considered to have lifelong immunity to poliovirus, but data are lacking (12). As a precaution, persons aged ≥18 years who are traveling to areas where there has been WPV circulation in the last 12 months and who have received a routine series with either IPV or OPV in childhood should receive another dose of IPV before departure. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.
