Interim CDC Guidance for Travel to and from Countries Affected by the New Polio Vaccine Requirements
- The World Health Organization (WHO) declared the international spread of wild poliovirus (WPV) a public health emergency of international concern.
- New temporary polio vaccine requirements affect the following countries: Afghanistan, Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Nigeria, Pakistan, Somalia, and Syria.
- Long-term travelers (staying >4 weeks) to the polio-infected countries listed above may be required to show proof of polio vaccination when departing the polio-infected country. To meet these WHO requirements, long-term travelers should receive polio vaccine between 4 weeks and 12 months before the date of departure from the polio-infected country.
- Clinicians are encouraged to act on the side of caution and ensure patients are properly prepared for any requirements they may face exiting countries affected by the polio vaccine requirements.
- CDC reaffirmed and updated vaccine recommendations for health protection for travelers to countries where WPV has circulated during the last 12 months and adult workers in bordering countries where the risk of exposure to imported WPV may be high.
WHO held an emergency committee meeting at the end of April 2014 to address the international spread of WPV. Increasing evidence suggests adult travelers have contributed to the exportation of WPV from polio-endemic countries. The potential for exportation of WPV to additional countries exists unless more aggressive measures are taken to prevent infections (which are predominantly asymptomatic). As a result of the meeting, on May 5, the Director General of WHO declared the international spread of WPV a public health emergency of international concern (PHEIC) and is adding a new initiative (effective immediately) to reduce the risk of further international spread of WPV.
WHO Temporary Recommendations for Cameroon, Equatorial Guinea, Pakistan, and Syria
During 2014, there has already been international spread of WPV from 4 countries that are currently polio-infected: Cameroon, Equatorial Guinea, Pakistan, and Syria. WHO has defined these countries as WPV-exporting countries, having the greatest risk for further WPV exportation. As part of the elimination strategy, WHO is recommending that these 4 countries—
- Ensure that all residents and long-term visitors (staying >4 weeks) receive a dose of polio vaccine between 4 weeks and 12 months before international travel (exiting one of these 4 countries).
- Ensure that anyone who has not received a dose polio vaccine in the previous 4 weeks to 12 months receives a dose of polio vaccine at least by the time of departure.
- Ensure documentation of polio vaccine is on an International Certificate of Vaccination or Prophylaxis (ICVP) to serve as proof of identification.
Temporary Recommendations for Other Polio-Infected Countries
WHO has defined countries with WPV but not currently exporting as Afghanistan, Ethiopia, Iraq, Israel, Somalia, and particularly Nigeria (given the international spread from that country historically). These countries pose an ongoing risk for new WPV exportations in 2014. As part of the elimination initiative, WHO is recommending that these 6 countries—
- Encourage all residents and long-term visitors (staying >4 weeks) to receive a dose of polio vaccine between 4 weeks and 12 months before international travel (exiting one of these countries).
- Encourage anyone who has not received a dose polio vaccine in the previous 4 weeks to 12 months to receive a dose of polio vaccine at least by the time of departure.
- Ensure proper documentation of polio vaccine is given to the traveler.
Information for Clinicians
Ten countries (Afghanistan, Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Nigeria, Pakistan, Somalia, and Syria) are considered polio-infected; CDC recommends that travelers to any country with WPV circulation in the last 12 months protect their health by being fully vaccinated against polio, including a single lifetime polio vaccine booster for adults. For more information, see the Clinical Update: Polio Vaccine Guidance for Travelers and Note on Travel to Israel, the West Bank, and Gaza. For specific information related to US travelers and guidance on interpreting any ad hoc doses of polio vaccine in relation to the individual’s vaccine schedule, please consult the CDC MMWR, Interim CDC Guidance for Polio Vaccination for Travel to and from Countries Affected by Wild Poliovirus, specifically the section titled Interim Vaccination Guidance to Comply with WHO International Health Regulations Temporary Recommendations for Countries Designated as “Polio-Infected.”
As of June 12, 2014, Pakistan has implemented exit requirements for polio vaccination, but it has not been determined how the WHO recommendations will be enforced by the remaining polio-infected countries. In order for US residents to be properly prepared for any requirements they may face when exiting the polio-infected countries, clinicians are advised to ensure the following:
- All polio vaccination administration should be documented on an ICVP.
- Infants and Children
- Current recommendations for infants and children state that 4 doses of IPV should be given at ages 2, 4, and 6–18 months and 4–6 years.
- Children and adolescents who are unvaccinated, incompletely vaccinated, or have an unknown vaccination status for polio should receive the complete schedule of IPV following the accelerated schedule and minimum ages and intervals outlined in the Vaccine section in Chapter 3, Poliomyelitis, CDC Health Information for International Travel.
- For children and adolescents who are up-to-date with IPV vaccination (including those who have completed the routine IPV series), who will be in a polio-infected country for >4 weeks, and whose last dose of polio vaccine was administered >12 months before the date they will be departing that country, an additional dose of IPV should be given. Children who receive this additional dose as a 4th dose between ages 18 months and 4 years will still require an IPV booster dose at age ≥4 years.
- In order to comply with the vaccination requirements described above, all adult travelers who have completed a routine series of polio vaccine and an adult IPV booster dose, who will be in a polio-infected country for >4 weeks, and whose last dose of IPV was administered >12 months before the date they plan to exit the polio-infected country should be given an additional dose of IPV.
- Adult travelers who are unvaccinated, incompletely vaccinated, or have an unknown vaccination status for polio should receive 3 doses of IPV following the accelerated schedule and minimum intervals outlined in the Vaccine section in Chapter 3, Poliomyelitis, CDC Health Information for International Travel.
- Travelers staying in a polio-infected country longer than 12 months may receive available poliovirus vaccine (IPV or OPV) in the infected country to meet the departure requirement.
- No serious adverse reactions to IPV have been documented; however, there is limited experience with administration of multiple additional doses.
- Clinicians should be aware that patients’ travel plans may change and should discuss optional polio vaccination for travelers planning to stay <4 weeks.
WHO will be reassessing the situation periodically. As additional plans or modifications are announced regarding enforcement of the WHO recommendations, we will update this document and the polio vaccine information on our destination pages for affected countries.
Clinics may purchase ICVPs from the US Government Printing Office (GPO) using the GPO website or toll-free number (1-866-512-1800). Search or ask for “CDC 731.” Packages of 25 or 100 are available.
Completing ICVPs for Polio
Clinicians should document polio vaccine administration in the section of the ICVP used to document required vaccines, such as yellow fever vaccine. Use the following figure and instructions to help complete the required information for the certificate.
- The patient’s name should appear exactly as on the patient’s passport.
- The patient’s date of birth should be entered with the day in numerals, followed by the month in letters, then the year.
- This space is for the patient’s signature.
- ‘’Polio” should be written on this line. (If the ICVP is also being used to document other required vaccines or prophylaxis, each relevant disease or condition should be listed on this line. Other non-required vaccines may be listed on the other side of the card.)
- “Polio (IPV)” or “Polio (OPV)” should be written in this space.
- The date on which the vaccination is given should be entered with the day in numerals, followed by the month in letters, then the year.
- A handwritten signature of the clinician who administered the polio vaccine should appear in this box. A signature stamp is not acceptable.
- The polio vaccination certificate is valid between 4 weeks and 12 months after the date of vaccination. The ending date for a valid vaccination recorded on the ICVP is 1 calendar day before the calendar day on which the vaccine was given. For example, a vaccination given on 16 June 2014 will be valid between 14 July 2014 and 15 June 2015.
- If the provider has a Uniform Stamp used to validate yellow fever vaccination, then place it in this box. If not, the name and contact information of the health care facility should be recorded in this box.
- Interim CDC Guidance for Polio Vaccination for Travel to and from Countries Affected by Wild Poliovirus (MMWR, July 11, 2014)
- CDC HAN 362: 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
- Clinical Update: Polio Vaccine Guidance for Travelers and Note on Travel to Israel, the West Bank, and Gaza
- Poliomyelitis in CDC Health Information for International Travel—“Yellow Book”
- CDC Polio Homepage
- CDC Travelers’ Health Polio Disease Page
- Polio Vaccine Questions and Answers
- Vaccine Information Statements (VIS)
- Food and Water Safety
- Global Polio Eradication Initiative—Data and Monitoring
- Immunization Schedules (CDC's National Center for Immunization and Respiratory Diseases)
- Poliomyelitis in Epidemiology and Prevention of Vaccine-Preventable Diseases—“Pink Book”
- Polio-Immediate Notifiable Disease