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Clinical Update
Interim CDC Guidance for Travel to and from Countries Affected by the New Polio Vaccine Requirements

Key Points

  • The World Health Organization (WHO) declared the international spread of wild poliovirus (WPV) a public health emergency of international concern in 2014.
  • In May 2015, WHO released updated polio vaccine recommendations.
  • Temporary polio vaccine requirements affect the following countries: Afghanistan, Cameroon, Nigeria, Pakistan, and Somalia.
  • The requirements no longer apply to Equatorial Guinea, Ethiopia, Iraq, Israel, or Syria.
  • Long-term travelers (staying >4 weeks) to the polio-infected countries listed above may be required to show proof of polio vaccination when leaving the polio-infected country. To meet WHO requirements, long-term travelers should receive the polio vaccine between 4 weeks and 12 months before the date of departure from the polio-infected country.
  • Clinicians are encouraged to err on the side of caution by ensuring patients are properly prepared for any requirements they may face when leaving countries affected by the polio vaccine requirements.
  • CDC reaffirmed and updated vaccine recommendations for travelers to countries where WPV has circulated during the past 12 months and adult workers in bordering countries, where the risk of exposure to imported WPV may be high.

Situation Information

In May 2015, the World Health Organization (WHO) released an update regarding the international spread of polio, noting that strong progress had been made but that the spread has continued. The emergency committee unanimously agreed that the spread of polio still constitutes a public health emergency of international concern (PHEIC) and recommended extending revised temporary recommendations.

WHO Temporary Recommendations for Afghanistan and Pakistan

In the past year, WPV has spread internationally from 2 polio-infected countries: Afghanistan and Pakistan. These countries, defined as WPV-exporting countries by WHO, have the greatest risk for further WPV exportation. As part of the elimination strategy, WHO is recommending that these countries:

  • Ensure all residents and long-term visitors (staying >4 weeks) receive a dose of polio vaccine between 4 weeks and 12 months before leaving either country.
  • Ensure that anyone who has not received a dose of polio vaccine in the previous 4 weeks to 12 months do so before leaving either country.
  • Ensure documentation of polio vaccination on an International Certificate of Vaccination or Prophylaxis (ICVP) to serve as proof of vaccination.

Temporary Recommendations for Other Polio-Infected Countries

WHO has defined countries with WPV but not currently exporting as Cameroon, Nigeria, and Somalia. These countries pose an ongoing risk for new WPV exportations in 2015. As part of the elimination initiative, WHO is recommending that these 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 leaving any of these countries.
  • Encourage anyone who has not received a dose of polio vaccine in the previous 4 weeks to 12 months to do so before departure.
  • Ensure proper documentation of polio vaccination if it is given to the traveler.

Information for Clinicians

Five countries (Afghanistan, Cameroon, Nigeria, Pakistan, and Somalia) are considered polio-infected; CDC recommends that travelers to any country with WPV circulation in the past 12 months protect their health by being fully vaccinated against polio, including a single lifetime polio vaccine booster for adults. 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.”

To ensure US residents are properly prepared for any requirements they may face when leaving polio-infected countries, clinicians are advised to:

  • Document all polio vaccine administration 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, PoliomyelitisCDC 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 fourth dose between ages 18 months and 4 years will still require an IPV booster dose at age ≥4 years.
  • Adults
    • 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, PoliomyelitisCDC 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.

Ordering ICVPs

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

Polio - ICVP with polio sample info

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Clinicians should document polio vaccine administration in the ICVP section used for required vaccines, such as yellow fever vaccine. Use the figure above and instructions below to complete the required information for the certificate.

  1. The patient’s name should appear exactly as it is on the patient’s passport.
  2. The patient’s date of birth should be entered with the day in numerals, followed by the month in letters, and then the year (for example, 14 July 2014).
  3. This space is for the patient’s signature.
  4. ‘’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.)
  5. “Polio (IPV)” or “Polio (OPV)” should be written in this space.
  6. The date on which the vaccination is given should be entered with the day in numerals, followed by the month in letters, and then the year (for example, 14 July 2014).
  7. A handwritten signature of the clinician who administered the polio vaccine should appear in this box. A signature stamp is not acceptable.
  8. The ICVP 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 from 14 July 2014 through 15 June 2015.)
  9. If the provider has a Uniform Stamp used to validate yellow fever vaccination, then place it in this box. If not, record the name and contact information of the health care facility in this box.

Additional Information

 

 

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