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Clinical Update
Polio Vaccine Guidance for Travelers and Note on Travel to Israel

Destination-Specific Recommendations for Polio Vaccine

 

Country CDC Recommendation

Afghanistan
Cameroon
Equatorial Guinea
Ethiopia
Iraq
Israel
Kenya
Nigeria
Pakistan
Somalia
Syria

Single lifetime additional IPV (inactivated polio vaccine) dose recommended for adults who received routine vaccination series as children; routine series recommended for unvaccinated or incompletely vaccinated children and adults and those with unknown vaccination status.
Benin
Central African Republic (CAR)
Chad
China (Xinjiang province only)
Egypt
Gabon
Iran
Jordan
Lebanon
Niger
Republic of Congo
South Sudan
Sudan
Turkey
Uganda
Yemen
Recommended for travelers to these countries or provinces who will be in situations with a high risk of exposure to someone with imported poliovirus. These situations include working in health care settings involving direct patient contact, refugee camps, or other humanitarian aid settings. Single lifetime additional IPV dose recommended for adults who received routine vaccination series as children; routine series recommended for unvaccinated or incompletely vaccinated children and adults and those with unknown vaccination status.

Changes in CDC Polio Vaccine Recommendations

Many polio outbreaks occurred in previously polio-free countries during 2003–2011. For this reason, CDC has been recommending a one-time booster dose with inactivated poliovirus vaccine (IPV) for certain travelers. Previously, this recommendation has been not only for adults traveling to countries with active poliovirus circulation, but also for adults traveling to countries that bordered countries with active circulation.

Key Points

  • Changes in CDC polio vaccine guidance for travelers now harmonize CDC recommendations with World Health Organization recommendations.
  • CDC recommends that all international travelers be fully vaccinated against polio.
  • An additional, one-time adult polio vaccine booster dose is recommended for travelers to certain countries.
  • Although no human polio cases have been identified, environmental surveillance indicates that Israel has active poliovirus circulation. CDC is now recommending an adult polio vaccine booster dose for travelers to Israel.

Currently, endemic poliovirus circulation has never been interrupted in only 3 countries: Afghanistan, Nigeria, and Pakistan. Still, the affected areas within each of these countries have become smaller. Because of the substantial progress of the polio eradication initiative in 2012–2013, and in order to harmonize CDC recommendations with World Health Organization (WHO) recommendations, CDC now recommends an adult IPV booster dose only for travelers to countries with active poliovirus circulation. Countries are considered to have active poliovirus circulation if they have ongoing endemic circulation, active polio outbreaks, or environmental evidence of active wild poliovirus circulation.

In addition, CDC recommends an adult IPV booster dose for certain travelers to some countries that border areas with active poliovirus circulation. These recommendations are based on evidence of historical cross-border transmission. The recommendations apply only to travelers with a high risk of exposure to someone with imported wild poliovirus (WPV) infection. These travelers would include those working in health care settings, refugee camps, or other humanitarian aid settings.

See the Vaccine section in Chapter 3, Poliomyelitis, CDC Health Information for International Travel, for specific vaccination details.

Current Situation in Israel

On June 3, 2013, the WHO Disease Outbreak News reported detection of WPV type 1 in samples of sewage from Rahat, a Bedouin village in the Southern District of Israel. WHO assessed the risk of spread to other countries as “low to moderate” at that time (see the WHO report).

By July 15, testing had identified a total of 10 WPV-positive sampling sites in the Southern District (some with multiple WPV-positive specimens collected serially). WHO issued an update and assessed the risk of spread as “moderate to high” (see the WHO report). Since then, some sampling sites in the Central District have also yielded positive results.

On August 15, WHO issued further information indicating WPV had been detected in 67 sewage samples taken during February 3, 2013, through August 4, 2013. These samples were taken from sites in the Southern and Central Districts. WHO also indicated that positive stool specimens had been collected from some healthy children who had been fully-vaccinated with IPV (see the WHO report).

No human polio cases have been identified in Israel to date. Childhood vaccination coverage in Israel with 4 doses of IPV is very high (90%–95%). Israel also has an extensive system of environmental surveillance (i.e., testing of sewage samples for poliovirus). The Israel Ministry of Health is recommending increased attention to hand washing and undertaking catch-up vaccination of children who have not completed the polio vaccination series. On August 4, 2013, the Ministry of Health also initiated a campaign to vaccinate all children born since 2004 (and aged >2 months) in the Southern District with bivalent oral polio vaccine (OPV). On August 18th, the Ministry of Health extended the campaign nationally to vaccinate all children born since 2004.

At this time, CDC recommends that all travelers to Israel be fully vaccinated against polio and practice good personal hygiene and cleanliness. In addition, adults should receive a one-time IPV booster dose before traveling to Israel. See the Vaccine section in Chapter 3, Poliomyelitis, CDC Health Information for International Travel, for specific vaccination details.

Additional Information:

 
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