Interim CDC Guidance for Travel to and from Countries Affected by the New Polio Vaccine Requirements and Recommendations
- The World Health Organization (WHO) declared the international spread of wild poliovirus (WPV) a public health emergency of international concern in 2014.
- In May 2018, WHO released updated polio vaccine recommendations.
- Temporary polio vaccine recommendations affect the following countries: Afghanistan, Democratic Republic of the Congo, Kenya, Nigeria, Pakistan, Papua New Guinea, Somalia, and Syria.
- Long-term travelers (staying >4 weeks) to Afghanistan, Nigeria, Pakistan, Papua New Guinea, and Somalia may be required to show proof of polio vaccination when leaving these polio-infected countries. To meet WHO requirements, long-term travelers should receive the polio vaccine between 4 weeks and 12 months before the date of departure from these polio-infected countries.
- 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 for workers in institutional settings (such as health care facilities, refugee camps, or humanitarian aid settings) in bordering countries, where the risk of exposure to imported WPV may be high.
In May 2018, 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. In June 2018, WHO also confirmed circulation of vaccine-derived polivirus type 1 (cVDPV1) in Papua New Guinea.
WHO Temporary Recommendations for Afghanistan, Nigeria, Pakistan, Papua New Guinea, and Somalia
WPV has been reported in three countries: Afghanistan, Nigeria, and Pakistan. These countries, as well as any countries infected with circulating vaccine-derived polioviruses types 1 or 3 (cVDPV1 or cVDPV3), have been defined by WHO as having the potential risk of international spread. Circulation of cVDPV3 has been reported in Somalia and circulation of cVDPV1 has been reported in Papua New Guinea. As part of the elimination strategy, WHO is recommending that these five countries:
- Ensure all residents and long-term visitors (staying >4 weeks) of all ages receive a dose of inactivated polio vaccine (IPV) or bivalent oral polio vaccine (bOPV) between 4 weeks and 12 months before leaving the country.
- Ensure that anyone needing to leave the country in less than 4 weeks who has not received a dose of IPV or bOPV in the previous 4 weeks to 12 months get a dose before leaving the country
- Ensure documentation of polio vaccination on an International Certificate of Vaccination or Prophylaxis (ICVP).
Temporary Recommendations for Other Polio-infected Countries
WHO has identified Democratic Republic of the Congo, Kenya, Nigeria, Somalia, and Syria as countries infected with circulating vaccine-derived poliovirus type 2 (cVDPV2). As part of the elimination initiative, WHO is recommending that these countries:
- Encourage all residents and long-term visitors (staying >4 weeks) of all ages to receive a dose of IPV (if available) between 4 weeks and 12 months before exiting one of these countries.
- Encourage anyone needing to leave the country in less than 4 weeks who has not received a dose of IPV in the previous 4 weeks to 12 months to receive a dose of polio vaccine at least by the time of departure.
- Ensure that the traveler receives proper documentation of their polio vaccination.
Because there is a global shortage of IPV, these countries may not be able to implement these guidelines. The priority in such countries is providing a single dose of IPV to children as part of the routine immunization schedule.
Information for Clinicians
CDC recommends that travelers to any country with WPV or cVDPV circulation in the past 12 months protect their health by being fully vaccinated against polio, including a single lifetime polio vaccine booster for previously vaccinated 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” (note that the country information in this 2014 article is out of date).
- 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 International Certificate of Vaccination or Prophylaxis (ICVP).
- Infants and children
- Four doses of IPV should be given at ages 2 months, 4 months, 6–18 months, and 4–6 years.
- Children and adolescents who are unvaccinated or 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 depart 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.
- 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, are 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 poliovirus-infected country longer than 12 months may receive available IPV or bOPV in the infected country to meet the departure requirement. Children who receive OPV overseas should be evaluated when they return to the United States to ensure they are up-to-date per the US vaccine schedule.
- 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 reassess 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 buy ICVPs from the US Government Publishing 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 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.
- The patient’s name should appear exactly as it does 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, and then the year (for example, 14 July 2014).
- 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. 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, and then the year (for example, 14 July 2014).
- A handwritten signature of the clinician who administered the polio vaccine should appear in this box. A signature stamp is not acceptable.
- 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.)
- If the provider has a Uniform Stamp used to validate yellow fever vaccination, place it in this box. If not, record the name and contact information of the health care facility in this box.
- Interim CDC Guidance for Polio Vaccination for Travel to and from Countries Affected by Wild Poliovirus (MMWR, July 11, 2014)
- Poliomyelitis in CDC Health Information for International Travel ("Yellow Book”)
- CDC Polio for Healthcare Providers Homepage
- CDC Travelers’ Health Polio Disease Page
- Polio Vaccination: Information for Healthcare Professionals
- Polio Vaccine Information Statements
- 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")
- Page created: July 25, 2014
- Page last updated: July 12, 2018
- Page last reviewed: July 12, 2018
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