Skip directly to search Skip directly to A to Z list Skip directly to page options Skip directly to site content

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 February 2018, WHO released updated polio vaccine recommendations.
  • Temporary polio vaccine recommendations affect the following countries: Afghanistan, Democratic Republic of the Congo, Nigeria, Pakistan, and Syria.
  • Long-term travelers (staying >4 weeks) to Afghanistan, Nigeria, and Pakistan 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 adult workers in bordering countries, where the risk of exposure to imported WPV may be high.

Situation

In February 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. The committee also revised and updated the temporary recommendations by changing the risk categories for countries subject to the recommendations.

WHO Temporary Recommendations for Afghanistan, Nigeria, and Pakistan

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. As part of the elimination strategy, WHO is recommending that these 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 undertaking urgent travel who has not received a dose of IPV or bOPV in the previous 4 weeks to 12 months do so before leaving the 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 identified Democratic Republic of the Congo, Nigeria, Pakistan, 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 undertaking urgent travel 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 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 reference 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, 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 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.
  • Adults
    • 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 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.

Ordering ICVPs

Clinics may buy 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

View larger version

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 does 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, place it in this box. If not, record the name and contact information of the health care facility in this box.

Additional Information

 

 

TOP