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

Key Points

  • Temporary polio vaccine recommendations affect the following countries: Afghanistan, Angola, Benin, Burma (Myanmar), Central African Republic, Democratic Republic of the Congo, Ethiopia, Ghana, Indonesia, Mozambique, Niger, Nigeria, Pakistan, Papua New Guinea, the  Philippines, and Somalia.
  • Long-term travelers (staying longer than 4 weeks) in Afghanistan, Burma, Indonesia, Nigeria, Pakistan, Papua New Guinea, and Somalia may be required to show proof of polio vaccination when leaving these countries. To meet this requirement, long-term travelers should receive the polio vaccine between 4 weeks and 12 months before their date of departure from these polio-infected countries.
  • Clinicians are encouraged to err on the side of caution by ensuring patients are 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 wild poliovirus (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.

Situation

In May 2019, the World Health Organization (WHO) updated its statement regarding the international spread of poliovirus, noting that strong progress had been made but that the spread has continued. The WHO 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, Burma, Indonesia, Nigeria,1 Pakistan, Papua New Guinea, and Somalia1

WPV1 has been reported in three countries: Afghanistan, Nigeria, and Pakistan. These countries, as well as any countries infected with circulating vaccine-derived polioviruses type 1 or 3 (cVDPV1 or cVDPV3), have been defined by WHO as having the potential risk of international spread. Circulation of cVDPV1 has been reported in Burma, Indonesia, and Papua New Guinea, and circulation of cVDPV3 has been reported in Somalia. As part of the elimination strategy, WHO recommends that these 7 countries:

  • Ensure that all residents and long-term visitors receive a dose of inactivated polio vaccine (IPV) or bivalent oral polio vaccine (bOPV) before international travel. This guidance applies to all departing travelers who have been in country for longer than 4 weeks. Travelers should receive a dose of IPV or bOPV not less than 4 weeks and not more than 12 months before leaving the country.
  • Ensure that any travelers departing the country in less than 4 weeks who have not received a dose of IPV or bOPV in the previous 4 weeks to 12 months get a dose at least by the time of departure, as it will still provide benefit, particularly for frequent travelers.
  • Ensure proper documentation of polio vaccination on an International Certificate of Vaccination or Prophylaxis (ICVP) yellow card.

WHO Temporary Recommendations for Angola, Benin, Central African Republic, Democratic Republic of the Congo, Ethiopia, Ghana, Mozambique, Niger, Nigeria,1 the Philippines, and Somalia1

WHO has identified Angola, Benin, Central African Republic, Democratic Republic of the Congo, Ethiopia, Ghana, Mozambique, Niger, Nigeria, the Philippines, and Somalia as countries infected with circulating vaccine-derived poliovirus type 2 (cVDPV2). As part of the elimination strategy, WHO recommends that these 11 countries:

  • Encourage all residents and long-term visitors to receive a dose of IPV before leaving the country. This guidance applies to all departing travelers who have been in the country for longer than 4 weeks. Travelers should receive their vaccination not less than 4 weeks and not more than 12 months before leaving the country.
  • Encourage any travelers departing the country in less than 4 weeks who have not received a dose of IPV in the previous 4 weeks to 12 months to get a dose at least by the time of departure.
  • Ensure proper documentation of polio vaccination on an ICVP yellow card.

Because of a global shortage of IPV, these countries may be unable 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.

1Nigeria and Somalia have cVDPV2 in addition to WPV1 (in Nigeria) and cVDPV3 (in Somalia). To provide the broadest possible protection against disease, expatriates and long-term visitors to these countries should receive IPV. If IPV is not available, however, they should receive bOPV but should be aware that bOPV does not protect against cVDPV2.

Information for Clinicians

CDC recommends that travelers to any country with WPV or cVDPV circulation in the past 12 months be protected fully 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 2014 CDC MMWR Interim CDC Guidance for Polio Vaccination for Travel to and from Countries Affected by Wild Poliovirus. See the section Interim Vaccination Guidance to Comply with WHO International Health Regulations Temporary Recommendations for Countries Designated as “Polio-infected” (but note that the country-specific information provided in this 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 ICVP.
  • Infants and children
    • One dose of IPV should be given at 2 months, 4 months, 6–18 months, and 4–6 years (for a total of 4 doses).
    • Children and adolescents who are unvaccinated or incompletely vaccinated or who 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 4, PoliomyelitisCDC Yellow Book.
    • 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 receive 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 4, PoliomyelitisCDC Yellow Book.
  • Travelers staying in a poliovirus-infected country longer than 12 months may receive available IPV or bOPV in that country to meet the departure vaccination 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, CDC will update this document and the polio vaccine information on the destination pages for affected countries.

Table. Summary of countries affected by wild and vaccine-derived poliovirus

Country cVDPV1 cVDPV2 cVDPV3 WPV1 Long-term (≥4 weeks) travelers show proof of polio vaccination when leaving
Required Recommended
Afghanistan      

x

x

 
Angola  

x

     

x

Benin          

x

Burma

x

     

x

 
Central African Republic  

x

     

x

Democratic Republic of the Congo  

x

     

x

Ethiopia  

x

     

x

Ghana  

x

     

x

Indonesia

x

     

x

 
Mozambique  

x

     

x

Niger  

x

     

x

Nigeria  

x

 

x

x

 
Pakistan      

x

x

 
Papua New Guinea

x

     

x

 
The Philippines  

x

     

x

Somalia  

x

x

 

x

 

 

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