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Article

Polio vaccination for stays in countries with polio outbreaks

After the World Health Organization (WHO) reported an increase in the number of cases and more countries with polio outbreaks (poliomyelitis) in 2019 and 2020, there has been a reduction in the number of reported cases in 2021. Nevertheless, the WHO considers that the risk of polio transmission is concerning. The ongoing COVID-19 pandemic and conflicts in some regions can make preventive work and polio vaccination challenging. The Norwegian Institute of Public Health recommends vaccination before travel to countries with ongoing or recent outbreaks of polio in order to protect the individual and prevent further transmission.

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After the World Health Organization (WHO) reported an increase in the number of cases and more countries with polio outbreaks (poliomyelitis) in 2019 and 2020, there has been a reduction in the number of reported cases in 2021. Nevertheless, the WHO considers that the risk of polio transmission is concerning. The ongoing COVID-19 pandemic and conflicts in some regions can make preventive work and polio vaccination challenging. The Norwegian Institute of Public Health recommends vaccination before travel to countries with ongoing or recent outbreaks of polio in order to protect the individual and prevent further transmission.


From March 2022, the recommendation applies to the following countries:

Afghanistan, Benin, Burkina Faso, Central African Republic, Djibouti, DR Congo, Egypt, Ivory Coast, Ehtiopia, Gambia, Ghana, Guinea, Guinea-Bissau, Iran, Yemen, Cameroon, Kenya, China, Liberia, Malawi, Mali, Madagascar, Mauritania, Mozambique, Niger, Nigeria, Pakistan, Rep Congo, Senegal, Sierra Leone, Somalia, Sudan, South-Sudan, Tajikistan, Togo, Chad, Ukraine and Uganda.

Vaccine advice for stays in countries with polio outbreaks

WHO requires countries that are at risk of exporting wild poliovirus to offer polio vaccine to anyone leaving these countries. This applies as of March 2022:

  • Wild poliovirus: Afghanistan, Pakistan and Malawi
  • Vaccine-derived poliovirus type 1: Madagascar and Yemen 

This is in addition to an intensification of the polio vaccination of the population. To prevent export of the infection out of these countries, you must have received the polio vaccine between 4 weeks and 12 months before departure from these countries. This applies to visitors who will stay in the country for more than 4 weeks. The vaccination must be documented with an international vaccine certificate.

The vaccination advice applies to people of all ages. Children must also be vaccinated against polio within 12 months before departure from these countries, even if they are considered fully vaccinated according to the Norwegian immunisation programme. If infants are going to travel to the countries mentioned above, the public health nurse / doctor should consider bringing vaccination forward and possibly switching to a 4-dose programme for infants who would otherwise not be able to receive two doses of polio vaccine before departure. The polio vaccine is given at vaccination clinics, public health clinics or by doctors (GPs).

A number of countries have an incidence of vaccine-derived poliovirus type 2. WHO and the Norwegian health authorities encourage travellers from these countries to follow the same advice as above. This applies from March 2022:

Afghanistan, Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Democratic Republic of the Congo, Djibouti, Egypt, Ethiopia, Gambia, Guinea, Guinea-Bissau, Iran, Liberia, Mauritania, Mozambique, Niger, Nigeria, Pakistan, Republic of the Congo, Senegal, Sierra Leone, Somalia, South Sudan, Tajikistan, Togo, Uganda and Yemen.

The countries of China, Ivory Coast, Ghana, Kenya, Mali, Sudan and Togo are considered by the WHO to be exposed to the reintroduction of poliovirus, although they have not yet reported cases of polio. For travel to these countries, it is extra important to ensure up-to-date polio vaccination, but the same applies to many other countries in the border areas of all the countries mentioned here.
 
In addition to information in the Statement of the Thirty-first Polio IHR Emergency Committee, the WHO reports an outbreak of vaccine-derived polio type 3 in Jerusalem, Israel. Polio was first detected on March 7 in an unvaccinated child with new-onset paralysis. Extensive testing for polio is ongoing to map the extent of the outbreak. Vaccination campaigns have been launched in Jerusalem for children between 6 weeks and 10 years. Vaccination coverage in the country is nevertheless high and the risk of exporting polio to other countries is considered low. The WHO emphasises the importance of ensuring up-to-date polio vaccination when traveling to Israel.

The Norwegian Institute of Public Health recommends that everyone should be protected against against diphtheria, tetanus, pertussis and polio, and receive a booster dose every 10 years.

About polio and polio vaccine

Polio (poliomyelitis) is a viral disease that can be eradicated with a vaccine, because the virus is only found in humans. Over 90 per cent of those infected have no symptoms, 9 per cent have influenza-like symptoms, while less than 1 per cent have paralysis. The paralysis can occur in muscles anywhere in the body, and can be fatal. The last major polio epidemic in Norway was in the mid-1950s, and domestic polio infection last occurred in 1969. The use of polio vaccines has kept the disease under control in most parts of the world, and the WHO's European Region was declared polio-free in 2002.

There are two types of polio vaccine, an inactivated (IPV - used in Norway) and a live, attenuated oral vaccine (OPV) that is used in many countries. Vaccine-related polio can only occur with the use of the live, attenuated polio vaccine, and is a rare occurrence, but can occur where vaccine coverage is low. In a population with low polio immunity, vaccine viruses can begin to circulate, and in a few cases gradually regain the ability to induce polio with paralysis (circulating vaccine-derived poliovirus (cVDPV)).

Wild poliovirus is currently found only in Pakistan, Afghanistan and most recently detected in Malawi (November 2021). The poliovirus detected in Malawi is genetically similar to the poliovirus found in Pakistan and is considered to be an import infection from Pakistan / Afghanistan. Investigation with extended testing for polio together with enhanced surveillance and polio vaccination has been initiated in Malawi and several neighbouring countries.

History

20.05.2022: Updated according to 31st Polio IHR Emergency Committee (WHO March 2022)

22.10.2021: Updated advice according to WHO report from August 2021