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  • Polio vaccination for stays in countries with polio outbreaks


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 during the COVID-19 pandemic. Nevertheless, the WHO considers that the risk of polio transmission is concerning.


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 during the COVID-19 pandemic. Nevertheless, the WHO considers that the risk of polio transmission is concerning.

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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 November 2022, the recommendation applies to the following countries:

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

Vaccine advice for stays in countries with polio incidence

Countries with outbreaks of wild poliovirus or vaccine-derived poliovirus type 1 or type 3

The WHO requires countries that are at risk of exporting wild poliovirus or vaccine-derived polio type 1 or 3 should ensure that everyone travelling out of these countries has received the polio vaccine. This is in addition to an intensification of the polio vaccination of the population.

From November 2022, this applies to:

  • Wild poliovirus: Afghanistan, Pakistan and Malawi
  • Vaccine-derived poliovirus type 1: Madagascar, Mozambique, Malawi, DR Congo
  • Vaccine-derived poliovirus type 3: Israel

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 the country. This applies for 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).

Wild poliovirus is endemic today only in Pakistan and Afghanistan. Recently confirmed cases of wild poliovirus in Malawi and Mozambique are considered to be imported infection due to genetic similarity to poliovirus found in Pakistan.

Vaccine-derived polio type 3 was detected in Jerusalem, Israel in March 2022 in an unvaccinated child with new-onset paralysis.

Countries with vaccine-derived poliovirus type 2 in circulation

For travel to countries where vaccine-derived poliovirus type 2 is present, it is extra important to ensure up-to-date polio vaccination and to consider bringing forward vaccination of infants. WHO and the Norwegian health authorities encourage visitors who have stayed in these countries for over 4 weeks to follow the same advice in the above section.

From November 2022, this applies for:

Algeria, Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Democratic Republic of the Congo, Djibouti, Egypt, Eritrea, Ethiopia, Gambia, Ghana, Iran, Israel, Ivory Coast, Mauritania, Mozambique, Niger, Nigeria, Senegal, Somalia, Togo, Uganda, Ukraine, UK, USA and Yemen.

Several countries have incidences of vaccine-derived poliovirus type 2. Polio outbreaks in Yemen, DR Congo and Nigeria account for 85 % of all disease cases worldwide in 2021-2022. In 2021, two cases were reported in Ukraine.

By 2022, four new countries have reported circulating vaccine-derived poliovirus type 2: Algeria, Israel, UK and USA.

In July 2022, the WHO reported a polio case in Rockland County, in the state of New York, USA. The patient was an unvaccinated adult who developed paralysis. Corresponding polioviruses have been detected in several sewage samples in the same area. Related viruses have also been detected in sewage in London, UK and in Jerusalem, Israel in 2022, with no cases of disease detected. The relation between detected viruses speaks indicates vaccine virus circulation across national borders in connection with travel.

Vaccination coverage in the US, UK and Israel is generally high, but the virus has been detected in geographic local areas with under-vaccinated population groups. Therefore, the vaccine virus has been able to circulate and regain disease-causing abilities. Vaccination campaigns have been launched and surveillance heightened in these countries.

Countries without detected cases, but vulnerable to reintroduction of poliovirus

The countries of Guinea, Guinea-Bissau, Iran, China, Kenya, Liberia, Congo, Sierra Leone, Sudan, South Sudan and Tajikistan 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 particularly 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.

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. 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)).

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.


28.11.2022: Updated for polio according to Statement of the Thirty-third Polio IHR Emergency Committee (WHO november 2022)

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