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Health Alert

WHO temporary polio vaccine recommendations

Updated: September 14, 2016

Travel Health Notice

Polio is a very contagious infection that is caused by the poliovirus. There are currently two types of poliovirus circulating in some countries which cause human infection:

• Wild polioviruses are those that occur naturally.
• Circulating vaccine derived polioviruses (cVDPV) are rare strains of poliovirus that have mutated from the strain contained in the oral polio vaccine. CVDPV takes a long time to occur; it happens when immunization activities are poorly conducted and a population is left susceptible to either the vaccine-derived or the wild poliovirus.  Hence, the problem is not with the vaccine itself, but low vaccination coverage in a population where oral polio vaccination programs are in place.

If a population is fully immunized, its members will be protected against both vaccine-derived and wild poliovirus.

On August 22, 2016, the World Health Organization (WHO) reassessed the temporary polio recommendations and declared that the international spread of wild poliovirus continues to constitute a public health emergency of international concern. As such, the WHO temporary recommendations continue to be in place. The situation will be reassessed by the WHO within 3 months.

The WHO temporary recommendations currently apply to long term travellers (over 4 weeks) to:

• countries currently exporting wild poliovirus or vaccine derived poliovirus (Afghanistan and Pakistan)
• countries infected with wild poliovirus or vaccine derived poliovirus but not currently exporting Burma (Myanmar), Guinea, Laos, Madagascar and Nigeria.

Travellers to these countries should follow the recommendations outlined below.

The Global Polio Eradication Initiative website offers additional detailed information regarding the temporary recommendations including weekly updates on the epidemiological situation and a breakdown of the number of cases of wild poliovirus by country.

The Public Health Agency of Canada continues to monitor the situation and inform the public as information becomes available.

Recommendations for travellers

Consult a health care provider or visit a travel health clinic, preferably six weeks before you travel outside of Canada.
Follow the WHO temporary recommendations:

1. The WHO temporary recommendations apply to long term travellers (more than 4 weeks) to Afghanistan and Pakistan. These countries have been designated as “states currently exporting wild poliovirus or cVDPV” by the WHO IHR Emergency Committee. The WHO recommendations state that these countries should ensure that long term travellers to these countries:
   • Be fully vaccinated against polio.
   • Receive an additional dose of oral poliovirus vaccine (OPV) or inactivated poliovirus vaccine (IPV) between 4 weeks and 12 months prior to international travel.
   • Be aware that a polio booster may be required to exit a designated country or enter into another, even if you already received an adult booster dose over a year ago.
   • Carry the appropriate documentation. It is recommended that you carry a written vaccination record in the event that evidence of vaccination is requested for country entry or exit requirements. Your proof of vaccination should be documented in the International Certificate of Vaccination or Prophylaxis which you can get from a Yellow Fever Vaccination Centre.
2. The WHO temporary recommendations also apply to long term travellers (more than 4 weeks) to countries “infected with wild poliovirus or cVDPV but not currently exporting” (Burma (Myanmar), Guinea, Laos, Madagascar and Nigeria).  The WHO recommendations state that these countries should encourage that long term travellers to these countries:
   • Be fully vaccinated against polio.
   • Receive an additional dose of oral poliovirus vaccine (OPV) or inactivated poliovirus vaccine (IPV) between 4 weeks and 12 months prior to international travel.
   • Should carry appropriate documentation of their vaccination status, such as a card or booklet.
3. Consult the Travel Health Notice on Polio: Global Update for further recommendations for travellers.

For additional information, WHO has developed frequently asked questions for travellers about the temporary recommendations.

Recommendations for health care providers

The Committee to Advise on Tropical Medicine and Travel (CATMAT) has developed a statement in accordance with the WHO temporary recommendations to provide guidance for health care professionals who are preparing travellers to visit areas with a risk of polio transmission. For the latest updates on Temporary Recommendations to Reduce International Spread of Poliovirus please consult the Global Eradication Initiative.

It is recommended that travellers affected by these temporary recommendations carry a written vaccination record in the event that evidence of vaccination is requested for country entry or exit requirements. The International Certificate of Vaccination or Prophylaxis  is the official document to show proof of vaccination against polio. It is currently available at Yellow Fever Vaccination Centres in Canada.  A complete list of these centres is available on the Public Health Agency of Canada website.