Poliomyelitis

WHO declares the international spread of wild poliovirus a public health emergency of international concern.

Page last updated: 18 July 2014

On Monday 5 May 2014, the WHO Director General (DG) declared the recent international spread of wild poliovirus a “public health emergency of international concern” and issued Temporary Recommendations under the International Health Regulations (2005).

The WHO statement is available on the WHO website. Further updates are available on the Global Polio Eradication Initiative website.

These recommendations aim to prevent further international spread of poliomyelitis which, if it occurs, could result in the failure to eradicate one of the world’s most serious vaccine preventable diseases.

Health professionals are reminded to be vigilant for signs of poliovirus infection, including acute flaccid paralysis, in travellers returning from polio infected countries and to notify their Department of Health and the National Enterovirus Reference Laboratory immediately on suspicion of this disease.

WHO emergency recommendations

For countries currently exporting wild poliovirus (Pakistan, Cameroon, Syria and Equatorial Guinea):

  • the head of state or government should officially declare that the interruption of polio transmission is now a national public health emergency, if this has not been done already;
  • they should ensure that all residents and long-term visitors (of over 4 weeks) receive an additional dose of oral polio vaccine (OPV) or inactivated poliovirus vaccine (IPV) between 4 weeks and 12 months before each international journey;
  • they should ensure that residents and long-term visitors who are going on urgent travel (less than 4 weeks notice) and have not been vaccinated with OPV or IPV within the previous 4 weeks to 12 months, receive a dose at least by the time of departure as this will still provide benefit, particularly for frequent travellers;
  • they should ensure travellers are provided with a WHO/IHR “yellow booklet” International Certificate of Vaccination or Prophylaxis or equivalent to record their polio vaccination and serve as proof of vaccination;
  • they should maintain these measures until at least 6 months have passed without new exportations and with documentation that there is strong surveillance for the virus and that people are getting vaccinated in all infected and high risk areas. Without such documentation, these measures should be maintained until at least 12 months have passed without new exportations.

For countries which currently have wild poliovirus but have not transmitted it to another country in the low-transmission season in 2014 (Afghanistan, Ethiopia, Iraq, Israel, Somalia and Nigeria):

  • the head of state or government should officially declare that the interruption of polio transmission is now a national public health emergency, if this has not been done already;
  • they should encourage residents and long-term visitors to receive an additional dose of OPV or IPV 4 weeks to 12 months prior to each international journey; those undertaking urgent travel (less than 4 weeks notice) who have not been vaccinated with a dose of OPV or IPV within the previous 4 weeks to 12 months should be encouraged to receive a dose by the time of departure;
  • ensure travellers have access to an appropriate document to record their polio vaccination status;
  • maintain these measures until at least 6 months have passed without the detection of wild poliovirus transmission in the country from any source.

Recommendations for Australian travellers

It is recommended that Australians travelling to Pakistan, Cameroon, Syria, Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia or Nigeria are up to date with routinely recommended vaccinations against polio, including a booster, prior to departure.

Australians travelling to Pakistan, Cameroon, Syria or Equatorial Guinea, and staying for periods greater than 4 weeks, will be required to have documented evidence of having received a dose of polio vaccine within 12 months prior to departure from these countries. If you do not have documented evidence of polio vaccination within this 12 month period, you may be required to be vaccinated prior to departure from these countries.

Australians travelling to Afghanistan, Ethiopia, Iraq, Israel, Somalia or Nigeria, and staying for periods greater than 4 weeks, are encouraged to have documented evidence of having received a dose of polio vaccine within 12 months prior to departure from these countries. If you do not have documented evidence of polio vaccination within this 12 month period, you may be encouraged to be vaccinated prior to departure from these countries.

Documented evidence should include a completed World Health Organization “yellow booklet” International Certificate of Vaccination or Prophylaxis which are available at some travel clinics or otherwise can be ordered by your doctor from the WHO.

Australian travellers should consult with their general practitioner regarding their vaccination requirements.

The Global Polio Eradication Programme

The Global Polio Eradication Programme has made significant progress in eliminating poliomyelitis since its inception in 1988. At that time over 125 countries were considered to have endemic polio and an estimated 350,000 children were paralysed each year. By 2012, global case numbers had decreased to a low of 223 before increasing to 417 last year.

In 2014, poliovirus has already been exported internationally from three countries during the low transmission season between January and April resulting in the risk of an exponential increase in cases moving into the high season.

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Status of Polio in Australia

The Western Pacific Region, including Australia, was declared polio-free in 2000. Australia has an excellent record of polio control with the last case of poliomyelitis caused by a locally acquired wild poliovirus in Australia reported in 1972. A comprehensive national risk assessment was undertaken in 2012 which found that the risk of polio transmission following importation of a poliovirus in Australia was low. This low risk is mainly due to the very high vaccination coverage against polio in Australia.

In Australia the National Immunisation Programme provides polio immunisation for children with doses of inactivated polio vaccine provided at 2, 4 and 6 months of age followed by a booster at 4 years of age. Coverage rates associated with this programme for children are above 90%. A booster dose is also recommended, though not funded, for adults who are travelling to polio infected areas as per WHO International Travel and Health, 2012 guidelines and health care workers in possible contact with the poliovirus.

The Department provides advice on the need for vaccination when travelling to polio infected countries through the Department of Foreign Affairs and Trade’s Smartraveller website.

Poliovirus infections are nationally notifiable in Australia. Australia has maintained WHO certification standard surveillance including for clinical cases of acute flaccid paralysis (AFP) which is supplemented by sentinel environmental and human enterovirus surveillance.

Australia maintains a polio response plan, ‘An Acute Flaccid Paralysis and Polio Response Plan for Australia’. Any single case of poliomyelitis in Australia is considered a public health emergency and would activate the polio response plan. The plan is available on the Department of Health website.