International Health Regulations



Polio declared a Public Health Emergency of International Concern
 

Polio declared a Public Health Emergency of International Concern At a meeting of the International Health Regulations Emergency Committee on 28 and 29 April to discuss the international spread of polio virus, the committee advised that “hat the international spread of polio to date in 2014 constitutes an ‘extraordinary event’ and a public health risk to other States for which a coordinated international response is essential”.

The committee issued a statement saying: “The current situation stands in stark contrast to the near-cessation of international spread of wild poliovirus from January 2012 through the 2013 low transmission season for this disease (i.e. January to April). If unchecked, this situation could result in failure to eradicate globally one of the world’s most serious vaccine preventable diseases. It was the unanimous view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have been met.”

At end-2013, 60% of polio cases were the result of international spread of wild poliovirus, and there was increasing evidence that adult travellers contributed to this spread. During the 2014 low transmission season there has already been international spread of wild poliovirus from 3 of the 10 States that are currently infected: in central Asia (from Pakistan to Afghanistan), in the Middle East (Syrian Arab Republic to Iraq) and in Central Africa (Cameroon to Equatorial Guinea). A coordinated international response is deemed essential to stop this international spread of wild poliovirus and to prevent new spread with the onset of the high transmission season in May/June 2014; unilateral measures may prove less effective in stopping international spread than a coordinated response. The consequences of further international spread are particularly acute today given the large number of polio-free but conflict-torn and fragile States which have severely compromised routine immunization services and are at high risk of re-infection. Such States would experience extreme difficulty in mounting an effective response were wild poliovirus to be reintroduced. As much international spread occurs across land borders, WHO should continue to facilitate a coordinated regional approach to accelerate interruption of virus transmission in each epidemiologic zone.

The over-riding priority for all polioinfected States must be to interrupt wild poliovirus transmission within their borders as rapidly as possible through the immediate and full application in all geographic areas of the polio eradication strategies, specifically: supplementary immunization campaigns with oral poliovirus vaccine (OPV), surveillance for poliovirus, and routine immunization. The Committee provided the following advice to the Director-General for her consideration to reduce the international spread of wild poliovirus, based on a risk stratification of the 10 States with active transmission (i.e. within the previous 6 months) as of 29 April 2014.

States currently exporting wild poliovirus Pakistan, Cameroon, and the Syrian Arab Republic pose the greatest risk of further wild poliovirus exportations in 2014. These States should:

- officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency;

- ensure that all residents and longterm visitors (i.e. > 4 weeks) receive a dose of OPV or inactivated poliovirus vaccine (IPV) between 4 weeks and 12 months prior to international travel;

- ensure that those undertaking urgent travel (i.e. within 4 weeks), who have not received a dose of OPV or IPV in the previous 4 weeks to 12 months, receive a dose of polio vaccine at least by the time of departure as this will still provide benefit, particularly for frequent travellers;

- ensure that such travellers are provided with an International Certificate of Vaccination or Prophylaxis in the form specified in Annex 6 of the International Health Regulations (2005) to record their polio vaccination and serve as proof of vaccination;

- maintain these measures until the following criteria have been met: (i) at least 6 months have passed without new exportations and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until at least 12 months have passed without new exportations.

States infected with wild poliovirus but not currently exporting
Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and particularly Nigeria, given the international spread from that State historically, pose an ongoing risk for new wild poliovirus exportations in 2014.

 Date of upload: 14th July 2014

 

                                  
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