Current confusion regarding Oral Polio Vaccine requirements by Government of India, applicable from 14th Feb 2014 - what the experts say ?

Here is what one expert has to say regarding the current Oral Polio Vaccine requirement that will become mandatory from 14th February, 2014 for all travelers from 7 countries including Nigeria, Kenya, Pakistan, Afghanistan, Ethiopia, Somalia & Israel.

"We've been attempting to get clarity on a number of issues and so far have not been able to pin down details of implementation. 
What is clear is that the Ministry of Health requires proof of OPV for all travellers arriving in India from Afghanistan, Ethiopia, Israel, Kenya, Nigeria, Pakistan or Somalia, from 14th February onwards. The vaccination must have been administered between six weeks to one year before arrival in India. Proof of vaccination is also required from Indian citizens who travel to those seven countries.
This has been stated at on the websites of the Indian Foreign Missions at least in Nigeriahttp://www.indianhcabuja.com/ , and Pakistan :  http://www.india.org.pk/
There is an announcement on Kenyan Airways as well http://www.kenya-airways.com/Global/About_Kenya_Airways/News/Full_Polio_Vaccination_for_travelers_entering_India_from_Kenya/?dis=y

Beyond that we only have verbal information from government sources and which at times seems to be contradictory.
What we can piece together so far is that it is likely that the requirement to show proof of vaccination will be tied to the visa process. We do not know if any control at entry points will be implemented i.e. will the immigration officers at the airports be checking for vaccination certificates. So far we haven't seen anything in visa documentation that requests vaccination information / certification. The arrival card doesn't ask about vaccination but does ask for country of residence and countries visited in the last 6 days. People who transit through the target countries don't appear to fall under the requirement. When we asked how long someone would need to be in those countries to become subject to the requirement we were advised "a considerable amount of time" with no indication as to whether this meant days, weeks or months. So for the scenario below it is completely unclear whether your traveler will be required to show proof, even if he / she has a valid visa.
In addition it is not clear what will be accepted as proof. Inquiries to the Ministry of External Affairs seems to point to the WHO yellow card ICV 2005 as being required, and the sample document on the Indian High Comm in Pakistan website is a Word document with text that mirrors that on the yellow card ICV. However in India at this point, the yellow card is only readily available at government facilities that provide yellow fever vaccination. However these centers do not have OPV. (and the facilities that do have OPV don't have yellow cards)

We are hoping that process will be clearer after 14th February 2014. At the moment the more digging we do, the more conflicting information we appear to turn up

Best regards
Irene

Dr Irene Lai, M.B.,B.S,  FFTM RCPS(Glasg)
Medical Director
Medical Information and Analysis
International SOS"

How long can i wait after mixing the Yellow Fever Vaccine & reconstituting it?

Q: We reconstituted a dose of Stamaril vaccine, but the client was unable to take the same due to some reason. How long can I keep this liquid vaccine?
Ans. You have to discard any unused dose of a reconstituted Yellow Fever Vaccine after 1 hour at most. It is a very unstable vaccine after the diluent is mixed with the vaccine, and we need to use it as soon as possible. Any longer & it may not work, and more importantly may potentially lead to side-effects.
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Yellow fever vaccine production delay affects international travelers

SASKATOON A temporary production delay for the yellow fever vaccine has caused a shortage across North America.

Only people going to countries with a high risk of the mosquito-carrying disease are guaranteed to receive the shot.

The criteria for what constitutes a country as "high risk" is determined by the U.S. Centers for Disease Control.

Yellow fever, which gets its name from the yellowing of the skin and eyes that occurs when the virus attacks the liver, exists in tropical regions of Central and South America, as well as parts of Africa and Asia, but the risk levels differ from country to country.

The vaccine is manufactured in France by Sanofi Pasteur, but no one could be reached to explain the production delay.

“If a traveler is unable to receive the vaccine and still travels to that location, that’s a decision they’re making,” Schwandt said.

He adds that it’s still important for people to consult medical officials to see if they require any other vaccines or anti-malarial medication.

If travelers require a yellow fever vaccination certificate in order to enter a specific country, the health region will provide a medical waiver free of charge.

“And that is to say that the risk related to the vaccine is higher than the benefit, and this is only for those places where there is a low risk of yellow fever but our clients still require evidence of vaccination in order to enter those countries,” Schwandt said.

The health region expects the vaccine supply to be replenished by the end of the month. In the meantime, it’s asking people with travel dates further into the future to reschedule their appointment, which would free up vaccines for those travelling in the interim.

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Health regulations for travelers for entering & leaving India - GOI

Health Regulation

 (A) For entry into India:-

Any person, Foreigner or Indian, (excluding infants below six months) arriving by air or sea without a vaccination certificate of yellow fever will be kept in quarantine isolation for a period up to 6 days if :

• He arrives in India within 6 days of departure/transit from a yellow fever endemic area.
• Has come on a ship which has started from or transited at any port in a yellow fever endemic country within 30 days of its arrival in India provided such ship has not been disinfected in accordance with the procedure laid down by WHO.

(B) For leaving India:-

There is no health check requirement by Indian Government on passengers leaving India.
Persons leaving for a yellow fever infected area are advised in their own interest to get themselves vaccinated and to be possession of valid yellow fever vaccination certificates before they leave the country.
An administrative Arrangement for the health control of sea, air and land traffic exists between the Government of India and the Government of Bangladesh. It implies that ,if any aircraft or ship or land traffic from a third country arrives first at any airport or port or border check post in either of the agreement countries and then directly (without touching any other third country enroute) reaches the second country of the agreement, all health checks will be completed in the country of first arrival and the travellers will be exempted from any further health check on arrival in the second country.

Persons exempted from production of vaccination certificate :

The under mentioned persons are exempted from production yellow fever vaccination certificate:

• Infants below the age of six months.
• Any person suffering from some chronic illness and has poor resistance and is thereby exempted from being vaccinated.
• Crew and passengers of an aircraft transiting through an airport located in yellow fever infected area provided the Health Officer is satisfied that such persons remained within the airport premises during the period of stay.

Countries regarded as yellow fever infected

The following countries are regarded as yellow fever endemic :

Africa:

Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Cote d' Ivoire, Democratic Republic of Congo, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea Bissau,  Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Sudan, South Sudan,Togo, Uganda.

South America:

Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guyana, Guyana, Suriname, Trinidad (Trinidad only), Venezuela, Panama, Paraguay, Peru.
 

• A Yellow fever vaccination certificate is valid only if it conforms to the model. The validity period of international certificate of vaccination or re-vaccination against yellow fever is 10 years, beginning 10 days after vaccination.
• Foreign nationals residing or who have passed through the Yellow fever endemic countries during the preceding six days, are granted visas only after the production of vaccination certificate of Yellow Fever. After checking the vaccination certificate an entry reads as “Valid Yellow Fever Vaccination Certificate Checked” is made in the passport of the foreigner.

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Travel Health Question - Travel health: yellow fever jab renewal

Gill Rose writes

In February my husband and I are flying from South Africa to the Victoria Falls in Zambia for three days, then returning to South Africa to finish our holiday. We have been told that we need a yellow fever vaccination certificate. We had these vaccinations in 2001, which puts us outside the 10-year limit. There was talk of these vaccinations lasting a lifetime but we cannot find any definitive answers. We are both over 60 years old and would obviously prefer not to have further vaccinations if possible. Do you know whether our 2001 certificates would be acceptable for re-entry to South Africa? We are also planning to visit Sao Tome in September – would the same principle apply?

Dr Richard Dawood, travel health expert, replies

Although medical experts now acknowledge that yellow fever vaccine provides long-term protection, the International Health Regulations have not yet changed, and the validity of the official Yellow Fever Certificate is unchanged – it currently lasts 10 years and after that it is invalid. It could be a long time before international agreement is reached on changing these rules. Until then, when travelling to a country that requires a valid certificate as a condition of entry, the position is clear: your certificate will have to be updated if you want to continue travelling.

The issue of yellow fever vaccination in over-60s is an interesting one. Yellow fever vaccine contains live, weakened virus, and the risk of vaccine side effects is known to increase with age. However, the increased risk applies only to individuals who are being vaccinated for the first time, who therefore have no prior immunity to the vaccine virus. It does not apply to re-vaccination, so safety concerns should not be an issue.

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What is the maximum age for taking the Yellow fever Vaccine?

Q Hello Doctor, Can you please confirm if there is any age limit for a person beyond which he/she is not allowed to avail this vaccine to travel to African counties...
Actually my Aunt (age 72+) is all set to travel to Malawi this Mid of Feb and I am trying to fix a YF vaccine appointment (in kolkata) for her but someone told that 72+ age is a concern and can't avail YF vaccine. Is that true?

Ans. You can get the Yellow Fever Vaccination at any age. We have personally vaccinated clients 87 years old too. Yes there is a slightly increased risk of serious adverse effects with YF vaccine in older people, however the overall risk is still very low (1:40,000 or lower), hence if travel is necessary then this can certainly be given. 

A per WHO,  risk of contracting viscerotropic disease after YF vaccination of persons more than 70 years of age is estimated to be 2.4 cases/100 000 vaccine doses.

Hence I believe that if travel is necessary, your aunt can certainly consider taking the Stamaril (Yellow Fever) vaccination.

Read more here

CDC Report - Yellow Fever in Sudan

Released: January 08, 2014

What is the current situation?

As of December 3, 2013, the World Health Organization (WHO) has reported 44 suspected cases of yellow fever, including 14 deaths, from October 3 to November 24, 2013. Some of the cases have been laboratory-confirmed. The outbreak is located in West and South Kordofan states of Sudan. Sudan’s Federal Ministry of Health and WHO are planning a mass yellow fever vaccination campaign in the affected areas to control the outbreak.

What is yellow fever?

Yellow fever is a disease caused a virus, which is spread through mosquito bites. Symptoms take 3–6 days to develop and include fever, chills, headache, backache, and muscle aches. About 15% of people who get yellow fever develop serious illness that can lead to bleeding, shock, organ failure, and sometimes death.

How can travelers protect themselves?

Travelers can protect themselves from yellow fever by getting yellow fever vaccine and preventing mosquito bites. Learn more about CDC’s yellow fever recommendations for Sudan on the Sudan destination page.

Get yellow fever vaccine:

• Visit a yellow fever vaccination (travel) clinic and ask for a yellow fever vaccine.
  • You should receive this vaccine at least 10 days before your trip.
  • After receiving the vaccine, you will receive a signed and stamped International Certificate of Vaccination or Prophylaxis (ICVP, sometimes called the “yellow card”), which you must bring with you on your trip.
  • The vaccine lasts for 10 years.
  • In rare cases, the yellow fever vaccine can have serious and sometimes fatal side effects. People older than 60 years and people with weakened immune systems might be at higher risk of developing these side effects. Also, there are special concerns for pregnant and nursing women. Talk to your doctor about whether you should get the vaccine.

Prevent mosquito bites:

• Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.
• Use an appropriate insect repellent as directed.
• Higher percentages of active ingredient provide longer protection. Use products with the following active ingredients:
  • DEET (Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon)
  • Picaridin (also known as KBR 3023, Bayrepel, and icaridin) (Products containing picaridin include Cutter Advanced, Skin So Soft Bug Guard Plus, and Autan [outside the US])
  • Oil of lemon eucalyptus (OLE) or PMD (Products containing OLE include Repel and Off! Botanicals)
  • IR3535 (Products containing IR3535 include Skin So Soft Bug Guard Plus Expedition and SkinSmart)
• Always follow product directions and reapply as directed:
  • If you are also using sunscreen, apply sunscreen first and insect repellent second.
  • Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.
• Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:
  • Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last.
  • If treating items yourself, follow the product instructions carefully.
  • Do not use permethrin directly on skin.
• Stay and sleep in screened or air conditioned rooms.
• Use a bed net if the area where you are sleeping is exposed to the outdoors.

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Polio vaccination must for Pak travellers visiting India from January

NEW DELHI: Pakistanis visiting India will now have to take oral polio vaccination before travelling here. In a new rule coming into effect from January, Indian government has asked all Pakistanis to show evidence of a polio vaccination before being given a visa to India. It applies to Indians traveling to Pakistan or other countries where polio continues.

Pakistan, along with Nigeria and Afghanistan, remains one of the last places in the world where polio still persists. Pakistan is, in particular, sorely afflicted because the Taliban have been conducting a campaign against polio eradication campaigns in Khyber Pakhtunkhwa and FATA regions.

A press release by the Indian High Commission in Islamabad says, "All persons - adults and children - traveling to India from Pakistan after January 30, 2014 are required to obtain Oral Polio Vaccination (OPV) at least six week prior to their departure to India, but not more than one year before such departure. Travelers from Pakistan to India after January 30, 2014 are required to carry their vaccination record as evidence of Polio vaccination will be requested for entry into India thereafter."

The polio vaccine, the statement says, is valid only for a year, so it will have to be taken again, if the person is travelling to India again. The move, it explained, "is being taken to safeguard India's polio-free status attained after sustained after large efforts and investment. It is applicable to all travelers from all countries where polio disease is endemic or where cases of polio are reported. It is also applicable to Indian nationals travelling to and from these countries." The same rules will apply to travel from Nigeria and Afghanistan as well.

Pakistan's militants have long had an uneasy history with polio vaccination, with several religious leaders asserting it was a Western conspiracy to make Pakistani children sterile. But a concerted targeting of anti-polio campaigns by the Taliban came after the Osama bin Laden hit in 2011. US government said they used a fake polio vaccination programme to harvest DNA of bin Laden's family members from their hideout in Abbottabad. Since July 2012, at least 22 polio workers have been killed.

However, there has been a change of heart in recent weeks. Last week, Sami-ul-Haq, head of the powerful Darul uloom Haqqania, put out a fatwa that polio vaccines are not un-Islamic and asked Pakistanis to get themselves and their children vaccinated. It's the first reversal of opposition by radical Islamic groups in Pakistan.

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Comments: In fact there are currently at least 7 countries where this recommendation of compulsory Polio vaccination is valid for traveling to India

1. Somalia

2. Ethiopia

3. Israel

4. Kenya

5. Nigeria

6. Afghanistan 

7. Pakistan

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