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Thursday, February 6, 2014

Updated Polio Vaccine Guidelines from Govt of India - more confusion ?

Ministry of Health and Family Welfare, Government of India

Requirements of polio vaccination for international travelers between India and infected countries
The Ministry of Health and Family Welfare, Government of India has put in place, the requirement of a dose of oral polio vaccine (OPV) for all travelers to India from polio endemic countries and countries with polio virus circulation following importation.
The Ministry of Health and Family Welfare, Government of indie has also put in place, the requirement of a dose of OPV for travellers from india going to polio endemic countries and countries with poliovirus circulation following importation.

Polio infected countries:
a) Polio endemic countries: Afghanistan, Nigeria and Pakistan 
b} Countries with polio virus circulation following importation: Ethiopia, Kenya, Somalia
and Syria

The list of polio infected countries may be amended from time to time by Ministry of Health and Family Welfare, Government of lndia, depending on polio virus detection.

These mandatory requirements will be effective for travels from 1 March 2014 to mitigate the risk of importation of polio virus to India from these seven polio infected countries namely Afghanistan, Ethiopia, Kenya, Nigeria, Pakistan, Somalia and Syria.
OPV vaccination certificate will be issued after this additional dose which shall remain valid for a period of one year.

1. Vaccination requirements for inbound travellers to lndia from countries with ongoing poliovirus transmission
Resident nationals of the seven polio infected countries (Afghanistan, Nigeria, Pakistan, Ethiopia, Kenya, Somalia and Syria) are required to receive a close of OPV, regardless of age and vaccination status, at least four weeks prior to departure to lndia. A certificate of vaccination with OPV is required for resident nationals of these countries While applying for entry visa to lndia (copy of certificate uploaded).
It is not mandatory for foreign nationals residing in the seven polio infected countries to receive vaccination with OPV before travel to India.
Travellers to India should contact the local health authorities in their respective countries for vaccination with OPV and certificate of OPV vaccination. The certificate of vaccination should accompany other documents when applying for visa for India and during the travel.

2. Vaccination requirements for outbound travellers from India to countries with ongoing poliovirus transmission
lndian residents travelling from lndia to the seven polio infected countries are required to receive a dose of OPV at least four weeks prior to departure, regardless of age and vaccination status.
Each district in India has designated at least one center vvhere vaccination with OPV will be provided to travellers and OPV vaccination certificate will be issued. The District immunization Officer is the designated official for issuance of OF’V vaccination certificate to travelers.
It is not mandatory, for foreign nationals residing in India to receive vaccination with OPV before travelling to the seven polio infected countries. However, they are advised to receive a dose of OPV four weeks prior to travel in their own interests

Responses to frequently asked questions for polio vaccination of international
travefliers between India and polio infected countries
1. Why is vaccination with oral polio vaccine (OPV) required for international travel between
India and some countries?
lndia has completed three years Without Wild poliovirus being detected. However, polio continues to circulate in Afghanistan, Nigeria and Pakistan. There have also been recent outbreaks following importation in Ethiopia, Kenya, Somalia and Syria.
India faces the risk of importation of polio virus from countries that have ongoing transmission. Since 2000, more than 45 countries that were earlier polio-free had wild polio virus importations.
International travel between India and these polio infected countries can bring the polio virus
to India. To mitigate this risk, all such travelers are required to take a dose of OPV.

2. How is polio virus spread?
Poliovirus spreads through contaminated water and food. When individuals do not have
intestinal immunity, the poliovirus multiplies in the gut and is excreted by the infected
person in faeces.
A majority of the individuals infected with poliovirus do not develop paralysis and remain apparently healthy. However, they are capable of carrying the poliovirus in their intestine
and spreading it.

3. Why should adults and children who have completed their immunization schedule receive
an additional dose of OPV?
The ability of intestine to prevent multiplication and shedding of polio virus developed through vaccination decreases over time. Therefore, adults & children who have received vaccination earlier; can allow multiplication and shedding of the polio virus. An additional dose of OPV given at least four weeks prior to travel, boosts the immunity of intestine and reduces chances of virus being carried by travelers.

4. When should I take polio vaccination for travel between India and polio infected countries?
Polio vaccination is required to be taken at least four weeks prior to travel. Once received, it
is not required for a period of one year.

5. I am a citizen of a country not having poliovirus circulation and currently staying in one of
the polio infected countries such as Afghanistan, Ethiopia, Kenya, Nigeria, Pakistan, Somalia
and Syria. Is it mandatory for me to take OPV if I visit India?
No. It is not mandatory for you to take OPV before travel to India. However, during your stay
in any of these countries, you are advised to take a dose of polio vaccine for your own
protection as per WHO international travel and health recommendations (http://www.vvho.int/ith/en/l.

6. I am a resident of a country not having polioyirus circulation and currently staying in India.
is it mandatory for me'to take OPV if I visit any of the polio infected countries such as
Afghanistan, Ethiopia, Kenya, Nigeria, Pakistan, Somalia and Syria from india?
No. It is not mandatory for you to take OPV. However, you are advised to take a dose of polio
vaccine for your own protection as per WHO International travel and health
recommendations (http://WWW.Wh0.int/ith[en/).

7. Is this additional dose of OP'V also required for passengers in transit through polio infected
countries?
No. Passengers in transit through polio infected countries do not need additional OPV dose.

8. Do I need to take OPV as l have already been vaccinated with IPV?
Yes; you need to take a dose of OPV. lnactivated polio virus vaccine (IPV) protects through developing antibodies in the blood (i.e. humoral immunity). Individuals who received only IPV remain capable of multiplying polio virus in the intestine and shedding of polio virus through faeces. OPV develops humoral as well as intestinal immunity, therefore preventing the multiplication and shedding of polio virus. Individuals provided with additional dose of OPV are unlikely to carry polio virus and thus restraining the polio virus spread.

9. My child has received inactivated polio vaccine few days ago. Is it necessary for the
child to get OPV?
Yes. It is important for the child to get OPV to boost the gut immunity.

10. My child has received all OPV doses under the routine immunization schedule. Is it safe for the child to get an additional close of OPV? 
Yes, it is safe to give this additional dose of OPV to your child.

11. Do I need to take OPV each time | visit a polio infected country?
No, if the travel is within one year of taking OPV. However if the travel date is more than one
year since the last OPV dose, then another dose will be required.

12. From where should I take polio vaccination?
You should contact local health authorities for vaccination with OPV. All District Immunization Officers (DlOs) in India have been designated to arrange vaccination with OPV and issue a certificate to travelers.

13. Can I get a vaccination certificate from my doctor or any other practitioner?
N0. Polio vaccination certificate for travelers can only be issued by the DIO or a vaccination
center designated by DIO for this purpose. The certification has to be done on a standard
format available with the DIO or the designated center.

14. What if I lose my vaccination certificate?
Travellers who are unable to produce the certificate of Vaccination shall be considered as
unvaccinated. They will be vaccinated with a dose of OPV and issued a fresh vaccination
certificate.

15. Are there any charges for OPV or vaccination certificate?
NO. OPV and vaccination certificate will be provided by DIO or the designated center free of
cost.

16. Are these guidelines in line with WHO recommendation for international traveiers’
vaccination?
Yes. These are in line with WHO recommendations for international travels and health.
(http://WWW.who.int/ith/en/ ).
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