Africa travel just got less painful

BY PROF. DR. WOLFGANG H. THOME, ETN AFRICA CORESPONDENT | MAY 26, 2014

According to information received, the 67th World Health Organization Assembly has resolved to make significant changes to the administration and requirements of Yellow Fever inoculations. At present, the vaccination has to be repeated every 10 years, but studies conducted have revealed that a once-in-a-lifetime jab will be enough to ensure lasting protection against the fever, which periodically registers outbreaks in Africa and subsequently requires travelers to be vaccinated to avoid the risk of infection.

Countries like the Seychelles for instance require a Yellow Fever vaccination certificate from every passenger arriving from the mainland’s areas on the Yellow Fever map, even if only connecting for instance in Nairobi for an onward flight to Mahe. Even African countries have periodically “thrown the book” at travelers requiring them to produce Yellow Fever vaccination certificates, leading to protests by neighboring countries about making travel unnecessarily difficult, one such example being the imposition of such requirements last year by South Africa on visitors from for instance Zambia and Zimbabwe or as in the past seen by Tanzania for travelers from Kenya and Uganda.

The change in regulations will no doubt be warmly welcomed by travelers, more so as of late there has been a significant shortage of vaccination doses, complicating travel when the 10-year period was about to expire. It is advisable, however, to check prior to travel about the current requirements for a Yellow Fever vaccination card in particular during the coming weeks as the implementation of the new rules may well take time to percolate down to the health desks at airports and land borders.

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NEJM - Embracing Oral Cholera Vaccine — The Shifting Response to Cholera

Cholera, a rapidly dehydrating diarrheal disease, is caused by ingestion of Vibrio cholerae,serogroup O1 or O139. The World Health Organization (WHO) estimates that 1.4 billion people were at risk for cholera in 2012.1 More than 90% of reported cases occur in Africa, and most of the remainder occur in southern Asia. In 2010, only 10 months after it was hit by a major earthquake, Haiti experienced the most severe cholera epidemic of the past century, with 699,579 cases and 8539 related deaths reported as of February 11, 2014. This was the first time cholera had been documented in Haiti, despite the occurrence of devastating outbreaks in the Caribbean in the 19th century and in Latin America between 1991 and 2001 (see mapMajor Cholera Outbreaks since 1990.).

Cholera is a disease of poverty, linked to poor sanitation and a lack of potable water. Establishment of an adequate sanitation and potable-water system is the most definitive way to prevent and limit its spread. However, the cost of instituting adequate sanitation systems, one of the United Nations Millennium Development Goals, is prohibitive for the countries that are affected by cholera: it would cost an estimated $2.2 billion, for example, to adequately improve access to water and sanitation in Haiti. Water, sanitation, and hygiene (WASH) practices are the cornerstones of cholera prevention and control. The promotion of WASH practices, the creation of rehydration centers, use of antibiotics, and training of health personnel during the first months of the Haitian epidemic led to a dramatic reduction in cholera-associated mortality, from 4% to 1.5%.2 Yet a survey in the slums of Port-au-Prince showed that although people were aware of hand-washing methods, they did not have soap and water to implement them. What role should oral cholera vaccine (OCV) play, in combination with WASH practices, in epidemic conditions?

The three currently licensed OCVs are formulations of killed V. cholerae cells. Two of them, Dukoral and Shanchol, have been prequalified by the WHO for purchase by United Nations agencies. The third one, mORCVAX, is licensed and produced exclusively in Vietnam. For all three vaccines, there is evidence of safety and efficacy (66 to 85%) after two doses, with inferred herd protection and immunity lasting up to 5 years (in the case of Shanchol). Dukoral includes a cholera toxin B subunit requiring administration with a buffer, and it costs $3.64 to $6.00 per dose. Shanchol does not require a buffer and costs $1.85 per dose. Despite the evidence of safety and efficacy, international agencies cited several reasons for not including OCV in the prevention package during the 2010 Haitian epidemic.2

First, there was a limited number of OCV doses available worldwide. Second, Shanchol, the cheaper and easier-to-administer vaccine, could not be purchased by United Nations agencies until it received WHO approval in 2011. Third, there was concern that OCV implementation would compete with other WASH interventions in countries with fragile health systems.

After sustained lobbying by multiple institutions and organizations, a pilot intervention was initiated in Haiti using OCV with other WASH measures to control the outbreak (“reactive vaccination”). An urban project was conducted by the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), and a rural project was conducted by Partners in Health, both in collaboration with the Haitian Ministry of Health. The outcomes showed that OCV can be effectively employed as part of a comprehensive cholera-control program: 91% of 97,774 participants received two vaccine doses during a 90-day period.3,4

The WHO has since changed its policy and promotes OCV use in outbreaks worldwide.5 During the past 3 years, more than 1.6 million doses of Shanchol have been administered in Asia, Africa, and the Caribbean. A remaining challenge to OCV implementation was the lack of field evidence for its effectiveness early in an epidemic. The matched case–control study in Guinea, reported on by Luquero et al. in this issue of the Journal (pages 2111–2120), clearly illustrates the role OCV can play in countering cholera epidemics, with greater than 86% protection after administration of two doses.

Although the global stockpile of Shanchol is growing — the WHO has 2 million doses, and the Global Alliance for Vaccines and Immunization (GAVI) has pledged support for 20 million doses over the next 5 years — the world will need millions more doses. Moreover, many questions remain. For instance, how should priorities be set for use of the stockpile when there are multiple simultaneous epidemics (requiring reactive vaccination), other high-risk situations (e.g., encampments of refugees who could benefit from preemptive vaccination), and regions where cholera is endemic and peaks in incidence are expected during the rainy season? Risk evaluation and cost-effectiveness will certainly be important considerations.

In addition, because of their study's small sample size, Luquero et al. could not test the efficacy of one versus two doses of OCV. A one-dose regimen would reduce the cost and logistic constraints for national scale-up programs. A collaborative double-blind, placebo-controlled study that the International Vaccine Institute and the International Center for Diarrheal Disease Research, Bangladesh, are conducting in Dhaka may provide this information.

Another question is whether OCV can be stored at room temperature so that the cold-chain requirement can be bypassed. In the study by Luquero et al., the vaccine was refrigerated during storage, but the cold chain was not maintained in the field. It will be important to determine how long the vaccine can retain its efficacy at room temperature.

Furthermore, can Shanchol be used in pregnancy and in children younger than 1 year of age? Although WHO recommendations suggest targeting pregnant women at high risk for cholera, the manufacturer has not approved use of the vaccine in pregnancy, and there are no guidelines for children under 1 year old.

Since 2010, some major obstacles preventing the use of OCV have been overcome. Shanchol, the cheapest and easiest-to-administer vaccine, is being stockpiled. OCV has been used in 13 countries on three continents (Asia, Africa, and the North American Caribbean) and in three risk settings. The study by Luquero et al. provides further evidence in favor of using OCV in emerging outbreaks.

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Comment: It is heartening to note that a vaccine made in India - Shanchol, is likely to be used worldwide in reducing cholera cases and death. However, large requirements of the vaccine by GAVI & WHO is probably the reason why it is no longer available in India depriving us of the use of this vaccine !

What is the most common illness a traveler to Brazil World Cup is most likely to get ? Scientific American finds out

A global network of clinicians assess the most common diseases among travelers to Brazil, and the winner is surprising...

Stadiums quaked as U.S. soccer fans urgedtheir men’s national team toward their successful qualification for the upcoming FIFA World Cup. Many of these supporters will soon descend on Brazil. There they will be joined by an estimated 600,000 revelers from around the globe. Unfortunately, these travelers may catch far more than the beautiful game.

To forewarn tourists of disease threats in Brazil, a new study led by Harvard University scientists has assessed the illnesses most often contracted during journeys to the South American nation. Researchers studied the case reports of 1,600 people who became sick after returning from Brazil between 1997 and 2013 to offer a snapshot of what people might soon encounter at the World Cup and the 2016 Summer Olympics.

Three big clusters of disease emerged: Feverish blights such as dengue virus and malaria are no strangers to the tropics, yet they landed in third place on the list. Traveler’s diarrhea—that familiar spoiler of overseas trips—was second.

The unexpected winner was skin worms, which accounted for two of every five recorded diagnoses among voyagers. “We were a little surprised by how common these skin infestations were,” says Harvard’s Mary Wilson, a global health specialist who headed the study. “But then if you consider that many cities visited by people are right on the coast, it makes sense.”

The leading skin worm was cutaneous larva migrans (CLM), a hookworm typically caught while hanging around beaches. The worm larvae live in sand and can penetrate the intact skin of a bare foot or an exposed bum. The major source of CLM is dog and cat poop littered on the seashore. One survey of a São Paulo district discovered the parasite in 90 percent of canines and felines whereas a separate inspection of Recife’s Alto Beach, a popular tourist destination, found the worm’s larvae in one of every three sand samples. Rather than discourage beach-goers, however, Wilson and her colleagues hope that the findings encourage people to wear proper footwear and avoid sitting on bare sand.

The report is useful for doctors back home, too, says Susan McLellan, a clinical professor of public health at Tulane University who was not involved with the study. “Family-practice doctors miss CLM all the time or mistake it for another kind of worm,” McLellan says. “The article provides a nice review of the infections that might arise during these mass gatherings.” The survey comprised health data from the GeoSentinel network, a collective of health clinics spanning 40 countries and six continents whose purpose is to measure maladies as they cross international borders.

Mosquito-borne dengue virus, malaria and yellow fever are constant concerns for Brazilian public health officials. Other fears for the World Cup surround the emergence of chikungunya virus, which is carried by the same mosquitoes as dengue and which also causes fevers and rashes. The virus first appeared in the Western Hemisphere in December 2013, and experts have warned that the World Cup might increase the possibility that a new catastrophic epidemic will spread across the Americas.

Four of the 12 World Cup stadiums are located in regions endemic with yellow fever or malaria (see map); the risk of dengue is high throughout the country. Dengue virus and malaria caused the most hospitalizations among the surveyed travelers. No cases of yellow fever were recorded in the study, but the U.S. Centers for Disease Control and Prevention advises vaccination for those attending inland matches in yellow fever hotspots. Immunizations for measles and influenza are recommended, too, given that these infections thrive in crowds. The agency’s website also features a list of health-related Portuguese expressions for visitors to learn, including phrases such as, “I have been bitten by mosquitoes” (Fui picado por pernilongo).
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Yellow Fever Mosquito spreads in France !

THE TIGER mosquito - which causes infectious diseases such as yellow fever, dengue fever and chikungunya - has spread to 18 departments in France.

The insect, which reportedly first arrived in France in 1999, has now been spotted in Alpes-Maritimes, Alpes de Haute-Provence, Var, Bouches-du-Rhône, Haute Corse, Corse- du-Sud, Gard, Hérault, Aude, Pyrénées-Orientales, Ardèche, Vaucluse, Drôme, Isère, Rhône, Haute-Garonne, Lot-et-Garonne and Gironde.

The tiger mosquito is one of the world's most invasive pests, and is easily recognised by its black and white striped legs, and small black and white striped body. It grows to between 2mm and 10mm.

It is a native of southeast Asia, but the boom in international travel over the past few decades has meant it has invaded many other countries.

It prefers biting humans to animals.

The National Centre of Expertise on Vectors (CNEV) has launched a website - www.signalement-moustique.fr - so people can alert them to sightings of the insect.

CNEV advises people to take a photo of the animal and post it to the site, so the spread of the mosquito can be tracked.

Expert Rémi Foussadier said: “It is an invasive species that lives in cities and villages. Its life cycle is subservient to the urban lifestyle , and it likes small bodies of water - small reservoirs can be found in gardens, or balconies.”

Earlier this month, officials asked for help tracking the spread of the asian hornet 
- See more at: http://www.connexionfrance.com/france-tiger-mosquito-dengue-yellow-fever-chikungunya-departments-website-track-spread-15808-view-article.html#sthash.2PUGdPAw.dpuf

Costa Rica advises - Going to the Brazil World Cup? Get your vaccines first

Local fans planning to support Costa Rica’s National Football Team, known as “La Sele,” next month in Brazil must comply with a health requirement for vaccines against yellow fever and measles.

The Amazon region is at risk for the spread of yellow fever, a disease eradicated in Costa Rica more than 80 years ago. According to international health regulations, yellow fever vaccinations are required for all travelers at least two weeks before their departure from Costa Rica.

The vaccine is not required to enter Brazil, but it is mandatory for all travelers arriving in Costa Rica from that country. Most airlines and travel agencies already are asking for vaccine certification before selling air tickets to the South American country.

FIFA World Cup Brazil 2014 will be held in 12 Brazilian cities from June 12-July 13, meaning that all those traveling from Costa Rica should obtain vaccination certificates by May 30.

Vaccines can be purchased at any drugstore, but the vaccination certificate only can be obtained at the Health Ministry. National Director of Immunizations Roberto Arroba explained that certificates can be issued at any Health Ministry office across the country by presenting the vaccination receipt from the drugstore.

Yellow fever is a disease that affects multiple body systems and is potentially lethal. It is caused by a hemorrhagic virus transmitted through mosquito bites, similar to dengue, explained Gustavo Lazo, a physician with the pharmaceutical company Sanofi Pasteur, which distributes the vaccine in the country.

“Yellow fever diagnosis is difficult, especially in its early stages. Symptoms are very similar to influenza: yellow skin or eyes, bleeding in various parts of the body, failures of liver, kidney, respiratory systems and other organs,” Lazo added.

Recommended: Let’s stop measles from crashing the World Cup in Brazil

Vaccination against yellow fever cannot be applied during pregnancy and lactation, nor to people with fever, allergies to any component of the vaccine or to patients with malfunctioning immune systems.

The Social Security System, or Caja, also warned World Cup travelers to get vaccinated against measles after a recent outbreak caused more than 100 cases in Brazil, according to the Pan-American Health Organization.

Measles is a highly contagious disease with symptoms that include fever, conjunctivitis, cough, and spots inside the mouth, among others.

The last four cases of measles in Costa Rica were recorded in 1999: The first two patients were infected abroad and the others were related to the first two.

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Jamaica Health ministry reiterates vaccination warning ahead of Brazil World Cup

THE Ministry of Health is reminding those who will be travelling to this year's FIFA World Cup in Brazil to ensure that they get immunised against measles and yellow fever at least 10 days before their scheduled departure.

Required medication for malaria should also be taken in advance of departing the island.

In a release to the media yesterday, Director of Emergency, Disaster Management & Special Services in the ministry Marion Bullock-Ducasse said the precaution is in light of the fact that people from a number of countries which either currently have an outbreak, or are endemic for certain vaccine- preventable diseases, will gather in Brazil for the World Cup.

DuCasse noted that Brazil itself is presently in the midst of a measles outbreak.

"There are countries involved in the World Cup that also have the risk of transmission of yellow fever and malaria and so we want to ensure that our population is protected and also prevent a reintroduction of these diseases in Jamaica," she explained.

Zambia: Govt Engages SA Over Yellow Fever Requirement

THE Government has engaged the South African authorities on the need for that country to waive the yellow fever certificate requirement for travellers and discussions will start soon.

The Zambian Government says the yellow fever certificate requirement by South Africa for travellers to and from Zambia is the biggest barrier to tourist inflows into the country.

Tourism and Arts Permanent Secretary Steven Mwansa said it was important for South Africa to withdraw the yellow fever vaccination requirement for travellers to and from Zambia saying that this proved to be the biggest hurdle to tourist inflows.

In an interview in Lusaka yesterday, Mr Mwansa said the Government had engaged the South African government on the matter and discussions would resume soon.

"The matter has been taken up by the Ministry of Health as it is considered a health matter. South Africa was in voting gear recently so engagements will resume shortly at ministerial level," Mr Mwansa said.

According to Zambia Tourism Board (ZTB), the removal of the yellow fever vaccination certificate requirement by South Africa will push up international tourist arrival figures by at least 10 per cent.

Last year, the Ministry of Health and World Health Organisation (WTO) carried out a survey on the prevalence rate of the yellow fever in Zambia.

The findings of the survey should now be able to facilitate the effective removal of the yellow fever certificate requirement by South Africa.

Mr Mwansa acknowledged that yellow fever was a Ministry of Health issue but pointed out that its impact on the tourism industry required his ministry to play a role.

Meanwhile, in a statement issued in Lusaka yesterday by ZTB public relations and media manager Caristo Chitamfya, Mr Mwansa said that Zambia and South Africa have agreed to work together to promote regional tourism.

He said that Zambia did not consider South Africa as a threat but as a 'big brother' with whom the country shares strong political, historical and cultural ties.

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Traveling abroad for work, pleasure or even visiting friends & relatives. Do I need vaccinations?

Travelers to other countries often face health issues they wouldn't ordinarily experience at home. To minimize your risks of becoming seriously ill when traveling abroad, you should find out in advance whether any specificimmunizations may be recommended for travel to the region of the world you'll be visiting. It's also a good time to review your own immunization history.

According to the U.S. Centers for Disease Control and Prevention (CDC), it's best to schedule a visit to your doctor or travel medicine clinic four to six weeks before an international trip. Since your body needs time to build up immunity after receiving a vaccine and many vaccines are given in a series over time, getting an early start on your immunizations is the best way to protect yourself. Even if you are making a last-minute trip or plan to leave in less than four weeks, you should still check with your doctor to see if any vaccines or preventive medications might be recommended.

The CDC divides travel vaccinations into three categories: routine, recommended, and required. The only vaccine classified as "required" by International Health Regulations is the yellow fever vaccination for travel to certain countries in sub-Saharan Africa and tropical South America.

"Routine" vaccinations are those that are normally administered, usually during childhood, in the United States. These include immunizations against

• diphtheria,
• tetanus,
• pertussis,
• measles,
• mumps,
• rubella,
• varicella,
• poliomyelitis,
• hepatitis B,
• hepatitis A,
• Haemophilus influenzae type b,
• rotavirus,
• meningococcus,
• human papillomavirus, and
• pneumococcus.

International travelers should make sure that these vaccinations are up to date and that no boosters are required, since many conditions which are rare in the U.S. due to immunity in the general population may be more common in other countries.

"Recommended" vaccinations are given to protect travelers from illnesses that occur routinely in other parts of the world. Doctors determine which vaccines are recommended for international travel on an individual basis, taking into consideration your destination, whether you will be spending time in rural areas, the season of the year you are traveling, your age, your overall health status, and your immunization history. The CDC lists travel-specific vaccination requirements for individual countries on their Web site.

Some examples of vaccines that may be recommended for international travelers (remember you may need more, fewer, or different vaccinations, depending on your individual circumstances) include the following:

• Rabies: Rabies virus is endemic in dogs in many countries throughout the world, including, but not limited to, parts of Thailand, Vietnam, Brazil, China, the Philippines, Sri Lanka, and Indonesia.
• Typhoid fever: This condition may be contracted in many areas of the world through contaminated drinking water or food or by consuming food or beverages that have been handled by an infected person.
• Japanese encephalitis: This condition is transmitted by a flavavirus acquired from the bite of an infected mosquito. It is the most common cause of vaccine-preventable encephalitis in Asia. It is found throughout most of Asia and the western Pacific regions.

Many travelers to tropical countries are concerned about the possibility of contracting malaria, a potentially fatal infection transmitted by the bite of a female Anopheles mosquito. While malaria is most common in Africa, the disease occurs in over 100 countries. While there is no vaccination available to prevent malaria, your doctor can prescribe preventive, or prophylactic, antimalarial medications if you are traveling to an at-risk area.

REFERENCE:

CDC.GOV. Travelers' Health: Vaccinations.

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Vaccination in pregnancy - a simplified approach

Vaccination in pregnancy

Vaccine	Use in pregnancy	Comments
BCGa	No	sdf
Hepatitis A	Yes, administer if indicated	Safety not determined
Hepatitis B	Yes, administer if indicated	sdf
Influenza	Yes, administer if indicated	In some circumstances, consult a physician
Japanese encephalitis	sdf	Safety not determined
Measlesa	No	sdf
Meningococcal disease	Yes, administer if indicated	sdf
Mumpsa	No	sdf
PoliomyelitisOPV IPV	Yes, administer if indicated Yes, administer if indicated	Normally avoided
Rubellaa	No	sdf
Tetanus/diphteria	Yes, administer if indicated	sdf
Rabies	Yes, administer if indicated	sdf
Varicellaa	No	sdfsdf
Yellow fevera	Yes, administer if indicated	Avoided unless at high risk

·        ^a Live vaccine – to be avoided during pregnancy

Source - AP Government website for International Traveler vaccination

Experiences for Yellow Fever vaccination in government center in Mumbai in Andheri

My experience is indeed very pathetic. The system is on line in Hyderabad, said to be taking say 3,4 hours in other cities. Today at Mumbai which is the biggest city of India we are in such a chaotic situation that a list is made containing 80 persons name and while going in for vaccination, we find that already the numbers are full and we have to make to for the next day. Where is question of entering in a common register? Making a list, circulating and running around is done by the people, and the officials, have neither any work conscience nor there is any system of a pucca register maintained at any place. 
Everywhere money plays its role. Let any scam say Adarsh scam, or 2G spectrum scam, or LIC housing finance scam or others come people are scotch free to move around and they are not bothered, since they know that they will not be punished. Why not make it online like pass port authorites, so that I can get my slot, in advance through internet and straight away go to the place and get vaccinated after paying the necessary fee?? Perhaps it is a curse that we are in a place like Mumbai and have to undergo this suffering continuously.
Svkiyengar

fins*****@hotmail.com | 99*****220Jaya Peter

jaya*****@setindia.com | 98*****50742 Months Ago

The place is a shameful reflection of the appalling state of goverment run organisations in our country. The people who hand out tokens are unnecesarily rude and give preferential treatment to people of importance.A common man had to stand in the queue for hours while a DGP breezed in and got his token.We are submitted to the whim and fancies of the 2 people(who hand out tokens) and are completely under their mercy.So even if you have been waiting for a couple of hours in the hot sun, they will take their breaks, loiter around, finish up the previous days work etc.The worst part is to come back in the afternoon and wait again in a queue for the actual injection! Makes no sense at all.So what was the point of the queue in the morning? Why can`t the injection be given once and for all in the morning ? It is not possible to dedicate an entire day for a yellow fever shot.I wish there was another option.

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Mass vaccination campaigns reduce the substantial burden of yellow fever in Africa

Yellow fever, an acute viral disease, is estimated to have been responsible for 78,000 deaths in Africa in 2013 according to new research published in PLOS Medicine this week. The research by Neil Ferguson from Imperial College London, UK and colleagues from Imperial College, WHO and other institutions also estimates that recent mass vaccination campaigns against yellow fever have led to a 27% decrease in the burden of yellow fever across Africa in 2013.

Yellow fever is a serious viral disease that affects people living in and visiting tropical regions of Africa and Central and South America. In rural areas next to forests, the virus typically causes sporadic cases or even small-scale epidemics (outbreaks) but, if it is introduced into urban areas, it can cause large explosive epidemics that are hard to control. Although many people who contract yellow fever do not develop any symptoms, some have mild flu-like symptoms, and others develop a high fever with jaundice or hemorrhaging from the mouth, nose, eyes, or stomach. About 50% of patients who develop these severe symptoms die. Fortunately, an effective vaccine against the disease exists.

The authors of the study used sophisticated statistical methods to estimate the burden of yellow fever in Africa based on outbreak data, serological surveys and environmental data but note that there is substantial uncertainty in their estimates because of the difficulty of diagnosing yellow fever and a lack of available data. Therefore the estimates for the number of severe cases of yellow fever in Africa in 2013 range from 51,000 to 380,000, and from 19,000 to 180,000 for deaths due to the disease

Nevertheless, the study provides the most reliable contemporary estimates for the burden of yellow fever and the impact of vaccination campaigns in Africa. The researchers estimate that vaccination has reduced yellow fever cases and deaths by 27% across Africa, with much higher reductions in some countries targeted by vaccination campaigns. The authors note that their study has already been influential, "[p]artly as a result of [our estimates], in late 2013 the GAVI [Global Alliance for Vaccines and Immunization] Board decided to make available support for additional yellow fever vaccination campaigns, targeting 144 million people across the endemic region in Africa"

The authors also note, "[t]he impact of both past and future mass vaccination campaigns will prevent a substantial proportion of yellow fever disease burden for years to come... the achievements of the current mass vaccination campaigns could be sustained if a high level of immunization is achieved through a strong EPI [infant immunization] program and preventive vaccination of populations that remain at risk, such as migrants or populations from as yet unvaccinated districts."

More information: Garske T, Van Kerkhove MD, Yactayo S, Ronveaux O, Lewis RF, et al. (2014) Yellow Fever in Africa: Estimating the Burden of Disease and Impact of Mass Vaccination from Outbreak and Serological Data. PLoS Med 11(5): e1001638.DOI: 10.1371/journal.pmed.1001638

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WHO declares the international spread of wild poliovirus a Public Health Emergency of International Concern (PHEIC)

We just learned that the WHO declared the international spread of wild poliovirus a Public Health Emergency of International Concern (PHEIC). Pakistan, Cameroon, and the Syrian Arab Republic pose the greatest risk of further wild poliovirus exportations.

Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and particularly Nigeria pose ongoing risk for new wild poliovirus exportations.

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 long-term 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.

Once a State has met the criteria to be assessed as no longer exporting wild poliovirus, it should continue to be considered as an infected State until such time as it has met the criteria to be removed from that category.

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. 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;
• encourage residents and long-term visitors to receive a dose of OPV or IPV 4 weeks to 12 months prior to international travel; those undertaking urgent travel (i.e. within 4 weeks) should be encouraged to receive a dose at least by the time of departure;
• ensure that travellers who receive such vaccination have access to an appropriate document to record their polio vaccination status;
• maintain these measures until the following criteria have been met: (i) at least 6 months have passed without the detection of wild poliovirus transmission in the country from any source, 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.

Any polio-free State which becomes infected with wild poliovirus should immediately implement the advice for ‘States infected with wild poliovirus but not currently exporting’. The WHO Director-General should ensure an international assessment of the outbreak response is undertaken within 1 month of confirmation of the index case in any State which becomes newly infected. In the event of new international spread from an infected State, that State should immediately implement the vaccination requirements for ‘States currently exporting wild poliovirus’.

WHO and its partners should support States in implementing these recommendations.

Based on this advice, the reports made by affected States Parties and the currently available information, the Director-General accepted the Committee’s assessment and on 5 May 2014 declared the international spread of wild poliovirus in 2014 a Public Health Emergency of International Concern (PHEIC). The Director-General endorsed the Committee’s advice for ‘States currently exporting wild polioviruses’ and for ‘States infected with wild poliovirus but not currently exporting’ and issued them as Temporary Recommendations under the IHR (2005) to reduce the international spread of wild poliovirus, effective 5 May 2014. The Director-General thanked the Committee Members and Advisors for their advice and requested their reassessment of this situation in 3 months, particularly as the criteria for discontinuing these measures could for some States extend beyond the 3 months validity of these Temporary Recommendations.

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