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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