Experts: Make polio vaccine a travel prerequisite for some

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Nov 28, 2012 (CIDRAP News) – A panel of experts that advises the Global Polio Eradication Initiative (GPEI) is recommending that residents of polio-endemic countries be required to have polio vaccinations before they are allowed to travel abroad.

The Independent Monitoring Board (IMB), which monitors the GPEI on behalf of the World Health Organization (WHO), says in its November report that anyone from Afghanistan, Nigeria, or Pakistan should be required to be immunized before they can cross borders.

"We recommend that the International Health Regulations Expert Review Committee urgently issue a standing recommendation by May 2013 that will introduce pre-travel vaccination or vaccination checks in each of these countries until national transmission is stopped," the report says.

"No country should allow a citizen from any endemic polio state to cross their border without a valid vaccination certificate," it adds.

Because 19 polio outbreaks have occurred since 2010 in countries that had previously eliminated the virus, it seems essential to ensure that people from countries where polio is still entrenched get vaccinated before they travel internationally, the IMB said.

"Some will see this as [an] extreme move, but it is necessary. It is not the most extreme use of the International Health Regulations that could have been proposed," the report states.

Overall, the IMB report is positive about the progress of the polio battle, even though the GPEI will miss its 2010-12 goal of eradicating the disease by the end of this year.

The program "will now clearly not achieve this goal," the panel said. "Despite it missing yet another deadline, the IMB judges the Programme's prospects to be more positive than ever. If this level of progress had been achieved at the start, not the end, of the 2010-12 period, transmission could have been stopped by now."

"The end of 2012 will not bring the end of polio, but we may now be seeing the polio virus make its last stand," says a summary of the report.

The global polio count for this year stood at 193 cases on Nov 20, as compared with 536 at that time a year earlier and 650 for all of 2011, according to GPEI figures. This year's count includes 104 cases in Nigeria, 54 in Pakistan, 30 in Afghanistan, and 5 in Chad.

Nigeria is the only country with more cases this year than last, the IMB says. It adds that Nigeria's vaccination program may be on the verge of a breakthrough—but if case numbers are not reduced, spread to other countries is all but inevitable.

The report says Pakistan overhauled its polio program this year, and case numbers "plummeted" as a consequence. But an upcoming election and a complex security situation pose risks going forward.

Afghanistan has made steady but slow progress over the past 2 years, the report says. It calls the slow pace worrisome in the face of security risks as international troops withdraw from the country.

The advice about requiring immunization for travelers from endemic polio countries tops the list of recommendations in the report. Another recommendation says that every district-level task force in affected countries should have a representative of parents in the area.

The IMB also recommends that polio immunization be linked with other health and neighborhood benefits whenever possible, since local residents fighting more obvious challenges like measles, malaria, and poor sanitation often see no benefit in polio vaccine alone.

The report says the GPEI already knows the need for this approach, but "converting the rhetoric into substance" has proved difficult.

"We urge the Polio Programme to identify in every local community, a priority service that can be delivered with polio vaccine—and ensure it is delivered," the IMB says. In some cases already, vaccination programs have been paired with rubbish clearing and distribution of mosquito nets, the report adds.

See also:

Full text of IMB report

IMB report summary

GPEI polio case count chart

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