LAHORE: The United States has generated a Level 2 travel alert for Pakistan and other polio-endemic Asian countries following outbreak of the crippling disease, declaring the life-time booster dose for adults mandatory during the period of restrictions imposed by the World Health Organisation (WHO).

The US issued new guidelines for travelers bound for polio-endemic countries on the recommendations of its federal agency -- Center for Disease Control and Prevention (CDC) -- to stop spread of the virus to other states. “The World Health Organization recommends that these countries require residents and long-term (four weeks or more) visitors show proof of polio vaccination before leaving the country,” reads the level 2 travel alert by the US.

It says before traveling to these countries, adults who have completed their routine polio vaccine series as children should receive a single, lifetime adult booster dose of polio vaccine.

According to the CDC, the polio outbreaks have been reported in eight Asian countries including Pakistan, Afghanistan, China, Burma, Indonesia, Malaysia , Papua New Guinea and Philippines.

Particularly, the WHO had extended travel restrictions on Pakistan following frequent outbreaks of vaccine-derived poli-ovirus type 2 (cVDPV2) and wild polio-virus type 1 (WP1) cases.

Level 2 guidelines require visitors to show proof of polio vaccination

What can travelers do to prevent polio?

According to the US travel alert 2, the CDC recommends that all travelers to the countries in-question be vaccinated fully against polio.

The adults who were fully vaccinated during childhood should receive an additional (single) lifetime booster dose of polio vaccine.

“Even if you were vaccinated as a child or have been sick with polio before, you may need a booster dose to make sure you are protected”, reads the alert The World Health Organization recommends that these countries require residents and long-term (4 weeks or more) visitors show proof of polio vaccination before leaving the country, according to the CDC.

Clinician information

For travelers going to countries with circulating polio-virus who have completed their routine polio vaccine series but who have not already received an adult booster dose, the CDC recommends administering an inactivated poliovirus vaccine (IPV) booster dose.

Federal government version

A spokesperson for the Ministry of National Health Services, Regulations & Coordination (MoNHSRC), said on Friday that Pakistan faced a challenging year for polio eradication in 2019.

“As of today, 134 of our children have been paralysed by this debilitating disease”, he said adding that the government had put in place a comprehensive plan to reverse the situation in 2020, starting with a successful nationwide polio vaccination campaign last month.

Commenting on the WHO IHR

Emergency Committee recommendations regarding vaccination of international travellers from Pakistan and other infected countries, the spokesperson said that these were first implemented in May 2014 to prevent the transmission of virus from infected countries to other areas.

“Pakistan implemented the same immediately as a responsible member of the international community and has been doing so since then”, he said.

According to him, over 500,000 international travellers from Pakistan received polio vaccine every month prior to departure and the certificate issued in this respect was valid for 12 months.

Around 180,000 travellers of all ages were additionally vaccinated every month at Pak-Afghan border crossings.

Pakistan polio eradication programme faced special challenges in 2019 which led to resurgence of polio cases during the year, he said.

The programme, however, conducted a critical analysis of the situation and devised a comprehensive strategy to overcome challenges in sustainable manner.

“Our fightback has already started through the successful Dec NID that was inaugurated by the prime minister in the federal capital and all chief ministers in respective provinces”, the spokesperson said.

He added that a total of 40 million under five year age children were successfully reached and vaccinated to protect them against the crippling virus.

He said that the national coordinator of the Emergency Operations Centre (EOC) had planned an aggressive case response from Jan 13 targeting around 12 million children in currently infected districts.

This would be followed by two NIDs in February and April and another strategic response round during March.

“All these efforts will plug the immunity gaps and significantly reduce the transmission intensity by mid-2020 setting the stage for the final push”, he added.

Meanwhile, Minister of state for NHSRC Dr. Zafar Mirza said that the government was working across political divide to take the agenda forward as a shared priority.

“Besides extensive community engagement, the Ministry of NHSRC has already moved on integration of the Polio programme with EPI to quickly improve routine immunization coverage particularly in the high risk areas”, he said.

He said as many as many as 40 super high risk UCs had further been identified within core reservoirs where a broader package of services would be delivered aiming improvement of basic health services, nutrition as well as the safe water and sanitation by broadening partnership..

Dr Mirza also said that the transformation plan and the roadmap was shared with global leadership including the Polio Oversight Board that expressed it’s confidence on it and reassured Pakistan of the fullest support to achieve a polio free Pakistan and the world.

Published in Dawn, January 11th, 2020