WHO recommends travel restrictions on Pakistan

 

ISLAMABAD: The World Health Organisation (WHO) on Monday recommended six-month-long international travel restrictions on Pakistan, one of the three countries seen as “posing the greatest risk of further wild poliovirus exportations in 2014”.
The government will now have to ensure, with immediate effect, that all residents and long-term visitors receive a dose of oral polio vaccine (OPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel.

Pakistan will have to follow the travel restrictions until at least six months have passed without a new exportation of poliovirus. It will also have to provide documentation of full application of high-quality eradication activities in all infected and high-risk areas. Failure to do so will lead to an extension in restrictions until at least 12 months have passed without new exportations.

The government will also have to ensure that those undertaking urgent travel (i.e. within four weeks), and who have not received a dose of OPV or IPV in the previous four 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. Travellers will also have to obtain an international certificate of vaccination or prophylaxis to record their polio vaccination and serve as proof of vaccination.

The restrictions have been imposed on the recommendations of the emergency committee of the International Health Regulations (IHR) 2005, which was convened on the directive of WHO’s Director General Dr. Margaret Chan. The committee, which met on April 28-29, 2014, was entrusted with the task of advising WHO on whether the current developments on the spread of wild poliovirus constitute a Public Health Emergency of International Concern (PHEIC), and if so, what kind of temporary and permanent measures should be considered as part of a coordinated international response to eliminate the crippling disease.

Endorsing the recommendations of the committee, Dr Chan described the international spread of wild poliovirus an “extraordinary event constituting a PHEIC, and approved the recommended travel restrictions on countries posing a risk to global efforts for polio eradication.”

Alongside Pakistan, travel restrictions have also been imposed on Cameroon and the Syrian Arab Republic, all three countries have been categorised as ‘States currently exporting wild poliovirus.’

The restrictions have been imposed as part of a coordinated international response to stop this international spread of wild poliovirus and to prevent new spread with the onset of the high transmission season in May-June 2014. The WHO believes that unilateral measures may prove less effective in stopping international spread.

“The current situation stands in stark contrast to the near-cessation of international spread of wild poliovirus from January 2012 through the 2013 low transmission season for this disease (i.e. January to April). If unchecked, this situation could result in failure to eradicate globally, one of the world’s most serious vaccine preventable diseases,” a WHO press release states.

At end-2013, 60% of polio cases were the result of international spread of wild poliovirus, and there was increasing evidence that adult travellers contributed to this spread. During the 2014 low transmission season, there has already been international spread of wild poliovirus from three of the 10 states that are currently infected: in Central Asia (from Pakistan to Afghanistan), in the Middle East (Syrian Arab Republic to Iraq) and in Central Africa (Cameroon to Equatorial Guinea).

“The consequences of further international spread are particularly acute today, given the large number of polio-free but conflict-torn and fragile states which have severely compromised routine immunisation services and are at high risk of re-infection. Such states would experience extreme difficulty in mounting an effective response, were wild poliovirus to be reintroduced. As much international spread occurs across land borders, WHO will continue to facilitate a coordinated regional approach to accelerate interruption of virus transmission in each epidemiologic zone,” the WHO press release states.

The over-riding priority for all polio-infected states, WHO believes, “must be to interrupt wild poliovirus transmission within their borders as rapidly as possible through the immediate and full application in all geographic areas of the polio eradication strategies, specifically supplementary immunisation campaigns with OPV, surveillance for poliovirus, and routine immunisation.”

Similar travel restrictions have also been imposed on ‘States infected with wild poliovirus but not currently exporting,’ i.e., Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Nigeria. These states are also seen to be posing an ongoing risk for new wild poliovirus exportations in 2014.

According to WHO, any polio-free state which becomes infected with wild poliovirus will immediately implement the advice for ‘States infected with wild poliovirus but not currently exporting.’ The WHO director general will ensure that an international assessment of the outbreak response is undertaken within one 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 will immediately implement the vaccination requirements for ‘States currently exporting wild poliovirus.’ WHO and its partners will support states in implementing these recommendations.

The DG WHO has requested members and advisers of the emergency committee to reassess the situation in three months, as the criteria for discontinuing these temporary measures could, for some states, extend beyond the current validity of the recommendations.

Reuters adds: Polio virus has recently spread to Afghanistan, Iraq, Israel and Syria, the West Bank, Gaza Strip and greater Cairo, said WHO assistant director general Bruce Aylward. “In the majority of these re-infected areas, the viruses circulating actually trace back to Pakistan within the last 12-18 months,” Aylward told reporters.

Pakistan has called an emergency meeting of senior provincial and federal health officials for Wednesday to finalise how to implement the new requirements. “The best option would be vaccinating the passengers at the airport departure where polio vaccination cards would be issued to the passengers,” Minister of State for Health Services Saira Afzal Tarar said in a televised broadcast.