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.
