Conclusions of the twentieth IHR Emergency Committee do not change the ECDC risk assessment for Europe concerning polio

ECDC comment

Statement of the twentieth IHR Emergency Committee Regarding the International Spread of Poliovirus, 1 March 2019

The twentieth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by WHO’s Director General on 19 February 2019 at WHO headquarters in Geneva.

The Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV), agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) and recommended the extension of Temporary Recommendations for a further three months.

This conclusion was reached as a result of the increase in WPV1 cases in endemic countries during 2019; the risk of global complacency given the low number of WPV cases worldwide; the rising number and international spread of cVDPV outbreaks; weak routine immunisation and surveillance gaps in many countries; protracted outbreaks of cVDPV in Nigeria and Democratic Republic of Congo, lack of access to vaccines in parts of the world, and population movement.

ECDC comment on the risk to Europe

The conclusions of the IHR Emergency Committee do not change the ECDC risk assessment for Europe. The continuing circulation of wild poliovirus type 1 (WPV1) in three countries shows that there is a continued risk of the disease being imported into the EU/EEA. Furthermore, the occurrence of outbreaks of circulating vaccine-derived poliovirus (cVDPV), which only emerge and circulate due to lack of polio population immunity, shows the potential risk for further international spread. To limit the risk of reintroduction and sustained transmission of WPV in the EU/EEA, it is crucial to maintain high vaccine coverage in the general population and increase the vaccination uptake in the pockets of underimmunised populations.

ECDC previously concluded that in the event of importation of wild-type poliovirus resulting in the re-establishment of virus circulation in the EU, the overall risk to EU residents would be:

  • very low in oral polio vaccine (OPV)-vaccinated populations for both poliovirus infection and disease;
  • moderate in inactivated polio vaccine (IPV)-only cohorts for poliovirus infection and very low for disease, and;
  • high in low or unvaccinated groups for poliovirus infection and moderate for disease.

ECDC endorses WHO’s  temporary recommendations to reduce the risk of international spread of WPV1 and cVDPVs, in particular with regard to EU/EEA citizens who are resident in or long-term visitors (> 4 weeks) to:

  1. States infected with WPV1 (Afghanistan, Pakistan, Nigeria), cVDPV1 (Papua New Guinea, Indonesia) or cVDPV3 (Somalia), with potential risk of international spread:
    • Ensure that all residents and long­-term visitors (i.e. > four weeks) of all ages, receive a dose of bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel
    • Ensure that those undertaking urgent travel (i.e. within four weeks), who have not received a dose of bOPV 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
  2. States infected with cVDPV2 (Democratic Republic of Congo, Kenya, Mozambique, Niger, Nigeria, Somalia), with potential risk of international spread:
    • Encourage residents and long-­term visitors to receive a dose of IPV (if available in country) four weeks to 12 months prior to international travel; those undertaking urgent travel (i.e. within four weeks) should be encouraged to receive a dose at least by the time of departure.