WHO Statement on the 8th IHR Emergency Committee meeting regarding the international spread of poliovirus

ECDC comment
3 Mar 2016

​The 8th meeting of the International Health Regulations Emergency Committee regarding the international spread of wild poliovirus convened on 12 February 2016. The Committee noted that since the declaration that the international spread of polio constituted a Public Health Emergency of International Concern (PHEIC) in May 2014, strong progress has been made by countries toward interruption of wild poliovirus transmission.

​The Committee noted the overall decline in the occurrence of international spread of wild poliovirus and was particularly encouraged by the intensified efforts and progress toward interruption of poliovirus transmission in Pakistan and Afghanistan despite challenging circumstances.

The Committee noted however that the international spread of wild poliovirus has continued, with two new recent reports of exportations from Pakistan into Afghanistan which occurred in October and November 2015.

The committee noted that globally there are still significant vulnerable areas and populations that are inadequately immunized due to conflict, insecurity and poor coverage associated with weak immunization programmes. Such vulnerable areas include countries in the Middle East, the Horn of Africa, central Africa and parts of Europe. The large population movements across the Middle East and from Afghanistan and Pakistan create a heightened risk of international spread of polio. There is a risk of missing polio vaccination among refugee and mobile populations, adding to missed and under vaccinated populations in Europe, the Middle East and Africa. An estimated three to four million people have been displaced to Turkey, Lebanon, and Jordan and are at the centre of a mass migration across Europe.

The Committee unanimously agreed that the international spread of polio remains a Public Health Emergency of International Concern (PHEIC) and recommended the extension of the Temporary Recommendations for a further three months.

Risk to Europe

The conclusions of the International Health Regulations Emergency Committee do not change the ECDC risk assessment for Europe. The continuing circulation of wild poliovirus in ten countries shows that there is a continued risk for the disease being imported into the EU/EEA. 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 OPV-vaccinated populations for both poliovirus infection and disease;
  • moderate in 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 the temporary recommendation of WHO and suggests the following options for intervention to EU/EEA Member States:
  • Revise polio vaccination advice to EU travellers and residents to the ten affected countries, and in particular to Pakistan.
  • Advise travellers to, and EU residents in, polio-affected countries to have an additional IPV dose within 12 months from planned travel to polio-affected countries.
  • Prioritise assessment of polio vaccination uptake at the national, subnational and local levels, and the identification of vulnerable and under-vaccinated populations; efforts should be increased to improve vaccination coverage to 90 per cent in accordance with national or regional immunisation recommendations.
  • Assess the vaccination status of refugees and migrants from polio-affected countries at the time of entry into the EU/EEA; people not vaccinated against polio or other diseases should be offered age-appropriate vaccinations and in accordance with the host country’s vaccination schedule.

ECDC continues to support the EU-wide response to the threat of poliovirus spreading across Europe and will, upon request, support individual EU Member States in all areas related to their preparedness, e.g. the detection and control of poliovirus importations.