Issue 1125: June 4, 2014

Special Edition: CDC Health Advisory

CDC's Health Alert Network publishes an advisory to clinicians regarding new WHO polio vaccination requirements for travel by residents of and long-term visitors to countries with active polio transmission

On June 2, the CDC Health Alert Network (HAN) issued a CDC Health Advisory titled Guidance to US Clinicians Regarding New WHO Polio Vaccination Requirements for Travel by Residents of and Long-term Visitors to Countries with Active Polio Transmission. The "Summary" and "Guidance" sections are reprinted below.


On May 5, 2014, the Director-General of the World Health Organization (WHO) accepted the recommendations of an Emergency Committee, declaring the international spread of polio to be a public health emergency of international concern (PHEIC) under the authority of the International Health Regulations (IHR) (2005) and issued vaccination requirements for travelers in order to prevent further spread of the disease. IHR is an international agreement among countries to prevent, protect or control the international spread of disease. All countries have agreed to be bound by recommended activities under IHR.

The “temporary recommendations” in response to this PHEIC, the second ever to be issued under IHR, will be reviewed and possibly revised by WHO’s Emergency Committee in three months. The burden for enforcement of the polio vaccination requirements under this PHEIC declaration lies with polio-affected countries (termed “polio-infected” by WHO). At this time, the United States government is not expected to implement requirements for entry into the United States.

U.S. clinicians should be aware of possible new vaccination requirements for patients planning travel for greater than four weeks to countries with ongoing poliovirus transmission. The May 5 WHO statement names 10 such countries, three designated as “exporting wild poliovirus” (Cameroon, Pakistan and Syria [Syrian Arab Republic]) that should “ensure” recent (4 to 52 weeks before travel) polio boosters among all departing residents and long-term travelers (of more than 4 weeks), and an additional seven countries “infected with wild poliovirus” (Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Nigeria) that should “encourage” recent polio vaccination boosters among residents and long-term travelers.

At this time, CDC is not aware of what specific steps will be taken by these 10 countries to comply with the PHEIC declaration. U.S. citizens who plan to travel to any of the polio infected countries should have documentation of a polio booster in their yellow International Certificate of Vaccination in order to avoid delays in transit.


CDC routinely recommends that anyone planning travel to a polio-affected country be fully vaccinated against polio and that, in addition, adults should receive a one-time booster dose of polio vaccine. Because of the recent PHEIC declaration, anyone staying in any of the polio-affected countries for more than four (4) weeks may be required to have a polio booster shot within the 4 weeks to twelve months prior to departure from that country. This booster should be documented in the yellow International Certificate of Vaccination in order to avoid delays in transit or forced vaccination in country. Either oral poliovirus vaccine (OPV) or inactivated poliovirus vaccine (IPV) may be used for this booster, however only IPV is currently available in the United States.

Access the complete CDC HAN Health Advisory, which includes a more detailed "Recommendations" section.

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Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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