Wild poliovirus has circulated during the previous 12 months in Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel (also the West Bank and Gaza), Somalia, and Syria, as well as in those countries where polio is still endemic (Afghanistan, Nigeria, and Pakistan). The World Health Organization (WHO) has declared a public health emergency related to the possible spread of polio from affected countries. In response, the Centers for Disease Control and Prevention (CDC) has issued interim guidance for US residents planning travel to and from these countries.

Vaccine Recommendations – All travelers to countries with wild poliovirus circulation during the last 12 months should have completed a primary series of inactivated polio vaccine (IPV; IPOL – Sanofi-Pasteur) before departure. Adults who have not previously been immunized against polio should receive a 3-dose primary series of IPV (2 doses 4-8 weeks apart; third dose 6-12 months after the second). If protection is needed sooner, 2 or 3 doses ≥4 weeks apart can be given; if <4 weeks are available before protection is needed, a single dose is recommended. Adults who previously completed a primary series and have never had a booster should receive a single booster dose of IPV. Previously unimmunized children should receive a 4-dose primary series of IPV. The first dose can be given at age ≥6 weeks; the minimum interval is 4 weeks between doses 1 and 2 and 2 and 3, and is 6 months between doses 3 and 4. A child who received 4 doses before age 4 should be given a fifth dose.1

Interim Guidance – Travelers planning to stay for >4 weeks in a polio-infected country may be required to present proof of polio vaccination when departing that country. The CDC is now recommending that all polio vaccine administration for travelers be documented on an International Certificate of Vaccination or Prophylaxis ("yellow card"). Children and adults who will be in a polio-infected country for >4 weeks, and whose last dose of polio vaccine was administered >12 months before the date they will be leaving that country should receive an additional dose of IPV before leaving the US. Those who plan to reside in a polio-infected country for >12 months may be required to receive a dose of the polio vaccine that is available in that country (either IPV or oral polio vaccine) between 4 weeks and 12 months before their departure from the polio-infected country.2

1. Advice for Travelers. Treat Guidel Med Lett 2012; 10:45.
2. GS Wallace et al. Interim CDC guidance for polio vaccination for travel to and from countries affected by wild poliovirus. MMWR Morb Mortal Wkly Rep 2014; 63:591.

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Patients planning to travel to other countries often ask for information about appropriate vaccines and prevention of diarrhea and malaria. More detailed advice for travelers is available from the Centers for Disease Control and Prevention (CDC) at www.cdc.gov/travel. Guidelines are also available from the Infectious Diseases Society of America (IDSA).

Patients planning to travel to other countries often ask physicians for information about appropriate vaccines and prevention of diarrhea and malaria. Guidelines are also available from the Infectious Diseases Society of America (IDSA).

Patients planning to travel to other countries often ask physicians for information about immunizations and prevention of diarrhea and malaria. More detailed advice for travelers is available from the Centers for Disease Control and Prevention at 877-FYI-TRIP (877-394-8747) or www.cdc.gov/travel.

A new pentavalent vaccine (Pediarix - GlaxoSmithKline), licensed by the FDA for children 6 weeks to 7 years old, includes the antigens from vaccines already marketed against diphtheria, tetanus and pertussis (Infanrix) and hepatitis B (Engerix-B), and a new inactivated polio component.

Patients planning to travel to other countries often ask physicians for advice about immunizations and prevention of diarrhea and malaria. More detailed advice for travelers is available from the CDC at 877-FYI-TRIP (877-394-8747) or www.cdc.gov/travel.

Patients planning to travel to other countries often ask physicians for advice about immunizations and prevention of diarrhea and malaria. Legal requirements for entry and epidemiological conditions in different countries vary from time to time, often unpredictably, but some reasonable recommendations can be made. More detailed information is available in Health Information for International Travel, published bi-annually by the Centers for Disease Control and Prevention (CDC), which can be obtained from the Superintendent of Documents, US Goverment Printing Office, Washington, DC 20402 (202-512-1800). Up-to-date automated information is available from the CDC at 888-232-3228 or on the internet at www.cdc.gov.

Patients planning to travel to other countries often ask physicians for advice about immunizations and prevention of diarrhea and malaria. More detailed advice for travelers is available from the CDC at 877-FYI-TRIP (877-394-8747) or www.cdc.gov/travel.

Mupirocin (Bactroban - Beecham), a topical antibiotic formerly called pseudomonic acid, was recently approved by the US Food and Drug Administration for treatment of impetigo. It will be sold as a 2% ointment available only by prescription.

The US Food and Drug Administration recently licensed a new Salk-type injectable polio vaccine (Poliovirus Vaccine Inactivated - Connaught) that is more potent in its antigenicity than any other inactivated polio vaccine (IPV) previously available in the USA. Live oral polio vaccine (OPV) has been the preferred vaccine for routine immunization in the USA since the early 1960's. Its advantages over IPV have included ease of administration, superior immunogenicity, induction of gastrointestinal immunity, increased immunization through spread of vaccine virus to unimmunized susceptible contacts, and lower cost (AM McBean and JF Modlin, Pediatr Infect Dis J, 6:881, 1987).