The Medical Letter on Drugs and Therapeutics
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In Brief: New Polio Vaccination Guidance for Travelers
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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

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