IMPORTANT NOTICE FOR ALL TRAVELERS VISITING INDIA
ORAL POLIO VACCINATION (OPV) MANDATORY – W.E.F. 30.012014
World Health Organisation (WHO) has advised Government of India (G01) to take necessary precautions by seeking immunization of incoming visitors from polio affected countries six weeks prior to their arrival in India and also to arrange Oral Polio Vaccination (OPV) to Indian citizens travelling to those countries with a view to accord protection to Indian population.
Accordingly, Government of India has decided to make it a mandatory requirement for all travelers from WHO-identified seven countries inducing Nigeria, visiting India to have OPV six weeks before departure for India. The OPV is valid for one year from the date of its administration.
This mandatory requirement will take effect from 30, January, 2014. The OPV is also a mandatory requirement for all Incian nationals visiting Nigeria and the remaining six WHO-identified countries i.e. Afghanistan, Ethiopia, Israel, Kenya, Somalia and Pakistan.
Travelers of all age originating from any of the above WHO-identified seven countries may kindly ensure that they get OPV administered through a Govemment-approved medical centre/clinic/Institute/hospital six weeks prior to their travel to India and carry along the OPV Certificate. This is a mandatory requirement with effect from 30.01.2014.
Source – www.indiahcabuja.com
Comment: Given that India is now officially Polio free, the recommendations of Polio vaccination from countries reporting Polio make sense.
However, I am not sure that I agree with some of the actual suggestions made. Giving Oral Polio instead of IPV is debatable. There is a small risk of Vaccine induced Poliomyelitis (VAPP) due to oral polio vaccine, especially in adults. Even though the risk is very small (Less than 1 in 1 lakh) we can easily avoid this by giving the Polio Injection (IPV). Also, IPV has a longer protection ( it may last for life for adults), hence asking for yearly Oral Polio vaccines does not make sense in my opinion.
Israel has only reported Polio in sewage samples, and not any actual human polio cases. Hence I am not sure that it needs to be included in the list of countries from where Polio vaccine should be compulsory.
It is not clear if the letterhead of any doctor would be sufficient proof of Polio vaccination, or would the immigration insist on the certificate being issued on the pattern of WHO ICV 2005 (International certificate of Vaccination, as per International Health regulations 2005).
What about people who have taken polio drops as children, do they still need the Polio drops?
Finally, yearly OPV boosters are not recommended as per any Vaccine textbook that I am aware of. Giving yearly polio drops to adults is likely to be associated with increased risk of VAPP (Vaccine associated Polio), so I am not sure if this is a scientifically accurate suggestion as well.
What would I recommend?
I am suggesting my clients to take the Injectable Polio Vaccine (IPV), along with Polio drops to make sure that they are following the guidelines issued by the Govt of India, as well as avoiding any risk to self, PLUS getting long term protection against Polio for life!
Comments from International faculty of ISTM (International Society of Travel Medicine)
“The issue is that IPV does not prevent multiplication and then excretion of polio virus in the GI tract once ingested. IPV prevents clinical disease however in the individual who is infected. However, that person can still harbor and carry the virus out of the country to another country. Only OPV prevents intestinal carriage.
The reason Israel has this problem is that like the US, they moved to IPV only over a decade ago. The Israeli population is well vaccinated so no one is getting polio disease once the virus was introduced but now many well people are colonized and excreting into the environment causing the issue with the sewage and potential for some of the carriers to export virus to a country that has less good population vaccination coverage. This is one of the pitfalls of using IPV and may hamper eventual complete eradication efforts.
The issue of mutation to VAPP strains is a real one but is quite a rare occurrence in the grand scheme, especially when it involves a relatively few number of incoming travelers being vaccinated compared to the size of India.
David O. Freedman, MD
University of Alabama”