Warns of harsher measures if situation does not improve.
Travel restrictions imposed on Pakistan by International Health Regulations (IHR) Emergency Committee on May 5 this year for exporting poliovirus have been extended for further three months.
The committee will reassess the situation within three months and if the existing and additional temporary recommendations for the vaccination of travellers from Pakistan cannot be fully implemented by the time the committee next meets, it will consider additional measures such as entry screening to reduce the risk of international spread, said a statement issued by the World Health Organisation (WHO).
The third meeting of the Emergency Committee under the IHR (2005) regarding the international spread of wild poliovirus in 2014 was convened by the director general through electronic correspondence from 2 through 7 November, 2014. Cameroon, Equatorial Guinea, Pakistan and the Syrian Arab Republic submitted an update on the implementation of the temporary recommendation to the committee for assessment.
Recognising the escalating wild poliovirus transmission in Pakistan, with more reported cases than at any time in the past 14 years and ongoing cross-border exportation of the virus, the committee provided additional advice to the director general for her consideration to reduce further the risk of international spread of wild poliovirus.
“Pakistan should restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination. These recommendations apply to international travellers from all points of departure, irrespective of the means of conveyance (e.g. road, air, sea),” recommended the IHR Committee.
Pakistan should note that the recommendation stated previously for urgent travel remains valid (i.e. those undertaking urgent travel who have not received appropriate polio vaccination must receive a dose of polio vaccine at least by the time of departure and be provided with appropriate documentation of that dose).
It advises that in advance of the next meeting of the committee, Pakistan should provide to the director general a report on the implementation by month of the temporary recommendations on international travel, including the number of residents whose travel was restricted and the number of travellers who were vaccinated and provided appropriate documentation at the point of departure.
The committee noted that the international spread of wild poliovirus has continued since July 31, 2014, with at least three new exportations from Pakistan into neighbouring Afghanistan. There has been no other documented international spread of wild poliovirus since March 2014.
“The risk of new international spread from Pakistan was assessed to have increased substantively since July 31, 2014, as cases have escalated during the current high transmission season and there has been no significant improvement in the underlying factors that are driving transmission in the country. The risk of new international spread from the other nine currently infected states appears to have declined, with only two of those states having reported new cases since July 31: Somalia (1 case) and Afghanistan (7 cases, most of which were due to imported virus),” states the WHO statement.
The IHR committee recommends that the states currently exporting wild poliovirus: Pakistan, Cameroon, Equatorial Guinea and the Syrian Arab Republic should ensure that all residents and long-term visitors (i.e. > 4 weeks) receive a dose of oral polio vaccine (OPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel.
And ensure that those undertaking urgent travel (i.e. within four weeks), who have not received a dose of OPV or IPV in the previous four weeks to 12 months, receive a dose of polio vaccine at least by the time of departure as this will still provide benefit, particularly for frequent travellers. It also recommends this time to maintain these measures until the following criteria have been met: (i) at least six months have passed without new exportations and (ii) there is documentation of full application of high-quality eradication activities in all infected and high-risk areas; in the absence of such documentation these measures should be maintained until at least 12 months have passed without new exportations.
According to WHO officials, though the recommendations have been extended for all three countries - Pakistan, Syria and Cameroon - slapped with restrictions in May but Syria and Cameroon reported no cases since the committee last met on July 31, 2014 but Pakistan has reported over 100 cases since then.
The officials believe the statement indicates that the restrictions on Syria and Cameroon may be lifted and become harsher for Pakistan after three months when the situation would be reviewed by the IHR again.
Pakistan has reported this year 246 cases so far with Federally Administered Tribal Areas 158 cases, Khyber Pakhtunkhwa 49, Sindh 25, Punjab three and Balochistan 11 cases. State Minister for National Health Services, Regulations and Coordination Saira Afzal and Prime Minister’s Focal Person on Polio Eradication Ayesha Raza Farooq, however, maintained the same restrictions imposed earlier will stay that Pakistan is already following. The WHO has just asked for provision of monthly data of vaccinated travellers and of those unvaccinated travellers who were barred to travel that will be provided to them, they added.
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