Thursday 29 June 2017

Polio and PHEIC

A Public Health Emergency of International Concern (PHEIC) is a formal declaration made by the World Health Organization and one was called regarding polio in May 2014.  As a result, the Emergency Committee (EC) meets every three months under the International Health Regulations (2005) (IHR) to review the situation regarding the international spread of polio virus.  To see the details of the latest meeting see here.  Of late measures were in place just for Pakistan, but from the last meeting, Afghanistan and Nigeria have been added to countries we need to provide special advice to our travellers.  The intent is to stop polio being exported from these countries.

Polio will eventually be eradicated, but for now it's about controlling numbers of cases of wild polio virus and also circulating vaccine derived polio virus (CVDPV).  To see an encouraging map of progress look at this.  This is on the Polio Global Eradication Iniative site which has some excellent information explaining the situation.

Please note, this is a changing picture and guidance may alter after the EC meets every 3 months but updates are then subsequently put onto the NaTHNaC (TravelHealthPro) and TRAVAX websites to inform you.

So what do you need to do as a nurse seeing a traveller going to one of these countries?

  • If they are going there for LONGER THAN 4 WEEKS they should be asked provide evidence of having received polio vaccine IN THE LAST 12 MONTHS when they leave the country
  • This evidence has to be produced on an International Certificate of Vaccination or Prophylaxis (ICVP).  
  • If they can't provide this, they may be given oral polio vaccine immediately on exit and provided with a certificate - all free of charge.  
  • For most travellers this is FINE but because the vaccine given will be oral polio vaccine (OPV) which is a live vaccine, we wouldn't want certain groups to have it e.g. a pregnant woman, someone who is immunosuppressed (see more detail below).  
  • Therefore certain groups are advised to be vaccinated prior to departure.    
I have been teaching this since 2014 but there are still many who aren't aware of some of the guidance and perhaps you don't know depending on the database you use, but see the following:

If you work in Scotland then the advice on TRAVAX allows anyone who needs the vaccine and ICVP for this situation to have it on the NHS if they live in Scotland and the Scottish Government funds it.

If you work in England the guidance is different and you must follow the information on NaTHNaC.  This information will be found in the vaccine advice for polio in the relevant country page information.  Polio vaccine will need to be given within Revaxis or Repevax (depending on age of traveller) but NOT ALL travellers can have this on the NHS.

If working in England, therefore following the NaTHNaC advice, who can you provide the vaccine to as an NHS provision?

  • A person who hasn't yet completed their UK schedule and doesn't have 5 doses recorded
  • A person who hasn't had a Revaxis booster in the last 10 years for travel purposes
  • A pregnant woman
  • A person who is immunosuppressed and their household contacts
  • A person travelling to a setting with extremely poor hygiene (e.g. refugee camps) or likely to be in close proximity with cases (e.g. healthcare workers)
  • A traveller visiting for 6 months or more

All other travellers seen in a GP surgery in England would NOT be entitled to vaccine as an NHS provision but receiving oral polio vaccine on exit from the country should present no problem.

If a traveller is unhappy with this advice, then they could access a polio containing vaccine, but need to obtain this from a private travel clinic and pay for both the vaccine and the ICVP.  A GP surgery cannot provide this privately and charge for the vaccine.

ICVP certificates - guidance in England

  • These need to be obtained from the NaTHNaC via this link 
  • Guidance on how to complete the certificate is on NaTHNaC here 
  • You are able to charge for just the certificate in a GP setting - the certificate booklet costs just over £1 per unit so could add on a modest amount to allow for the work involved 
  • NaTHNaC does not advise writing yellow fever and poliomyelitis on the same certificate - one ICVP per disease should be given - reference on the guidance page here 

Note: there is anecdotal evidence that ICVPs are not being checked on exit from the country, nor vaccine given, but the advice is a WHO recommendation so we should be following the guidance and inform our travellers about this regardless.

Important resources
NaTHNaC factsheet 
Public Health England Polio: guidance, data and analysis
WHO factsheet on polio