Polio Outbreak in Pakistan and Travel Restrictions

Polio Outbreak in Pakistan and Travel Restrictions

Polio is a disease caused by a virus. It enters the body through the mouth. The virus usually spreads through feces. It also spreads via oral route due to bad hygienic habits.  Contaminated water, food or unhealthy environmental conditions add in spread. Usually it does not cause serious illness. But sometimes it causes paralysis (can’t move arm or leg), and it can cause meningitis (irritation of the lining of the brain). It can kill people who get it, usually by paralyzing the muscles that help them breathe.

Questions:

 

Polio Design

 

Causative Agent: Polio Virus

Symptoms:

  • Acute onset of fever
  • Headache
  • Malaise
  • Flaccid Paralysis
  • Skeletal Deformity

Climate/ Environment: More common in hot summer or early autumn.

Why get vaccinated?

According to the recent report of WHO, Unfortunately Pakistan is one of only three countries where the Poliovirus is endemic. The other two countries are Nigeria and Afghanistan.

In a statement, the WHO said Pakistan, Cameroon, and the Syrian Arab Republic pose the greatest risk of further wild poliovirus exportations in 2014. The WHO recommended:

“These States should:

  1. officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency;
  2. ensure that all residents and long-term visitors (i.e. > 4 weeks) receive a dose of OPV or inactivated poliovirus vaccine (IPV) between 4 weeks and 12 months prior to international travel;
  3. ensure that those undertaking urgent travel (i.e. within 4 weeks), who have not received a dose of OPV or IPV in the previous 4 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 travelers;
  4. ensure that such travelers are provided with an International Certificate of Vaccination or Prophylaxis in the form specified in Annex 6 of the International Health Regulations (2005) to record their polio vaccination and serve as proof of vaccination;
  5. maintain these measures until the following criteria have been met: (i) at least 6 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.”
  6. “Once a State has met the criteria to be assessed as no longer exporting wild poliovirus, it should continue to be considered as an infected State until such time as it has met the criteria to be removed from that category,” added the WHO statement.

Polio has been eliminated from the United States. But the disease is still common in some parts of the world including Pakistan. World Health Organization has declared Polio as “Public Health Emergency” with Pakistan Syria and Cameroon as posing the risk of exportation of virus beyond their borders. It would only take one person infected with polio virus coming from victim country to spread the disease if we are not protected by vaccine. If the effort to eliminate the disease from the world is successful, some day we won’t need polio vaccine. Until then, we need to keep getting ourselves and our children vaccinated.

Who should get polio vaccine and when?

As of now Pakistan is under travel restriction, it is the responsibility of every citizen to ensure that his/her family, including him/her have been vaccinated in the past or before traveling to another country.

Government of Pakistan is putting laborious efforts to fight the virus and eradicate this disease and we will, in our capacity, provide all the services to make this campaign a success.

In this regard following guidelines are issued for the awareness of public

  • All travelers proceeding abroad must be vaccinated for polio.
  • All residents and visitors staying for more than four weeks in Pakistan should receive Polio vaccination
  • At Airports, only those, who are undertaking urgent travel will be vaccinated
  • All DHO’s Teaching Hospital MS and other tertiary hospital will provide facility.
  • An international certificate of Vaccination prophylaxis as per IHR (05) will be issued after vaccination (At airport only).
  • Certificate of Vaccination 04 weeks prior to travel which may be received from the vaccination center, will remain valid for 1 year
  • Polio vaccination counter will get operational in short time as soon as the vaccine is provided by the ministry which will be intimated accordingly

Where can you get vaccinated?
Government of Pakistan has declared Public Health Emergency in the country. All the DHQ, THQ, BHU, RHC and Teaching Hospitals have been directed to provide the facility of vaccination and certification for every citizen. You can go to your nearest place to get yourself vaccinated. These hospitals will also issue vaccine administration certification to those who intend to travel abroad.

You may also call up Punjab Health Center to get information of the nearest Vaccine center in your area.

Punjab Health Center: 0800-99000

Government will soon activate Polio Help Line which is 0800-88588

Which Vaccine You will be given for vaccination?

The Polio vaccine can be given to you in two forms

Oral Polio Drops (OPV): You may be given two drops orally to vaccinate you

Injection of Polio Vaccine: You may also get vaccine in the form of injection. IPV (Inactivated Polio Virus Vaccine) is a shot, given in the leg or arm, depending on age.

What are the risks from IPV?

Some people who get IPV get a sore spot where the shot was given. IPV has not been known to cause serious problems, and most people don’t have any problems at all with it.

However, any medicine could cause a serious side effect, such as a severe allergic reaction or even death. The risk of polio vaccine causing serious harm is extremely small.

OPV (Oral Polio Drops) remains the vaccine of choice for mass vaccination to control polio outbreaks.

The preference for OPV in an outbreak setting is supported by

a) Higher seroconversion rates after a single dose of OPV compared with a single dose of IPV;

b) A greater degree of intestinal immunity, which limits community spread of wild poliovirus; and

c) Beneficial secondary spread (intestinal shedding) of vaccine virus, which improves overall protection in the community.

OPV can protect more persons who are susceptible in a population, making it the preferred vaccine for rapid intervention during an outbreak.

 

What should you look for?

Look for anything that concerns you, such as signs of a severe allergic reaction, very high fever, or behavior changes. Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination.

What should I do?

If you think it is a severe allergic reaction or other emergency that can’t wait, call 1122 or get the person to the nearest hospital. Otherwise, call your doctor.

These people should wait:

Anyone who is moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting polio vaccine. People with minor illnesses, such as a cold, may be vaccinated.

What should I do?

If you think it is a severe allergic reaction or other emergency that can’t wait, call 1122 or get the person to the nearest hospital. Otherwise, call your doctor.

For reference, please see the circular below.

 

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