WHO declares polio a public health emergency

BMJ 2014; 348 doi: (Published 06 May 2014) Cite this as: BMJ 2014;348:g3124
  1. Anne Gulland
  1. 1London

The World Health Organization has declared the spread of polio a global public health emergency, which, if left unchecked, could derail efforts to eradicate the disease.1

The 14 members of WHO’s international health regulations emergency committee met at the end of April alongside representatives from the nine states where wild poliovirus has been found in the past 12 months: Afghanistan, Cameroon, Equatorial Guinea, Ethiopia, Israel, Nigeria, Pakistan, Somalia, and Syria.

The committee presented its findings to Margaret Chan, WHO’s director general, informing her that the cross border spread of wild poliovirus in 2014 was an “extraordinary event.” On 5 May Chan declared the situation a global public health emergency under international health regulations. The last such declaration was made in 2009 over the H1N1 influenza pandemic.

Bruce Aylward, WHO’s assistant director general for polio eradication and emergencies, told a press conference that about two thirds of cases of wild poliovirus seen this year were caused by the international spread of the virus and that evidence showed that adult travellers were contributing to this spread.

The virus has spread from Pakistan to Afghanistan, from Syria to Iraq, and from Cameroon to Equatorial Guinea, which is also battling an outbreak of the Ebola virus.

Helen Rees, a member of the committee and executive director of the Wits Reproductive Health and HIV Institute at the University of the Witwatersrand in Johannesburg, South Africa, said that the committee members were particularly concerned about the spread of the virus in the low season, January to April.

“The real concern was the issue of low season transmission and the exportation from the three countries. If this happens in the low season it poses a very real threat to the global eradication effort,” she said.

There have been 74 cases of type 1 poliovirus reported so far in 2014, compared with 24 for the same period in 2013. Pakistan reported 59 of the 74 cases, four cases occurred in Afghanistan, and three occurred in each of Cameroon and Equatorial Guinea. Nigeria has reported two cases, and Iraq, Syria, and Ethiopia each reported one case.

Somalia had 194 cases of the disease in 2013, the last case being reported on 20 December. Wild poliovirus has been found in sewage in Israel, but no human cases have been reported.

WHO declared that the three countries exporting the virus—Pakistan, Cameroon, and Syria—posed the greatest risk, and it said that these states should take a number of measures, including ensuring that all residents and long term visitors receive a dose of oral polio vaccine (OPV) or inactivated polio vaccine (IPV) between four weeks and 12 months before international travel and that they carry an international certificate of vaccination or prophylaxis. Those undertaking urgent travel should ensure that they have had a dose of OPV or IPV at least by the time of departure.

The other countries infected with polio should “encourage” residents to have a dose of OPV or IPV before travelling abroad, WHO said. The regulations will remain in place until at least six months have passed without new exportations of the virus. Aylward said that the committee would meet again in three months, or sooner if the situation changed.

He said that WHO would support countries to help implement the measures and that the extra vaccine needed was only a small proportion of the “billions” of doses of vaccines that were delivered every year. He was confident that the WHO measures would be implemented in the government controlled areas of Syria and that the opposition areas would get support from non-governmental organisations.

He said, “The expectation is that these measures will be [implemented] extremely fast. We are entering the high season for the virus . . . It’s in the interests of countries to get this in place quickly.”

Most of the cases of polio in Pakistan, where polio workers have been shot at and murdered, have occurred in the Peshawar valley and North Waziristan. Aylward said that Pakistan had made great strides in improving the security of its vaccination campaigns, including banning motorbikes, which were used by many of the killers.


Cite this as: BMJ 2014;348:g3124


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