ISLAMABAD    -  International Health Regulations (IHR) showing concerns over polio outbreaks has recommended further three months temporary travel restrictions on Pakistan, statement said on Saturday.

IHR, the World Health Organization (WHO) body in its 22nd Emergency Committee meeting held previous month regarding the international spread of poliovirus, expressed grave concerns on polio situation in Pakistan.

The statement draft said “The Committee is gravely concerned by the significant further increase in wild poliovirus (WPV1) cases globally to 73 in 2019 to date, compared to 15 for the same period in 2018, with most of the increase due to the ongoing outbreaks in Pakistan.”

It said that the Committee believes that the risk of international spread of poliovirus still remains a Public Health Emergency of International Concern (PHEIC), and that “progress made in recent years appears to have reversed.”

It further said that in Pakistan, transmission continues to be widespread, as indicated by both AFP (acute flaccid paralysis) surveillance and environmental sampling, although the Khyber Pakhtunkhwa province was of particular concern. 

“The increasing refusal by individuals and communities to accept vaccination is a serious setback to eradication. The committee was very concerned about the current status of the management of the polio programme in Pakistan but understood that steps are being taken to get the programme back on track,” reads the statement.

“The resumption of WPV1 international spread between Pakistan and Afghanistan suggests that rising transmission in Pakistan correlates with increasing risk of WPV1 exportation beyond the single epidemiological block formed by the two countries,” statement said.

It was concerned that after five years of vaccinating travellers as a means to limit the risk of international spread, there was some evidence of complacency about this aspect of the programme, particularly at airports, and this must be addressed to prevent further international spread.

The committee noted that as the risk of international spread of WPV1 was the highest since 2014, the risk of exportation events from Pakistan and Afghanistan through air travel was also greater than in recent years and urged both countries to ensure adequate funding and monitoring of airport and travel vaccination was in place.

The recommendations require Pakistan to maintain the emergency status of poliovirus transmission being a national public health emergency; to ensure that all residents and long-term visitors (i.e. > four weeks) of all ages, receive a dose of bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel; to ensure that those undertaking urgent travel (i.e. within four weeks), who have not received a dose of bOPV or IPV in the previous four weeks to 12 months, receive a dose of polio vaccine at least by the time of departure; ensure that such travellers are provided with an international certificate of vaccination to record their polio vaccination and serve as proof of vaccination; and restrict 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).

Pakistan is required to maintain these measures until at least six months have passed without new infections and there is documentation of full application of high-quality eradication activities in all infected and high-risk areas.

It is also required to provide to the Director-General of WHO, a regular report on implementation of the temporary recommendations on international travel.