KARACHI: Pakistan Islamic Medical Association (PIMA) held an advisory group meeting on Monday with health experts to clear the confusion surrounding the current restriction on Pakistani travelers of mandatory polio vaccination.
Dr Naseem Salahuddin, a renowned infectious disease expert, Prof Ejaz A Vohra, professor of medicine, Dr Shahid Mustufa, consultant neurologist, Prof Sohail Akhtar, Professor of Medicine and President PIMA, Dr Saqib Ansari and Dr Ahmer Hamid, consultant pediatricians and other doctors participated.
Dr Naseem briefed the audience about the history of polio vaccine, its serotypes and its different vaccinations. The most commonly used oral vaccine, (OPV), popularly known as ‘polio drops’, is made up of live attenuated virus, like many other vaccines, whose ingredient virus is unable to introduce infection while creating antibodies against the virus for a lasting immunity. Its benefit is ‘herd immunity’ i.e. protection of non immunized persons in the community apart from the vaccinated person, being easy to administer and cheap. Its widespread use has largely eliminated polio in most part of the world many decades ago. There is no danger, she stressed, of the vaccine causing polio itself as is feared by some; the chance is one in 2.7 million doses, more so in malnourished and immune compromised (those on anti-transplant rejection and anti cancer medicines in particular) children and adults who cannot make adequate antibodies against the virus. Even in pregnant women there is no real danger, although it is recommended that they and the immune compromised individuals avoid it. The alternative for them is the injectable vaccine, (IPV) which is made of dead virus, is equally effective, but is protective to the individual only and is slightly costly.
In 2013, 60% of polio cases in the world were the result of international spread of wild poliovirus, particularly from 3 (Pakistan, Syria, Cameroon) of the 10 polio-infected countries. Travelers from infected areas were therefore advised recently by the world health organization (WHO) to receive an additional dose of OPV or IPV, in order to boost immunity and reduce the risk of poliovirus shedding, which could lead to re- introduction of poliovirus into a polio-free area. Both OPV and IPV can be given.
As per WHO recommendations, following strategy is being implemented in Pakistan to immunize adult residents and travelers:
1. All resident travelers and long-term visitors (i.e. > 4 weeks), regardless of age and vaccination status, will receive a dose of OPV or inactivated poliovirus vaccine (IPV) between 4 weeks and 12 months prior to international travel.
2. In case of urgent travel (i.e. within 4 weeks) persons who have not received a documented dose of OPV or IPV within the previous 12 months will receive a dose of polio vaccine at the time of departure at the airport.
3. International Certificate of Vaccination or Prophylaxis” will be issued by Government hospitals, EDOs and THOs, and Polio vaccination counters at Airports.
In very rare instances (estimated 1 in 2.7 million), OPV has been associated with paralytic poliomyelitis in healthy recipients receiving their first dose of OPV, while no serious side effects of currently available IPV have been documented.
Prof Ejaz Vohra stressed on the need to vaccinate all children in Pakistan against polio to make it a safe country, a status achieved by many time larger countries like India and China. He expressed concerns on news of travelers getting fake certificates of polio vaccination whereas it is a safe and cheap protective measure.
Dr Shahid Mustufa termed the recent travel restrictions regarding polio vaccination a grave step for Pakistan. He stressed on urgent measures to get it lifted, the only possible way being to reduce the number of new polio cases to zero by effective vaccination.
Experts also pointed out to loopholes in the national vaccination program, the EPI, which has also contributed to emerging of new polio cases. They stressed that the government should facilitate the administration of polio vaccine to all travelers, not only by its availability at the airports but also at major govt. and private hospitals. The certification process should be cost effective and free of hassle.
The sick, immune compromised persons and pregnant women among the travelers should be given exemption certificate. In case they have to be vaccinated, the injectable vaccine, IPV, should be made available free of cost for them. The public should be reassured that the oral (and injectable) polio vaccine is safe; they should get themselves vaccinated and certified, well in advance of anticipated travel. There is no need to recertify for twelve months following a single dose. Media should highlight these issues for the satisfaction of the society. Existing polio vaccination should be intensified especially to the deprived parts of the country, in order to make this country a polio safe country.