Addendum to Technical Instructions for Vaccinations: Polio

August 28, 2019

The medical screening of persons overseas applying for US immigration status and non-immigrants who are required to have an overseas medical examination, both hereafter referred to as applicants, is an essential component of the immigration process. The International Health Regulations Emergency Committee of the World Health Organization (WHO) met in May 2014 regarding the international spread of wild polioviruses (WPV) in 2014 and declared that the conditions were a Public Health Emergency of International Concern (PHEIC). Since that time, WHO has issued regular updates to both the categories of risk and the states that fall into those risk categories. The most recent update, published in March 2019, includes countries with either wild poliovirus (WPV) or circulating vaccine-derived poliovirus (cVDPV).

Based upon the information in the most recent WHO declaration, the instructions in this Addendum to Technical Instructions for Panel Physicians for Vaccinations are to be followed for applicants for US immigration from the countries infected with WPV1 (Afghanistan, Pakistan, and Nigeria), cVDPV1 (Papua New Guinea and Indonesia), and cVDPV3 (Somalia), with potential risk for international spread. These Technical Instructions are effective from the date of issuance until the Centers for Disease Control and Prevention (CDC) determines they are no longer needed to prevent the importation and spread of WPV or cVDPV. These Technical Instructions are also subject to modification if there are changes to the countries listed in the above risk categories. CDC will communicate discontinuation or modification of these instructions to the US Department of State and other relevant parties.

For inquiries about these Technical Instructions, please contact the Immigrant, Refugee, and Migrant Health Branch, Division of Global Migration and Quarantine, at CDCQAP@cdc.gov. These Technical Instructions and other information pertinent to them and to the medical examination for applicants for US immigration can be found online at the Panel Physician Portal.

Background

On May 5, 2014, the International Health Regulations Emergency Committee of WHO declared that a PHEIC exists for WPV and recommended polio vaccination for all residents and long-term visitors (i.e., >4 weeks) before their departure from countries identified to be infected with WPV. Since then, WHO has issued regular updates to both the categories of risk and the states that fall into those risk categories. The most recent update, published in March 2019, includes recommendations for both WPV and cVDPV. The current poliovirus situation globally, including exportations, represents an opportunity to introduce this virus into the United States, a country that has eliminated WPV. The guidelines presented in this addendum are intended to address this concern and reduce the risk of reintroduction of WPV or cVDPV into the United States.

Read more about WHO’s most recent statement on the meeting of the Emergency Committeeexternal icon concerning the international spread of poliovirus. For CDC guidance on how US physicians should interpret additional doses of poliovirus vaccine in relation to an applicant’s vaccine schedule after they arrive in the United States, consult the Interim CDC Guidance for Polio Vaccination for Travel to and from Countries Affected by Wild Poliovirus in CDC’s Morbidity and Mortality Weekly Report.

Poliovirus Vaccination

The instructions in this addendum are in effect for all panel physicians who are conducting examinations in the following countries infected with WPV1, cVDPV1, or cVDPV3, with potential risk of international spread:

  • WPV1: Afghanistan, Pakistan, and Nigeria
  • cVDPV1: Papua New Guinea and Indonesia
  • cVDPV3: Somalia

These instructions also apply to all panel physicians in other countries when examining applicants who have been a long-term visitor (i.e., > 4 weeks) to any of the above countries within 12 months of the immigration medical examination.

In order to complete the visa medical examination, as well as the polio vaccination exit requirements for these countries:

  • All applicants for US immigration who are either residents of or long-term visitors (i.e., > 4 weeks) to the above countries are required to receive one dose of either bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) within the 12 months before travel to the United States.
  • Any applicant not meeting this vaccination requirement should receive the dose of vaccine at the panel physician examination.
  • The contraindications and precautions detailed in the Technical Instructions for Vaccination are in effect for this addendum. Applicants who are pregnant at the time of the immigration medical examination may receive either bOPV or IPV.
  • While US-bound refugees are not normally required to receive vaccinations, any refugee meeting the criteria outlined in this addendum is required to receive polio vaccination before travel to the United States.
  • Panel physicians should follow the Technical Instructions for Vaccination for all other vaccinations as they normally would.

Panel physicians examining applicants not specified in this addendum should continue to follow the Technical Instructions for Vaccination, including routine poliovirus vaccination for all applicants aged 2 months to 17 years.

Documentation

Panel physicians should follow the Vaccination Technical Instructions for Panel Physicians for instructions on documenting vaccine doses on the Department of State Vaccination Documentation Worksheet, DS 3025.

In addition, panel physicians should collaborate with governments at the examination site to provide all immigrants and refugees with an International Certificate of Vaccination or Prophylaxis (“Yellow Card”) that records their polio vaccination and serves as proof of vaccination.

Glossary of Abbreviations
  • bOPV– Bivalent oral poliovirus vaccine
  • CDC – Centers for Disease Control and Prevention
  • cVDPV – Circulating vaccine-derived poliovirus
  • DS – Department of State
  • IPV – Inactivated poliovirus vaccine
  • PHEIC – Public Health Emergency of International Concern
  • WHO – World Health Organization
  • WPV – Wild poliovirus