Poliomyelitis

Keeping up to date: Things to know in practice currently:

• 31st July: Polio: Public Health Emergency of International Concern: An update in the 42nd EC Statement, countries with a change in polio status since the last EC meeting (which may mean a change to polio vaccination recommendation) are Burkina Faso, Central African Republic, Equatorial Guinea, Gambia, Israel, Mali, Mozambique, Papua New Guinea and Tanzania. See polio vaccination recommendations and certificate information on the individual Country Information pages for those who plan to travel to these countries.

• 5th June 2025: PGD template update for the Hexavalent vaccine DTaP/IPV/Hib/HepB.

• 2nd June 2025: This guidance got an update: "Hexavalent DTaP/IPV/Hib/HepB combination vaccine: information for healthcare practitioners". As did this page (Hexavalent combination vaccine: programme guidance) in general. The Polio Green Book chapter has been updated today as well, and I think this will be the first of many Green Book changes relating to the new schedules.

• 29th May 2025: More resources - an updated slideset for the hexavalent programme. Will help with understanding the upcoming changes in the programme from July 2025.

• 21st May 2025: Two new polio cases have been confirmed in Khyber Pakhtunkhwa, raising Pakistan’s total for 2025 to 10.

• 16th May 2025: WHO declares polio outbreak in Papua New Guinea. Looks like there will be an "immediate" vaccination campaign after positive samples were found in two healthy children during a routine screening in Lae. Shocking to learn that less than half of the country's population are immunised against polio. Let's keep our fingers crossed that a campaign gets underway ASAP and is successful.

• 23rd April 2025: So terribly sad. Pakistan gunmen kill two police guarding polio vaccinators. But the campaign continues after 7 more childhood cases of polio are reported in Pakistan.

• 10th April 2025: Statement of the forty-first meeting of the Polio IHR Emergency Committee

• 9th April 2025: Polio: guidance, vaccination, data and analysis: This page has been updated to include information on the global polio eradication programme, the UK National Authority for Containment, and environmental surveillance.

• 3rd April 2025: Updated information on the reporting, investigation and management of acute flaccid paralysis (AFP) and acute flaccid myelitis (AFM).

• The WHO Emergency Committee for Polio met in March 2025 and based on evidence presented by UKHSA officials, WHO placed the UK on the list of Member States infected with cVDPV2, with or without evidence of local transmission. The UK would need to submit evidence that there were no detections for 12 months for WHO to consider removing the UK from this list.

• 30th Jan - article: Europe faces growing risk of polio despite ongoing vaccination efforts

• 23rd Jan 2025: The School leaver booster (Td/IPV): vaccine coverage estimates are out. It made me quite sad looking at the uptake data, I have to admit. Td/IPV coverage for year 10 students during the 2023/24 was 72.7%, which is 6.8 percentage points lower than the year 10 cohort in 2022/23.

• 22nd Jan 2025: The routine imms schedule has been updated to reflect a change to the use of REPEVAX rather than Boostrix-IPV at 3 years and 4 months.

• 10th Jan 2025: As of 10 January 2025, a further vaccine-derived poliovirus type 2 (VDPV2) has been detected in an environmental sewage sample from London collected in December 2024.

• 20th Nov: Sad news for Pakistan (and humankind in general) as they hit their 50th case of polio this year: A 20 month old girl who has been paralysed from something that so easily could have been prevented.

• 16th August. Sad news. The first case of polio has been confirmed in a 10-month-old child in Gaza. This article later appeared in the news on 30th August: WHO delivers 1.2m polio vaccine doses to Gaza as pauses in fighting agreed. Three-day humanitarian pauses in several areas planned to allow inoculation of more than 640,000 children.

• JULY 2024 Updated Td/IPV PGD 10th July.

• June 2024 - Adacel (a pertussis containing vaccine without polio- Tdap) is the primary vaccine from July 2024 for pertussis in pregnancy. This JCVI decision came about following studies measuring antibody levels in the infants of mothers who had received pertussis-containing vaccines (dTaP/IPV) in pregnancy. The results showed lower antibody responses to polio (after completion of their primary infant schedule) compared to infants born to unvaccinated mothers, although all remained above the protective threshold. But just to be on the safe side, it makes sense to omit the polio when vaccinating a pregnant woman, especially seeing as there is a vaccine that fits the bill!

• MAY 2023 More campaigns! Catch up campaign announced

• JUNE 2022 Government alerted to detection of VDPV2 in London sewage samples, some guidance started to get updated in response. Aug 2022 saw the start of a campaign.

• APRIL 2016 In some parts of the world, the oral polio vaccine started to contain only one or two strains. Not all three. Read the REALLY small print at the bottom of the incomplete immunisation algorithm. This is the reason why it recommends to disregard any oral polio doses given after April 2016 in other countries.

Bits and bobs to casually drop into conversation

The history of this one STILL influences clinical decisions today so is worth knowing a bit about!

Did you know....

• During the early 1950s, there were epidemics of poliomyelitis infections with up to 8000 annual notifications of paralytic poliomyelitis in the UK.

• Routine immunisation with inactivated poliomyelitis vaccine was introduced in 1956. This was replaced by live attenuated oral polio vaccine in 1962.

• Following the introduction of polio immunisation, cases fell rapidly (yay for vaccines!).

• The last outbreak of indigenous poliomyelitis was in the late 1970s.

• The last case of natural polio infection acquired in the UK was in 1984.

• Until 2004, OPV was used for routine immunisation in the UK because of the continuing risk of importation of wild virus.

• Individuals born before 1962 may not have been immunised or may have received a low-potency polio vaccine. The Green Book says: "no opportunity should be missed to immunise them".

Click on the image to see more Polio photos.

This image is courtesy of CDC via immunize.org