Importation of poliomyelitis by travelers.To the Editor: In July 2007, an Australian traveler imported polio polio: see poliomyelitis. from Pakistan to Australia (1). He was a 22-year-old man who had immigrated to Australia and had traveled to his country of origin (Pakistan) to visit friends and relatives. Pakistan is one of 4 countries (Afghanistan, India, Nigeria, Pakistan) where polio is still endemic. A diagnosis of polio was made shortly after his return to Australia. Australia was certified as polio-free in 2000. Australia will not be the last industrialized in·dus·tri·al·ize
v. in·dus·tri·al·ized, in·dus·tri·al·iz·ing, in·dus·tri·al·iz·es
1. To develop industry in (a country or society, for example).
2. country affected by importation of polio. All countries are at risk until polio has been completely eradicated.
Between 2003 and 2006, polio was imported by travelers (e.g., refugees, pilgrims Pilgrims, in American history, the group of separatists and other individuals who were the founders of Plymouth Colony. The name Pilgrim Fathers is given to those members who made the first crossing on the Mayflower. , traders) to 24 polio-free countries (2). The origin of these importations was largely the 4 countries where polio transmission was never completely interrupted. The importations resulted in about 1,400 secondary cases (2). The resurgence of polio by international spread was a setback to the Global Polio Eradication Initiative that had successfully decreased the number of polio-affected countries to only 9 in 2002.
The revised International Health Regulations, IHR IHR Institute for Historical Review (Orange Country, California)
IHR International Health Regulations
IHR Institute for Health Research (Lancaster University, UK)
IHR Inside Home Recording (2005) (3), entered into legal force on June 15, 2007. These regulations provide the legal framework for coordination of the international effort to reduce or prevent international spread of diseases of public health concern. IHR (2005) (2) lists polio as one of the diseases of public health emergencies of international concern. Preventing importation of polio into polio-free countries is therefore a test case for the revised International Health Regulations (4). Compared to the previous IHR (1969), IHR (2005) has moved away from the definition of fixed maximum measures relating to relating to relate prep → concernant
relating to relate prep → bezüglich +gen, mit Bezug auf +acc specific diseases and instead focuses on the issuance of context-specific recommendations, made either on a temporary emergency basis (a temporary recommendation) or routinely for established ongoing risks of disease spread (a standing recommendation).
One strategy to protect polio-free countries from reintroduction Noun 1. reintroduction - an act of renewed introduction
intro, introduction, presentation - formally making a person known to another or to the public of wild poliovirus poliovirus /po·lio·vi·rus/ (pol´-e-o-vi?rus) the causative agent of poliomyelitis, separable, on the basis of specificity of neutralizing antibody, into three serotypes designated types 1, 2, and 3. is by requiring proof of polio vaccination vaccination, means of producing immunity against pathogens, such as viruses and bacteria, by the introduction of live, killed, or altered antigens that stimulate the body to produce antibodies against more dangerous forms. for all incoming travelers from polio-endemic countries. This was proposed by the Advisory Committee on Poliomyelitis Eradication
The recent polio importation by an inadequately vaccinated traveler would add impetus to such considerations. However, this case also shows that focusing on travelers from polio-endemic countries alone may not be sufficient. Immigrants from developing countries to industrialized countries who subsequently return to their home countries to visit friends and relatives may also be at increased risk if traveling to polio-endemic countries, in particular as many may not have received adequate childhood vaccination including vaccination against polio (6). Targeting those visiting friends and relatives is therefore a potential additional strategy to reduce the risk for the worldwide spread of polio.
(1.) Department of Health and Public Aging. Public health alert over positive case of polio in Australia media release. Australian Government [cited 2007 Jul 13]. Available from http://www.health.gov.au/internet/wcms/publishing.nsf/Content/ health-mediarel-cmo-130707
(2.) Conclusions and recommendations of the Advisory Committee on Poliomyelitis Eradication, Geneva Geneva, canton and city, Switzerland
Geneva (jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. , 11-12 Oct 2006, Part I. Wkly Epidemiol Rec. 2006;81: 453-60.
(3.) World Health Organization. International Health Regulations 2005 [cited 2007 Nov 9]. Available from http://www.who.int/csr/ihr/en/
(4.) Hardiman M, Wilder-Smith A. The revised international health regulations and their relevance to travel medicine. J Travel Med. 2007;14:141-4.
(5.) World Health Organization. Sixtieth World Health Assembly. Poliomyelitis poliomyelitis (pō'lēōmī'əlī`tĭs), polio, or infantile paralysis, acute viral infection, mainly of children but also affecting older persons. : mechanism for management of potential risks to eradication [cited 2007 May 21]. Available from http://www.who.int/gb/ebwha/pdf_files/WHA60/A60_R14-en.pdf
(6.) Leder K, Tong S, Weld L, Kain KC, Wilder-Smith A, yon Sonnenburg F, et al. Illness in travelers visiting friends and relatives: a review of the GeoSentinel Surveillance Network. Clin Infect infect /in·fect/ (in-fekt´)
1. to invade and produce infection in.
2. to transmit a pathogen or disease to.
1. Dis. 2006;43:1185-93.
Address for correspondence: Annelies Wilder-Smith, Associate Professor, Department of Medicine, National University Singapore, Singapore; email: firstname.lastname@example.org
Annelies Wilder-Smith, * Karin Leder, ([dagger]) and Paul A. Tambyah *
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