Polio booster before travel: who, where and when

Where CDC lists it

Polio has disappeared from most of the world, but not everywhere. Wild poliovirus type 1 is endemic in Afghanistan and Pakistan only, according to the Yellow Book. Elsewhere, vaccine-derived poliovirus circulates where too few children are vaccinated, mostly in Africa: Nigeria, Niger, Chad, Ethiopia, Somalia, Sudan, the Democratic Republic of the Congo and others on the current list. The surprise on the list is a handful of high income countries, Germany, the United Kingdom and Israel among them, where the virus was identified in sewage samples during the year. On those pages CDC uses the same wording as for Pakistan: travelers are at increased risk of exposure, and fully vaccinated adults may receive one lifetime booster. The list changes as surveillance reports come in, which is why each destination page here shows the date of the CDC page it quotes.

Booster or full series

The plan depends on the traveler's history. An adult who completed the childhood series receives one IPV dose, once in a lifetime; a second trip ten years later does not need another, unless an exit rule asks for a recent dose. An adult who never had polio vaccine, or who is unsure, receives the full series: two IPV doses four to eight weeks apart and a third six to twelve months after the second, with shorter schedules available when the trip is close. Children follow the routine schedule, and those not fully vaccinated may be put on an accelerated one. The booster works at once for the purpose of the trip; the checker counts it as ready on the day it is given.

The exit rule for long stays

Under the temporary recommendations of the International Health Regulations, some countries where polio circulates may ask residents and long-stay visitors, those staying more than four weeks, to show proof of a polio dose received between 4 weeks and 12 months before they leave the country. The dose is recorded on the yellow International Certificate of Vaccination or Prophylaxis, the same booklet used for yellow fever. The list of countries concerned follows the temporary recommendations issued under the regulations and changes over time, so the embassy of the country is the place to confirm it. For a stay of more than four weeks in a country on CDC's polio list, it is worth asking the clinic to record the booster on the yellow booklet. A booster given at least four weeks before leaving home and less than a year before leaving the country covers both the trip and the exit check for most stays of a few months; for a stay of more than a year, a second dose may be needed in the country before departure.

What it costs

IPV is one of the cheaper lines of a travel list. The CDC private-sector list price is $48 a dose (IPOL), and the 8 health departments that publish a self-pay price charge $48 to $82, before any visit or administration fee. Because polio vaccine is part of the routine schedule, insurance covers it more often than travel-only vaccines. In the United Kingdom, polio is given free on the NHS for travel, combined with diphtheria and tetanus in a single injection. The trip cost page adds it to the rest of an itinerary.

Polio and the routine list

CDC's routine vaccines line, repeated on every destination page, also covers polio: travelers should be up to date before every trip. The booster discussed here is the extra step for places where the virus has been found. For destinations off the list, a completed childhood series is enough. Travelers who do not know whether they finished the series, often adults vaccinated abroad or whose records were lost, can ask a clinician, who decides between a single booster and a full series when records cannot be found. Polio vaccine can be given on the same day as the other travel vaccines, inactivated or live, so it rarely adds a visit to a plan that already includes hepatitis A or typhoid.