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Pregnant women refusing polio vaccine

ISLAMABAD: The travel restrictions imposed on Pakistan by the World Health Organisation (WHO) have become a problem for the Ministry of National Health Services (NHS), as a large number of pregnant women are refusing to take the polio vaccine.

They all quote the advice of gynecologists, who say that the vaccine should not be given to pregnant women.

To resolve the issue, the ministry has written to the WHO to clarify if polio vaccine should be given to pregnant women or not.

On May 5, WHO declared it mandatory for Pakistanis to take one dose of polio vaccine before travelling abroad. Moreover, WHO suggested that the government should issue immunisation certificates to the travellers. The decision was made to avoid the transfer of poliovirus to other countries.

Health Ministry seeks clarification from WHO

A health ministry official told Dawn that a majority of pregnant women who intended to travel abroad had refused to get vaccinated because they believed that it could be dangerous for them.

“We cannot force pregnant women to take the vaccine especially when they have written instructions from their doctors. In light of these developments, we have decided to seek clarification from the WHO,” he said.

The letter was written by Joint Secretary Dr Amer Sheikh to the WHO representative for Pakistan, Dr Michel Jean Julea Thieren, on July 16.

Dr Sheikh said several instances of gynecologists advising expecting mothers, who intend to travel abroad, against taking oral polio vaccine (OPV) had been brought to the notice of the ministry.

Polio certificate must for travellers from June 1

“There have also been instances where some pregnant ladies who presented themselves at the point of exit (airports etc) contended that oral polio vaccine was not essential in their case and therefore they be allowed to proceed abroad without vaccination.”

To substantiate their claim, the women also presented outdoor tickets/prescriptions of gynecologists advising them against taking OPV since it carried live attenuated poliovirus which can, according to them, potentially harm the foetus, stated the letter.

It added that the inactivated polio vaccine was currently not available in the public sector and only OPV was being administered to all intending travelers at designated centres.

The letter stated that according to the WHO guidelines OPV was not contra-indicated in pregnancy. A standard operating procedure (SOP) and certificates of vaccination issued by the ministry also clearly indicated that all intending travellers, including pregnant women, shall be immunised against polio with OPV.

The ministry has sought the clarification from WHO on the matter based on scientific evidence available internationally. WHO was also requested to consult leading pediatricians and gynecologists prior to responding to the letter.

A gynecologist at the Polyclinic hospital said that the world over, OPV was not given to adult women, especially pregnant women, because it could prove dangerous for them and their babies.

“I have looked into the literature and failed to find anything that indicates that OPV can be safely administered to pregnant women. I have concerns about administering OPV to pregnant women. Because of the active nature of the virus in the vaccine, both mother and child can be affected,” she said.

The head of the department of Gynaecology and Obstetrics at Pims, Prof Syeda Batool Mazhar, told Dawn that a number of pregnant women had contacted her asking if they can take OPV or not.

“Nowhere in the world is OPV given to adult women. In Pakistan, no one is an authority on that subject. So it would be better to seek a clarification from WHO. I am sure that WHO will look into the issue seriously and find a solution,” she said.