Questions and Answers, Ministry of Health

Questions and Answers

  • What is Polio?
    Polio is an infectious disease caused by the poliovirus. The virus is contagious and is transmitted from one person to the next (mainly among children). The virus enters the body via the mouth, and is excreted in the feces. In most cases, there are no signs of the disease. Only one person out of every thousand (people who are not vaccinated) suffers the paralytic form. 
  • How was the virus discovered? Why did it return? Did we think that it had been eradicated?
    In the framework of routine surveillance of the sewerage system that the Ministry of Health undertakes in various regions of Israel, poliovirus was discovered in the sewerage system of Rahat. Due to this discovery, the Ministry of Health broadened the testing to additional areas. In recent months, polio has also been found in the sewerage of the following places: Rahat, Tel Sheva, Kuseife, Arara, Tel Shoket, Qiryat Gat, Ramle, Lod, Horshim (which receives wastewater from the region of Horshim, Jaljulye, Kafar Bara), Tnuvot (which receives wastewater from Qalansawe and localities in Lev Hasharon). The virus exists in the world in Asia and in Africa, and has not yet been completely eradicated.
  • Who is at risk of contracting polio?
    Anybody who is not vaccinated, babies who have not yet been vaccinated, people who have been vaccinated in the past but their immunity may have weakened, as well as people who are immunosuppressed due to their medical background.
  • What is the difference between a carrier of the disease and a person who is ill with the disease?
    A person can be vaccinated, but still become infected and even transmit the disease to others, without he himself becoming ill with the disease. A person ill with the disease is one who suffers infantile paralysis as a result of the disease (as mentioned above, only one out of a thousand infected persons are ill with the disease).
  • How many carriers have been discovered? Has anybody become ill?
    Thus far, 42 carriers have been discovered. So far, nobody In Israel is has become ill.
  • How does one become infected with polio?
    The virus enters via the mouth (on contact with feces).
  • What is the most effective way to prevent polio?
    The most effective way to prevent polio is vaccination. A further means is being careful with the rules of hygiene, especially washing your hands with soap and water for 20 seconds after visiting the toilet, before contact with food and after changing an infant's diaper.
  • What vaccines against polio are there in Israel?
    Existing vaccines: IPV killed vaccine given by injection. This vaccine is given as part of the routine vaccines at Tipat Halav mother and infant care centers at ages two months, 4 months, 6 months, one year and in second grade. In the framework of the campaign commencing on 5-Aug-13, live attenuated OPV vaccine will be given in two drops.
  • What does the current "2 Drop" campaign mean?
    The objective of the campaign is to halt the spread of polio in Israel as soon as possible, in view of the concern that people could be infected and become ill with polio.
  • Who needs to be vaccinated?
    Starting August 18, the vaccination will be expanded to the entire country!
    Everybody born after 01-Jan-2004 who has received at least one IPV vaccine in the past. 
    Attend with your children, bringing with you their Immunization Booklet, and identity document of one of the parents.
  • Where are vaccinations against polio obtained?
    At the Tipat Halav - mother and infant care center where the children who will be called upon to be vaccinated are or were cared for. For a list of Tipat Halav stations, see the Ministry of Health website, or contact the Health Voice call center *5400.
    Attend with your children, bringing with you their Immunization Booklet, and identity document of one of the parents.
  • Who must not be vaccinated against polio?
    It should not be given to a baby or a premature infant who has not previously received at least one dose of IPV. It must not be given to infants or children who have not received any dose of IPV in the past. In case of illness with fever. The vaccine should also not be given to a child who has a first degree relative with an impaired immune system.
  • How can I know whether my children are vaccinated against the polio?
    You can check in the Immunization Booklet and/or at the Tipat Halav mother and infant care centers. 
  • My young children have been vaccinated against polio. Why do they need to be vaccinated again?
    The vaccine is intended to provide additional protection to your children and to the entire extended family.
  • Why has 1-Jan-2004 been set as the cut-off date of birth for being vaccinated?
    Close to this date, the use of OPV was stopped for children in Israel, as part of a worldwide trend set by the World Health Organization.
  • What percentage of the population is immunized?
    Over 98% are immunized.
  • Are the vaccines against polio safe and effective?
    Yes, the vaccines are safe and effective.
  • Are there guidelines regarding infants aged less than two months?
    There is no need to avoid vaccinating children who have siblings under the age of two months at home. Vaccinating the older siblings will prevent their becoming infected with the wild polio virus, and therefore the infants will be protected as well. As a rule, the infants themselves are protected during their first half year of life due to the transfer of maternal antibodies against polio via the placenta during the third trimester of pregnancy.
  • Why are adults not being vaccinated?
    The group that transmits the disease is children. Adults have already received live attenuated vaccine in the past, and there is therefore no basis for giving it to them again.
  • Can vaccines be purchased?
    It is not possible to purchase the vaccines privately, nor is there any need. The Ministry of Health will provide the vaccine at no charge to everybody for whom the vaccine is recommended.
  • My children missed a polio vaccine, and they are now over the age of 9. What should I do?
    The missed vaccine can be completed through the Student Health Service providers after returning to school, or through the companies' centers.
  • Is the vaccine given now in the framework of this campaign the same vaccine that was given in 1988?
    This is a better, improved and safer vaccine, as it does not contain the component against Strain 2 of polio, which has disappeared from the face of the earth, and is absent in the current episode.
  • Is it necessary to be vaccinated with two vaccines?
    The live attenuated vaccine (drops) may not be received without having received the killed vaccine, due to the fact that the killed vaccine (injection) protects against side effects of the live attenuated vaccine. A person who has never received the live attenuated vaccine (drops) should receive it, even if he has received the killed vaccine (injection) in the past.
  • What treatment is given to people who carry polio in their feces?
    There is no special treatment for carriers of the virus. Just as for the entire population, they should be careful with hygiene and receive the live attenuated vaccine.
  • Are there additional guidelines for prevention of spread and transmission?
    Apart from receiving the vaccine and being careful with hygiene, there are no additional guidelines.
  • Will children over the age of 9 be able to be vaccinated? If so, at whose expense and where?
    Children over the age of 9 do not need to receive the OPV vaccine and will not be able to receive it. Children up to the age of 18 will be able to complete routine vaccinations (IPV), as follows:
    Any children up to the age of 15 who have not received the routine vaccines will be able to receive them from the Student Health Service providers free of charge. Children aged above 15 years, up to the age of 18 years, will be able to complete their routine vaccines at the Health Bureaus.
  • Is the Ministry of Health considering restoring OPV to the routine vaccines?
    Routine vaccinations will continue unchanged. Discussions about this issue will be held later.
  • Why is it necessary to be vaccinated with the attenuated vaccine when over 98% of the population is vaccinated?
    There is a population of persons who are not immunized, whether this may be because they were never vaccinated, or because they were vaccinated but this has weakened over the years, or people with a suppressed immune system who are also at risk.
  • Why not give the vaccine only in those areas where the virus was detected?
    The virus will not disappear by itself. if the vaccines are performed according to the areas where the virus was detected, it may not be possible to catch up with the virus’s spread rate.
    It is better to get ahead of the violent polio virus and prevent its spread instead of “chasing” it by monitoring the sewerage, which means that the virus is already found in human beings. The wild polio virus is illusive and can show up and infect even without warning in the sewerage.
    The decision to immunize all the children born after January 01, 2004 with the live attenuated bOPV vaccine is the best way to stop the virus from spreading.
  • Are there guidelines for tourists?
    There are no special guidelines for tourists.
  • Is the Ministry of Health sufficiently organized as regards manpower levels?
    The Ministry of Health is fully organized as regards manpower levels.
  • Will the HMOs (Kupot Cholim) also provide vaccines?
    The vaccines will be given at Tipat Halav mother and infant care centers. At those locations where the Tipat Halav centers are operated by the HMOs, it is they who will provide the vaccines at their Tipat Halav centers.
  • Is it possible to continue routine vaccines in the framework of the Tipat Halav mother and infant care centers and the Student Health Services (ages 7-17)?
    Yes. Routine vaccinations will continue as usual.
  • Is it necessary to boil water?
    There is no need to boil water. The water is safe and fit for drinking. The virus was found in the sewerage and not in the water supply. There is no connection between the sewerage and the water supply.
  • What is the difference between killed and attenuated vaccine?
    Both protect those who have been vaccinated. The advantage of the live attenuated vaccine is that it prevents transmission from one person to another.
  • Why was the use of OPV stopped in 2005?
    In accordance with World Health Organization recommendations and the worldwide trend towards the eradication of the virus, it was decided to stop the use of the live attenuated vaccine.
  • Can children living in a household with pregnant women receive the vaccine?
    In is emphasized that children who live in a household in which there are pregnant women may be vaccinated with the live-atttenuated vaccine: there is no need to avoid vaccinating children who are candidates for the live-attenuated vaccine (bOPV) when there are pregnant women in the household, whether at the time of the vaccination or afterwards.
    Vaccinating the older siblings will prevent their becoming infected with the wild polio virus, and therefore the newborns will be protected as well. The newborns themselves are protected during their first half year of life due to the transfer of maternal antibodies against polio via the placenta during the third trimester of pregnancy.
    It is advised to maintain the personal hygiene of all the individuals living in the household by washing hands with water and soap for at least 20 seconds, in particular in the following situations: after visiting the toilet, before any contact with food, and also after changing diapers.
  • Can children with a sibling/siblings under the age of two months receive the vaccine?
    In is emphasized that children who live in a household in which there are infants under the age of two months can be vaccinated with the live-atttenuated vaccine.
    There is no need to avoid vaccinating children who have siblings under the age of two months in the household. Vaccinating the older siblings will prevent their becoming infected with the wild polio virus, and therefore the infants will be protected as well. The infants themselves are protected during their first half year of life due to the transfer of maternal antibodies against polio via the placenta during the third trimester of pregnancy.
    It is advised to maintain the personal hygiene of all the individuals living in the household by washing hands with water and soap for at least 20 seconds, in particular in the following situations: after visiting the toilet, before any contact with food, and also after changing diapers.
  • Can a child with an immunodeficiency stay in the proximity of children immunized with OPV (kindergarden, classroom)? 
    In the event of immunodeficiencies, we recommend that the child suffering from the immunodeficiency completes the first vaccine series with at least 3 doses of inactivated vaccine (IPV), before being exposed to any immunized individuals who received the live-attenuated vaccine (OPV).
  • As in everyday routine, it is important to maintain the personal hygiene of all the individuals living in the household with an immunosuppressed person, by washing hands with water and soap for at least 20 seconds, in particular in the following situations: after visiting the toilet, before any contact with food, and also after changing diapers.
  • Can a child receive the vaccine if he is treated with a drug that might suppress the immune system (such as Imuran or Methotrexate)?
    If, in the opinion of the attending physician, the drug’s dosage does not suppress the immune system, then the child may be immunized with the live-attenuated vaccine.
  • Can a child receive the vaccine in a household where a household member is treated with a drug that might suppress the immune system (such as Imuran or Methotrexate)?
    If, in the opinion of the parent’s attending physician, the drug’s dosage does not suppress the parent’s immune system, then the child may be immunized with the live-attenuated vaccine. 
  • What will be administered to a person who received IPV doses according to his age, and who has contraindication against bOPV?
    Children who received all the IPV doses according to age and have contraindications against receiving bOPV -  will not receive any vaccine dose.
  • Can a child receive the vaccine in a household where one of the household members is without a spleen?
    Yes. This is not a condition of immunosuppression as defined in the chapter on the live-attenuated vaccine bOPV in the vaccine guidebook.
  • Can a child receiving regular treatment with inhaled steroids or an inhalation device receive the vaccine? 
    If, in the opinion of the attending physician, treatment with steroids does not suppress the child’s immune system, then the child may be immunized with the live-attenuated vaccine.
  • Can a child with an IGA deficiency receive the vaccine?
    If, in the opinion of the attending physician, the child does not suffer from significant clinical effects, then the child may be immunized with the live-attenuated vaccine.
  • Can a child receive the vaccine in a household where one of the household members completed chemotherapy treatment several months ago?
    According to the chapter “Vaccination under special circumstances” in the vaccine guidebook, a person may receive the live-attenuated vaccine at the end of 3 months after completing an immunosuppressing treatment. Hence, a child may be immunized with the live-attenuated vaccine if 3 months have passed since the parent completed the chemotherapy treatment.
  • Can a child receive the vaccine if he has an immunosuppressed relative who does not reside in the same household with him (for example, a grandfather receiving chemotherapy treatment)?
    The child may receive the vaccine, but the immunosuppressed contact (who does not reside in the same household with him) avoid physical contact with the immunized person for 6 weeks, in order not to become a close-home contact of the immunized person.
  • What if a child already received the live-attenuated vaccine and an imunosuppressed family member was discovered in his household?
    If exposure to bOPV has already occurred in the household where an immunosuppressed individual or HIV carrier resides, contact between the immunosuppressed individual and the person immunized with bOPV should be reduced to the extent possible for 6 weeks after the vaccine in order to prevent fecal-oral transmission. These guidelines also include strict maintenance of the personal hygiene of the immunosuppressed person and household members, by washing hands with water and soap for at least 20 seconds, in particular in the following situations: after visiting the toilet, before any contact with food, and also after changing diapers. The immunosuppressed person himself should avoid changing the diapers of the individual immunized with the live-attenuated vaccine.
  • Do people regularly taking care of children (such as in kindergarden) who are in remission or have recovered from a malignant disease need special instructions? Are there limitations due to the possible exposure to the secretions of a child who received a live attenuated vaccine?
    • A. If, the attending doctor determines that the patient is no longer immunosuppressed - he does not need to avoid close contact with those immuned.
    • B. This is to clarify that patients with significant gamma globulin deficiency in the blood, or sub-gamma globulin (as determined by the attending physician) are considered to be immunosuppresed, in all that pertains the live attenuated polio vaccine, even if they receive regular treatment with IVIG.
    • C. As always, please maintain personal hygiene and the hygiene of the surrounding - wash hands with water and soap for at least 20 seconds, in particular in the following situations: after visiting the toilet, before any contact with food, and also before and after changing diapers.
  • Healthcare professionals - can a medical staff member, including a nurse administering the vaccine at the Infant Welfare stations with the live-attenuated vaccine, who is immunosuppressed or is currently receiving long-term steroids or an immunosuppressing therapy or is currently in remission/recovery from such a condition, treat children who received a live attenuated vaccine or administer such a vaccine?
    • A. These healthcare professionals may continue working in their workplace, after having consulted with their attending physician, if indeed their immune state allows them to continue working (there are some other viruses and bacteria from which immunosuppressed individuals have to be careful at all times). A person who was allowed to work, is not prevented from vaccinating children during the live-attenuated vaccine campaign or from treating these children. Please follow routine precautionary measures.
    • B. Please make sure that all healthcare professionals are immunized according to circular no. 7/13 by the Ministry of Health Director General “Vaccination of Health System Employees” dated March 04, 2013.
    • C. As always, please maintain personal hygiene and the hygiene of the surrounding, in the workplace as well - wash hands with water and soap for at least 20 seconds, in particular in the following situations: after visiting the toilet, before any contact with food, and also before and after changing diapers, and also use BIOHAZARD containers for discarding the remaining vaccine.
  • There are two different types of exposures to the live-attenuated vaccine of contacts in the presence of immunosuppression:
    • A. Home exposure
      A child, with whom reside immunosuppressed household members, will not recieve the live attenuated polio vaccine.
    • B. Exposure within the kindergarden / childcare or classroom
       If the immunosuppressed child received at least 3 doses of the inactivated vaccine (IPV) in the past, he can stay in the educational system. If he did not receive at least 3 doses of the inactivated vaccine (IPV), he needs to complete at least 7 doses of this vaccine, as soon as possible, and then he can return to the educational system.

      In the setting where the child is staying, please make sure to strictly maintain the rules of personal hygiene and the hygiene of the surrounding by the educational staff washing their hands with water and soap for at least 20 seconds, in particular in the following situations: after visiting the toilet, before any contact with food, and also before and after changing diapers.

      This is to clarify that children with significant gamma globulin deficiency in the blood, or sub-gamma globulin (as determined by the attending physician) cannot be sent to school and kindergarden during the period of the vaccine campaign, and up to 6 weeks after it ends, even if they receive regular treatment with IVIG.
  • Sections 6.4 and 6.5 of the Vaccination Guide-bOPV chapter are attached again with the table clarifying the various special conditions:
    • 6.4 A person who receive a first dose of IPV vaccine in the past: will receive a bOPV dose together with an IPV dose, providing that a minimum interval of 4 weeks has passed since the first IPV dose. The IPV dose will be administered as a combined vaccine, and will be counted as the second dose in the series of polio vaccines. The rest of the series will be given according to the vaccination routine schedule while maintaining the recommended intervals between doses. The bOPV dose will not be counted as a dose in the series.
      Emphasis for this section: in this case, do not give a bOPV dose without the second IPV during the same visit.
    • 6.5 A person who received at least 2 doses of IPV vaccine in the past: will receive a bOPV dose. There is no need for a minimum interval between the last dose of IPV and the bOPV dose. The rest of the series will be given according to the vaccination routine schedule while maintaining the recommended intervals between doses. The bOPV dose will not be counted as a dose in the series.
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