Evacuees of Afghanistan who have arrived in the United States must be vaccinated against measles and undergo quarantine for 21 days, according to a health advisory issued September 20 by the Centers for Disease Control and Prevention (CDC).
At the time of the announcement, 16 cases of measles among Afghanistan evacuees — a group that includes Afghan nationals and US citizens — had been identified. As previously reported by Medscape Medical News, the US Customs and Border Patrol halted US-bound evacuation flights as of September 10 following recommendations by the CDC.
The health advisory also urged clinicians to be on the lookout for cases of measles, as well as other infectious diseases, such as mumps, malaria, and leishmaniasis. The advisory noted that evacuees are at increased risk for gastrointestinal infections, including shigellosis, giardiasis, and cryptosporidiosis.
Although the United States declared in 2000 that measles had been eliminated, meaning that it is no longer endemic, international travelers can bring the disease into the country. Since 2000, measles cases in the United States have ranged from a low of 37 in 2004 to a high of 1282 in 2019. Most cases originated in India, the Philippines, China, the United Kingdom, Japan, and Ukraine. “Community transmission in connection with these travel-associated cases poses an ongoing risk to unvaccinated persons and thereby measles elimination,” the CDC said in the advisory. About 9 in 10 people who are not protected against the virus will become infected following exposure, according to the CDC.
Only about 60% of people living in Afghanistan are vaccinated against measles, and the country has the seventh-highest number of cases in the world, the CDC said. Crowded living conditions during the evacuation process would make it easier for the virus to spread, the agency noted. The advisory stated that all evacuees who have been confirmed to have measles have been isolated and have been provided care. Their contacts are quarantined as well.
In the announcement, the CDC urged clinicians to be on alert for measles cases in the communities near the eight military bases housing evacuees:
Marine Corps Base Quantico, Virginia
Fort Pickett, Virginia
Fort Lee, Virginia
Holloman Air Force Base, New Mexico
Fort McCoy, Wisconsin
Fort Bliss, Texas
Joint Base McGuire-Dix-Lakehurst, New Jersey
Camp Atterbury, Indiana
All suspected measles cases should be reported to the local or state health department.
Although this announcement may garner more attention because of its political nature, “measles is imported to the US frequently, unfortunately, because measles exists all over the world,” Daniel Salmon, PhD, MPH, professor and director of the Institute for Vaccine Safety at John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, told Medscape Medical News. “As long as public health authorities detect cases and conduct contact tracing and quarantine people, then we can make sure it is not a big problem.”