should continue to look for people with communicable disease symptoms , isolate those with symptoms , and track contacts to manage the spread of the illness , reporting to CDC as consistent with National Notifiable Diseases Surveillance System ( NNDSS ) requirements . CDC is also working with partners to identify infections at their onset and limit their spread .”
The alert added , “ In addition to the recognized concerns about vaccine-preventable diseases , evacuees are at increased likelihood of gastrointestinal infections , including shigellosis , giardiasis , cryptosporidiosis , hepatitis A , rotavirus , and viral diarrheal diseases . CDC is also aware of some cases of varicella , mumps , tuberculosis , malaria , leishmaniasis , hepatitis A , and COVID-19 among evacuees . Although COVID incidence in this population has been notably low , COVID immunization and testing is being provided for all evacuees . Environmental and personal hygiene , elimination of crowding , wearing masks , and safe food and water supplies will address most of these ; however , individuals supporting this effort should ideally be vaccinated against hepatitis A , in addition to being current on routine U . S . immunizations .”
The CDC advised clinicians to “ be cognizant of the possibility of infections among patients arriving in or returning to the U . S . from other countries . Collecting a detailed travel history , particularly when signs and / or symptoms of gastrointestinal infections as mentioned above , mumps , varicella , tuberculosis , malaria , leishmaniasis , hepatitis A , and COVID-19 are present , may help in identifying and taking appropriate action to prevent further spread of these diseases within the U . S .”
In a statement issued in mid-October , the Infectious Diseases Society of America ( IDSA ), the Pediatric Infectious Diseases Society ( PIDS ) and the Society for Healthcare Epidemiology of America ( SHEA ) recommend that clinicians caring for evacuees from Afghanistan “ consider the varied presentations of medical conditions , including infectious diseases . The spectrum of infections may include tropical diseases , vaccine preventable diseases and infections caused by multidrug-resistant organisms ( MDROs ).”
The statement continues , “ Many of the evacuees are from areas with limited access to health care and vaccinations , raising the risk of infectious diseases . Evacuees may also be colonized with MDROs , which increases their risk of MDRO infection . Antibiotic susceptibility testing of isolates from clinically significant cultures ( i . e ., those causing infections ) is an effective way to identify MDROs and inform antimicrobial treatment , if needed .”
Citing the CDC Health Alert Network guidance , the multi-society statement adds , “… clinicians should ensure that evacuees are evaluated and confirmed to be up to date on routine ACIP and CDC recommended immunizations and that appropriate actions are taken to prevent further spread of these diseases . Clinicians are encouraged to maintain heightened awareness for the possibility of MDROs , in addition to the infectious diseases noted above , and consider obtaining appropriate microbiologic cultures among patients arriving in or returning to the United States from other countries . This recommendation reinforces that clinicians should continue to collect a detailed travel history
The current public health infrastructure , weakened by the COVID-19 pandemic , is facing another potential test as the U . S . receives a great number of foreignborn individuals that could overwhelm the system .” to help identify and provide appropriate and effective treatment to prevent further spread of infectious diseases .”
According to U . S . Citizenship and Immigration Services ( USCIS ), “ Applicants who have communicable diseases of public health significance are inadmissible .” The Department of Health and Human Services ( HHS ) has designated certain conditions as communicable diseases of public health significance that apply to immigration medical examinations conducted in the U . S . and include gonorrhea , Hansen ’ s Disease ( infectious leprosy ), infectious syphilis , and active tuberculosis ( TB ). Currently , only a Class A TB diagnosis renders an applicant inadmissible to the U . S .; under CDC guidelines , Class A TB means TB that is clinically active and communicable . What qualifies as a communicable disease of public health significance is determined by HHS , not by USCIS .
The current public health infrastructure , weakened by the COVID-19 pandemic , is facing another potential test as the U . S . receives a great number of foreign-born individuals that could overwhelm the system . As Gushulak , et al . ( 2010 ) state , “ Identifying threats related to migrant populations has been driven by historical outbreaks of transmissible infectious diseases of public health significance , such as plague and cholera . As seen in recent years with the severe acute respiratory syndrome ( SARS , 2003 ) and influenza A / H1N1 ( 2009 pandemic ), many national responses regarding migrant populations tend to be traditional , based on the principles of border inspection , isolation or quarantine , and exclusion .”
Gushulak , et al . ( 2010 ) add that , “ In the sphere of infectious diseases , population mobility is one of the underlying factors in the emergence and reemergence of diseases of international public health importance as shown by communicable disease outbreaks .”
The impact of migration on national health and disease epidemiology must be considered , as global public health efforts vary greatly . Gushulak , et al . ( 2010 ) observe that , “ Many economically advantaged nations have gained the benefits of long-standing and effective public health and disease-control programs . The effective control of tuberculosis in much of the high-income world means that the major remaining public health challenges presented by the disease in developed countries are related to migration … Migration from less economically advantaged areas will affect the epidemiology of diseases in ‘ low-incidence ’ host environments . This is particularly true for diseases that occur at very low incidence levels , or which have been virtually eliminated locally .”
There are limitations to traditional responses to the public health-related challenges of migration , primarily communicable diseases of public health significance that may be associated with the arrival of migrants . Coordinated attempts at the international level to manage infectious disease transmission were organized and consolidated into the International Health Regulations ( IHR ). As Gushulak , et al . ( 2010 ) explain , “ Some nations with integrated and long-standing immigration programs have systematically screened applicants for permanent residency status ( immigrants ) and some other classes of mobile populations ( such as temporary