News Flash

Clinician Advisory

Vigilance for Measles & Polio in Afghan Arrivals

Requested Actions

• Maintain awareness of immunization recommendations for people arriving from Afghanistan.
• Maintain vigilance for measles or polio in patients with compatible symptoms, especially among people recently arriving from countries with measles or polio circulation, including Afghanistan.
• Institute airborne isolation precautions and use the Measles Assessment Checklist to evaluate suspected measles cases. A typical case presents with a several-day prodrome of fever, cough, coryza and conjunctivitis (“3Cs”) followed by a generalized maculopapular rash that usually begins on the face. White (Koplik) spots may appear on buccal mucosa 1–2 days prior to rash.
• Consider polio in patients with compatible symptoms. A typical case presents with acute onset of flaccid paralysis of one or more limbs with decreased or absent tendon reflexes in the affected limbs without other apparent cause. Standard and enteric precautions are indicated.
• Immediately report any suspected cases of measles or polio to the Health District at 425- 339-3503 before discharging or transferring the patient. The Health District will launch an investigation and provide guidance on specimen collection, handling and submission.

Background

• In the coming months, many Afghan emigrants will be entering the United States with a humanitarian parolee status or special immigrant visa. Overseas staging will be shorter and pre-departure health services may be abbreviated.
• Most individuals arriving from Afghanistan are choosing to have their documents processed at U.S. Department of Defense (DOD) bases before traveling to their final destinations. These DOD staging points are planning to conduct COVID-19 testing, screening for active tuberculosis, and immunization with measles-mumps-rubella (MMR), inactivated polio (IPV), and COVID-19 vaccines as part of the abbreviated health intervention package.
• Transmission of measles, wild poliovirus, and circulating vaccine-derived poliovirus is ongoing in Afghanistan. Flights bringing Afghan emigrants to the United States from overseas bases were put on hold September 10 due to detection of four measles cases. Stay tuned for updates.
• The Health District is collaborating with other governmental and community organizations to plan for, triage and address the disease control and health needs of these arrivals who come to Snohomish County, many of whom will not be eligible for healthcare benefits.
• New arrivals aged >6 months to 64 years (born in or after 1957) are required to receive one dose of measles, mumps, and rubella (MMR) vaccine, and those >6 weeks of age are required to receive one dose of inactivated polio vaccine (IPV), within seven days of being granted parole in the United States, unless already received overseas before arrival or medically contraindicated.

Additional Resources

• Washington State Department of Health
  • Measles
  • Polio
• Centers for Disease Control and Prevention
  • Measles
  • Polio
• Immunization Action Coaliton. Measles Photos.
• Global Measles Outbreaks
• Global Polio Eradication Initiative—Afghanistan
• World Health Organization—Afghanistan