Actions Requested

  • Maintain awareness of immunization recommendations for persons arriving from Afghanistan.
    • All persons from Afghanistan entering the United States with a humanitarian parolee status 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 IPV, within seven days of being granted parole in the United States, unless already received overseas before arrival or medically contraindicated.
    • Most individuals arriving from Afghanistan are choosing to have their documents processed at U.S. military bases, before traveling to their final destinations. The military bases will be providing these vaccinations free of charge.
  • 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.

Measles:

  • Use the Measles Assessment Checklist to evaluate the suspected measles case.
  • Consider measles infection in patients with compatible symptoms, including:
    • Prodrome of fever, cough, coryza and conjunctivitis lasting 2–4 days
    • Generalized maculopapular rash that usually begins on the face
    • Koplik spots may appear on buccal mucosa 1–2 days prior to rash
  • Assess patients with measles symptoms for recent international travel and/or exposure to a known measles case
  • Instruct reception/triage staff to identify patients who present with symptoms of suspected measles
    • Patients with symptoms of measles should wear a mask covering the nose and mouth and should be kept away from patient waiting rooms.
    • Room the patient immediately (in negative air pressure room when possible) and close the door.
    • Only staff with documented immunity to measles should be allowed to enter the patient’s room.
    • After the patient is discharged, do not use the room for 2 hours.
  • Report suspected cases of measles to Whatcom County Health Department immediately and before discharging or transferring patients.
  • Collect specimens on patients with suspected measles, as described in the Measles Specimen Shipping Guide:
    • Nasopharyngeal swab (preferred respiratory specimen) for PCR
    • Urine (at least 50 ml) for PCR
    • Serum (at least 1 cc) for measles IgM
  • Route laboratory specimens through Washington State Public Health Laboratories (WAPHL) to expedite testing, do not use a commercial laboratory. WAPHL receives specimens Monday-Sunday from 8:00AM to 5:00PM.

WA State Public Health Laboratories

1610 NE 150th St

Shoreline, WA 98155

  • For isolation and quarantine guidance, refer to Appendix E of the Measles Guideline.

Polio:

  • The Polio/AFM Guideline provides information on evaluating patients with suspected polio.
  • Consider polio in patients with compatible symptoms including:
    • Acute onset of flaccid paralysis of one or more limbs with decreased or absent tendon reflexes in the affected limbs without other apparent cause
  • Assess patients with polio symptoms for recent international travel and/or exposure to a known polio case
  • Patients with symptoms of polio should be placed on standard precautions, with contact precautions indicated for hospitalized infants and young children.
  • Report suspected cases of polio to Whatcom County Health Department immediately and before discharging or transferring patients.
  • WAPHL does not perform testing for poliovirus or other enteroviruses, but the recommended
    surveillance specimens should be sent to WAPHL as soon as possible. PHL will forward
    specimens to CDC for testing. Collect specimens on patients with suspected polio:

    • Whole stool – 2 samples taken at least 24 hours apart during the first 14 days after onset of paralytic disease
    • Throat specimens (OP swab) – 2 samples taken at least 24 hours apart during the first 14 days after onset of paralytic disease
    • Please use this requisition form to ship specimens to PHL. Please indicate Poliovirus as the organism requested for testing.

Background

Afghanistan ranks 7th in the world for measles cases, with a current outbreak, and is one of only two countries with both wild and vaccine-derived poliovirus in circulation. It also has low routine immunization coverage, including for measles-containing vaccine (MCV) and inactivated polio vaccine (IPV). Therefore, all persons entering the United States with a humanitarian parolee status 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 IPV, within seven days of being granted parole in the United States, unless already received overseas before arrival or medically contraindicated.

Many of those arriving from Afghanistan are choosing to have their documents processed at military bases in the United States supporting this operation, before traveling to their final destinations in the United States. The military bases will be providing these vaccinations free of charge. Thus, efforts are being made to deliver and document receipt of these vaccinations as soon as possible after arrival. However, clinicians should remain vigilant for signs and symptoms of measles or polio among those arriving from Afghanistan.

Resources

CDC Measles Information:  https://www.cdc.gov/measles/index.html

CDC Polio Information:  https://www.cdc.gov/polio/index.htm

Contacting the Whatcom County Health Department

360-778-6100     Main Call Line – available M-F 8:30am to 4:30pm

360-715-2588     Afterhours Answering Service – available after 4:30pm and weekends

360-778-6150     Communicable Disease Report Line – 24 hours a day 7 days a week

360-778-6103     Confidential Communicable Disease Fax – 24 hours a day 7 days a week