Clinical Considerations in Caring for Individuals Recently Returning and Evacuated from Afghanistan to the United States

The U.S. government is in the process of working with returning U.S. citizens and resettling Afghan nationals from Afghanistan. The Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society for Healthcare Epidemiology of America recommend, in collaboration with the U.S. Centers for Disease Control and Prevention, that clinicians caring for these evacuees 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.

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.  

IDSA, PIDS, and SHEA recommend that all clinicians who may care for evacuees are aware of the recent CDC Health Alert Network guidance, which reports that evacuees are at increased risk of gastrointestinal infections, including shigellosis, giardiasis, cryptosporidiosis, rotavirus and viral diarrheal diseases. CDC is also aware of some cases of measles, varicella, mumps, tuberculosis, malaria, leishmaniasis, hepatitis A and COVID-19 among evacuees. In addition, 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 and consider obtaining appropriate microbiologic cultures, in addition to monitoring for the infectious diseases noted above, 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 to help identify and provide appropriate and effective treatment to prevent further spread of infectious diseases, including vaccine-preventable diseases and infections due to MDROs. 

REFERENCES:

Immunization Requirements: 

• https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html 
• https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html 

MDRO Studies: 

• https://pubmed.ncbi.nlm.nih.gov/21795879/ 
• https://academic.oup.com/milmed/article/182/suppl_2/26/4626994 
• https://aricjournal.biomedcentral.com/articles/10.1186/s13756-018-0455-5 
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987489/ 

Multidrug-Resistant Organism Repository and Surveillance Network:

• https://www.wrair.army.mil/biomedical-research/mrsn