DGMQ strives to keep Americans safe by preventing, detecting, and responding to the spread of communicable diseases that impact the health of global and domestic travelers, migrants, immigrants, and refugees. Read the accomplishment fact sheets below to learn more about how DGMQ saves lives and protects the health of our communities in a globally mobile world.
Fiscal Year 2018
Refugee Vaccination Program Saving Millions of Dollars for Health Departments Nationwide
During FY 2018, 96% of refugees arriving from 66 countries received at least one US-recommended vaccination overseas, and 94% received presumptive treatment overseas. The cost of administering the same vaccines in the United States is $406, versus $180.73 per person, when administered overseas. By increasing overseas vaccination rates among arriving refugees, this approach can reduce the average per-person cost of administering vaccines by 56%.; Continuing these efforts can save US health departments up to $35 million annually (Joo, Vaccine, 2018external icon).
Improved the Quality of Overseas Medical Exam Data
DGMQ staff, in collaboration with experts from US Department of State, US Customs and Border Protection, and Australia’s Department of Home Affairs, established the USA eMedical system. The eMedical system can help the nearly 700 panel physicians, who are trained and licensed to practice overseas, to detect tuberculosis (TB) and similar health-related conditions. The system sends important medical information to CDC, increasing CDC’s ability to review the quality of medical exams and identify suspected cases of TB. The system is being rolled out in phases with the ultimate goal of having US panel physicians at nearly 400 sites in over 150 countries use the new system to improve record quality for required medical examinations of US-bound immigrants.
Prevented Public Health Threats Before They Could Spread in the United States
Disease outbreaks overseas, like Ebola, can travel rapidly across national borders, even to the United States. DGMQ border health experts have been protecting the United States from these public health threats.
In 2018, DGMQ sent border health experts to the Democratic Republic of the Congo and its neighboring countries—Uganda, Rwanda, and South Sudan—to train their ministries of health in best practices for detecting, communicating, and responding to the 2018 Ebola outbreaks. In Nigeria, they trained 15 health officers to become master trainers, who then delivered similar outbreak response trainings to 500 port-of-entry health officers at 30 border stations.
Inside the United States, DGMQ border health officers trained more than 1,450 US Customs and Border Protection officers and agricultural specialists to recognize and report sick international travelers and illegal products arriving at US ports of entry.
Preparedness, planning, and training efforts keep improving through our response and monitoring activities. In 2018, our border health officers monitored and contained 1,263 public health threats at US ports of entry; screened 549 passengers on one flight at New York’s JFK International for suspected MERS and severe flu; responded to 1,859 reports of illness and death among arriving travelers; and investigated 151 cases where passengers were exposed to a sick traveler.
Enhanced International Travel Disease Surveillance Systems
Cholera. Following the licensing of cholera vaccine (FDA, 2016external icon) in the United States, DGMQ collaborated with CDC’s Diseases and the Global Disease Detection Program to establish a global cholera surveillance system that gives healthcare providers and travelers a list of countries that have active cholera transmission. Based upon the Advisory Committee on Immunization Practices recommendations, this system also provides subnational data on active cholera transmission.
Medical Tourism. Thousands of US residents travel abroad for care each year, particularly for cosmetic surgery, dentistry, and heart surgery. CDC has received a number of reports of serious complications among medical tourists upon their return to the United States. To better respond to this travel medicine trend, DGMQ set up passive surveillance systems to help US clinicians report medical tourism-related infectious disease cases among US travelers to clinics abroad.
GeoSentinel. DGMQ worked with the International Society of Travel Medicine external iconto augment GeoSentinel surveillance for 1) migrant health issues, 2) rabies, 3) drug-resistant pathogens such as Salmonella and Campylobacter, and 4) travelers going to mass gatherings such as the Hajj in Saudi Arabia. GeoSentinel also identified sentinel disease events, such as monkeypox transmission among international travelers to Nigeria and yellow fever among travelers to Ilha Grande, Brazil. In 2018 alone, DGMQ subject matter experts were cited in seven GeoSentinel publications, including articles about fungal diseasesexternal icon, leptospirosisexternal icon, and students studying abroadexternal icon.
Engaged At-risk Travelers and Frontline Healthcare Providers through Targeted Campaigns
Yellow Fever Importation Risk Reduction. From the end of 2017 until mid-2018, a large yellow fever outbreak occurred in Brazil with approximately 1,400 confirmed cases and almost 500 fatalities, including 23 cases in foreign travelers. Concurrently, the United States experienced problems with yellow fever vaccine supply. To reduce the risk of unvaccinated US residents returning with yellow fever virus after traveling to Brazil, DGMQ rapidly organized a telebriefing with several high-visibility media outlets, emphasizing the need for travelers to Brazil to plan ahead to receive yellow fever vaccination, especially if going to areas affected by the outbreak. The multimedia push resulted in 467 media articles, generating 858 million impressions. To further amplify CDC health risk messages, tailored social media posts added 133,000 more impressions and nearly 2,000 engagements, driving more than 1,000 users to relevant yellow fever travel information and vaccination clinics webpages. During 2018, CDC did not receive any reports of yellow fever cases in travelers arriving from Brazil.
Viajo sin Zika, an engaging, culturally sensitive campaign, tackled a pronounced knowledge gap among high-risk, hard-to-reach travelers who visit friends and relatives in Latin America and the Caribbean. Tailored digital ads, partnerships, social media, word-of-mouth messages, and on-demand English and Spanish publications gave at-risk travelers specific and actionable prevention messages. The campaign surpassed 100 million digital media impressions and drove 341,810 visitors to both English and Spanish versions of these specialized Zika webpages and resources.
Think Travel, a first-of-its-kind healthcare provider campaign, targeted primary care clinicians, physician assistants, nurse practitioners, pharmacists, and urgent care providers in the places where they most commonly search for trusted medical information. Partnerships and online outreach laid the groundwork for a paradigm shift among frontline healthcare providers by providing simple tools to help them hold meaningful conversations with their patients about international travel health risks and what they should do before, during, and after travel. Social posts generated 26,107 impressions and 229 engagements on Twitter, while digital ads garnered 17,243,453 impressions, all leading to 61,231 new site clicks.
Identified New Social Distancing Strategy in K-12 Schools to Curb Influenza Pandemics
To slow virus transmission in schools and surrounding communities during influenza pandemics, CDC recommends preemptive school closures during severe flu pandemics. However, during the early stages of increasing influenza activity, or during mild and moderate influenza pandemics, school closures may be too costly and too premature to implement. Additionally, prolonged school closures may have adverse social and economic consequences for students and their families (such as lost access to subsidized school meals, or lost pay for parents missing work to stay home with their children). DGMQ assessed the feasibility of other social distancing strategies to reduce influenza transmission in schools while minimizing social and economic burdens on communities. Researchers led 36 focus groups of education and public health officials across the United States. The findings suggest that schools have several options other than closing to increase social distance. DGMQ will continue studying the most promising alternatives identified to ascertain their feasibility and effectiveness.
Worked with Mexico to Combat Antimicrobial Resistance and the Burden of Tuberculosis
In recent years, Mexico made significant progress toward reducing the burden of tuberculosis (TB) and preventing the spread of resistant bacterial infections. To continue this trend, DGMQ worked on the National Strategy for Combating Antibiotic-Resistant Bacteria (CARB) pdf icon[PDF – 37 pages]. In collaboration with other programs in CDC and in Mexico, DGMQ staff helped strengthen TB laboratory services in Mexico by advancing the use of rapid diagnostic tests for identifying and characterizing resistant bacteria.
Using Xpert MTB/RIF as an initial diagnostic test improved sensitivity of TB case detection and enabled more rapid TB therapy for patients with rifampicin-resistant disease. Throughout 2018, DGMQ helped expand testing services to priority high-risk populations in Mexico and ensured that electronic and paper-based surveillance systems include all pertinent patient and diagnostic information. This expansion of testing services helps with tracking individual patients and improving TB case detection and treatment rates. Lessons learned in 2018 will help strengthen TB case detection and treatment adherence among mobile TB populations in Baja California and Sonora―the two Mexican states with the highest TB burden. Ultimately, the TB detection and treatment strategy will expand to other priority regions in Mexico.
Connected Mobile Tuberculosis Patients to Appropriate Care
The CureTB program prevents the spread of tuberculosis (TB) among people who cross international borders. The program collaborates with health authorities throughout the United States and referring jurisdictions to reduce disease transmission and the emergence of drug-resistant TB. CureTB has improved connections between TB patients and healthcare providers who can treat them as they move between the United States and other countries. In 2018, CureTB made successful patient-centered, transnational referrals to 45 countries.
Fiscal Year 2017
- Coordinated with FDA for approval of new/additional vaccine
- Increased vaccine availability to 250 clinics throughout US
- Advanced global health security by preventing cross-border spread of infectious diseases
- Established public health coordination and communication between nine African countries
- Prevented large-scale outbreak of Lassa fever
- Improved medical examinations of US-bound immigrants and refugees
- Bolstered screening and treatment options to combat infectious diseases outside of US
- Trained doctors tasked with screening over 500,000 immigrants and 50,000 refugees who enter the US annually
- Expanded CureTB program to provide routine referrals to all countries around the world
- Ensures continuity of TB care for globally mobile patients
- Potential to reduce the burden of TB globally through collaboration with international public health authorities
Fiscal Year 2016
The US Centers for Disease Control and Prevention’s (CDC) Division of Global Migration and Quarantine (DGMQ) focuses on improving the health of globally mobile populations by preventing the introduction and spread of communicable disease. From October 2015 through September 2016, DGMQ responded to public health emergencies; applied innovative technology and collaboration; modernized and maintained regulations, policy, and guidance; provided support to international and domestic partners; and conducted communication, education, and training activities to protect the public’s health. To learn more about how DGMQ impacts the health of our communities, visit: www.cdc.gov/migrationhealth.
DGMQ Responds to Public Health Emergencies
- DGMQ’s Travelers’ Health Branch posted 57 Zika travel notices (Alert Level 2, “Practice Enhanced Precautions”) between October 1, 2015, and September 30, 2016, for people traveling to international destinations and US territories where Zika virus is spreading.
- DGMQ developed an interactive risk assessment tool to provide Zika messages tailored to users’ travel history and personal risk factors.
- DGMQ developed an opt-in Zika text message system to inform travelers about the status of Zika outbreaks and appropriate travel precautions. Travelers received Zika information for their destination as well as Zika prevention messages to help travelers stay healthy before, during, and after their trip.
- DGMQ conducted a risk analysis to predict countries at risk for Zika virus importation exclusively attributable to the 2016 Olympic and Paralympic Games in Rio de Janeiro, Brazil. The analysis was published in the MMWR: Projected Zika Virus Importation and Subsequent Transmission after Travel to the 2015 Olympic and Paralympic Games – Country Specific Assessment.
DGMQ Applies Innovative Technology and Collaboration
- The American Society of Tropical Medicine and Hygiene (ASTMH), DGMQ, and other partners created an interactive exhibit on refugee health, highlighting DGMQ’s role in ensuring US-bound refugees arrive healthy to the United States. The exhibit debuted at the ASTMH Annual Conference in Atlanta in November 2016.
- DGMQ collaborated with other CDC partners to release the “Mystery at the Border” outbreak scenario in CDC’s Solve the Outbreak app. This fictitious scenario is based on a binational Guillain-Barré syndrome outbreak in 2011.
- DGMQ piloted an innovative travel health awareness program, HealthTalker: Destination India, to improve acceptance of pre-travel vaccines, medicines, and preventive behaviors among high-risk travelers to India living in New York, New Jersey, and Connecticut. The program relies on volunteers (HealthTalkers) to share Travelers’ Health-approved messages and resources with their social networks by word of mouth.
- On January 26, 2016, DGMQ posted a Final Rule in the Federal Register for Medical Examination of Aliens(CFR- Part 34), which became effective March 28, 2016. These regulations govern the required medical examination for US-bound immigrants and refugees.
- DGMQ published a Notice of Proposed Rulemaking on August 15, 2016, to update the current domestic (interstate) and foreign quarantine regulations for the control of communicable diseases. Amendments to the rule improve CDC’s ability to protect the public health of the United States from the introduction, transmission, and spread of communicable diseases into the United States and interstate. The Final Rule for Control of Communicable Diseases: Interstate and Foreign was published on January 19, 2017.
DGMQ Provides Support to International and Domestic Partners
- DGMQ partnered with the International Panel Physicians Association and the Immigration and Refugee Health Working Group to deliver training and education to more than 300 panel physicians at the Intergovernmental Training Summit in Prague, Czech Republic.
- DGMQ and partners instituted an overseas presumptive parasite treatment and vaccination program for US-bound refugees in 2013. As of December 2016, vaccination project activities have been established in 18 countries, with 11 locations having implemented the program, including Pakistan and Indonesia in Asia; Tanzania, Burundi, Chad, and Rwanda in Africa; former Soviet Union countries, and emergency transit centers in Europe.
- DGMQ finalized an Operational Protocol for US-Mexico Binational Communication and Coordination on Disease Notifications and Outbreaks. This collaboration of local, state, and federal partners provided guidance for implementing standardized communication and follow-up of binational cases, as well as identification of, and response to, binational outbreaks.
DGMQ Offers Communication, Education, and Training to Protect the Public’s Health
- Through a partnership with the United States Olympic Committee, DGMQ identified top concerns for athletes, staff, and family and tailored the complex Zika guidance for these audiences. DGMQ developed customized communication materials for the Team USA Zika Prevention Playbook.
- DGMQ rolled out a new CDC course – “NPI 101: An Introduction to Nonpharmaceutical Interventions (NPIs) for Pandemic Influenza.” The web-based training assists state, tribal, local, and territorial public health professionals in preparing for, and responding to, flu pandemics through the use of NPIs.
- DGMQ developed six plain-language, pre-pandemic NPI Planning Guides for various audiences and community settings to enhance implementation of NPIs.
Fiscal Year 2014 – 2015
DGMQ Responds to Public Health Emergencies
Ebola in West Africa
DGMQ provided guidance on monitoring and movement of persons who might have been exposed to the Ebola virus. The purpose was to clarify recommendations for those considered at some risk and prevent the unneeded use of healthcare services for those with very low risk of exposure.
- DGMQ developed the CARE program (Check and Report Ebola) to help travelers monitor and report health concerns for the first 21 days upon arrival from countries with Ebola outbreaks. Team members distributed CARE Kits to travelers entering the United States through five international airports.
- DGMQ collaborated with officials in West Africa to provide assistance for exit screenings and travel restrictions in countries with Ebola outbreaks.
Middle East Respiratory Syndrome (MERS) in Arabian Peninsula and South Korea
DGMQ communication teams developed materials to educate travelers on how to protect themselves and prevent further introduction of MERS into the United States.
- DGMQ collaborated with partners to displayed electronic monitors in English and Arabic for travelers arriving from MERS-affected countries on U.S. Customs and Border Protection and CDC monitors at 13 international airports.
- DGMQ’s Travelers’ Health team provided MERS travel health notices on the CDC Travelers’ Health website specifically for persons making the Hajj pilgrimage to Mecca.
Chikungunya and Dengue in the United States-Mexico
DGMQ created a chikungunya awareness campaign and coordinated surveillance and communication strategies with state health departments.
- DGMQ developed culturally appropriate print materials to help border residents and border crossers take precautions to avoid the mosquito-borne disease.
DGMQ Applies Innovative Outbreak Response and Surveillance
DGMQ developed BioMosaic, a web application using epidemiologic and aviation data to help forecast the next cases of Middle East Respiratory Syndrome and Ebola. The tool combines information about travel, disease patterns, and where groups of people from other countries settle in the United States, to help public health agencies direct information and services where they are needed most.
DGMQ Maintains Regulations, Policy, and Guidance
DGMQ updated the Tuberculosis Screening and Treatment Technical Instructions using Cultures and Directly Observed Therapy for Panel Physicians (CDOT TB TIs) in 2014, to require digital images for any applicant having a chest X-ray overseas. These include persons applying for U.S. immigration status and nonimmigrants who are required to have an overseas medical examination. The requirements help physicians overseas identify more than 600 additional cases of TB each year. Research has shown a decrease in TB diagnoses after U.S. arrival.
- DGMQ staff made three visits to Cuba in 2014 and 2015 to assess required medical screenings for 20,000 U.S.-bound immigrants, refugees, and parolees a year. Re-established relations between DGMQ and the Cuban Ministry of Public Health, which oversees the panel physician program.
- DGMQ published Tuberculosis Incidence in Immigrants and RefugeesExternalexternal icon in Annals of Internal Medicine showing the positive effect of improved diagnostic procedures on reducing the number of U.S. immigrants with tuberculosis (TB). With the new TB screening requirements issued in 2007, there was a 1/3 decrease in TB cases among foreign-born persons during their first year in the United States. Also, physicians overseas identified 629 additional cases of TB in 2012 among immigrants and refugees bound for the United States.
- DGMQ published an interim final rule in the federal register revising medical examination of aliens, including the removal of three sexually transmitted infections, and an update to reflect current medical standards and terms commonly used by public health partners.
- DGMQ published a federal register noticeExternalexternal icon recommending federal travel restrictions for public health purposes. The notice describes the federal government’s tools to ensure that people with serious contagious diseases don’t board commercial flights or enter the United States without a public health evaluation.
DGMQ Offers Communication, Education, and Training to Protect the Public’s Health
The DGMQ teams expanded electronic communication at U.S. points of entry to capture the attention of 51 million travelers arriving annually. Posted health messages visible to 139,000 international travelers per day.
- DGMQ posted 96 travel notices on the Travelers’ Health website, with 65.5 million page views and 25.4 million visits from October 1, 2013 through September 30, 2015.
- DGMQ launched two mobile apps to help travelers plan safe and healthy international trips.
- DGMQ published the 2016 edition of CDC Health Information for International Travel: The Yellow Book, featuring the latest health recommendations for international travel.
- DGMQ won the ClearMark Awards of Distinction from the Center for Plain Language for Health Advisory: Ebola Outbreak.
- DGMQ co-sponsored Intergovernmental Panel Physicians Training Summits in Cape Town, South Africa (2014) and Hong Kong SAR, China (2015), which attracted 146 and 260 attendees, respectively, and presented multiple opportunities to increase the panel physicians’ knowledge of the Technical Instructions that govern the overseas medical examination.
DGMQ Provides Support to International and Domestic Partners
DGMQ conducted a large contact investigation related to a U.S. healthcare worker diagnosed with Ebola who traveled domestically on two commercial flights from Dallas to Cleveland and back. Interviewed all 268 contacts (passengers, flight crew, and cleaning crew) to determine their risk. No secondary cases were identified.
- DGMQ conducted two large contact investigations involving four international and domestic flights and one commercial bus for travelers possibly exposed to Middle East Respiratory Syndrome. No evidence of transmission was identified among the 655 passengers and crew members.
- DGMQ founded the Zoonoses Education Coalition with the American Veterinary Medical Association, U.S. Food and Drug Administration, National Association of State Public Health Veterinarians, Pet Industry Joint Advisory Council, and other representatives from the pet industry. The Coalition develops evidence-based recommendations for safe pet handling to prevent human illness.
- DGMQ developed U.S. guidance on Ebola for airport and airlines personnel, businesses, families, healthcare workers, humanitarian aid workers, K-12 schools, laboratory workers, law enforcement professionals, responders and their loved ones, ship crew members, travelers, U.S. and other countries’ port-of-entry partners, and West African audiences.
- DGMQ researched the causes, frequency, and characteristics of unplanned school closures during a flu epidemic. This studyExternalexternal icon helps communities, educators, and public health officials prepare for similar emergencies.
- DGMQ updated the Nonpharmaceutical Interventions (NPI) website with materials such as fact sheets and checklists to assist in planning for pandemic flu.
- DGMQ strengthened collaborations with Mexico City through a binational meeting to discuss binational issues such as Rocky Mountain spotted fever, dengue, and Ebola.
- DGMQ collaborated with states receiving refugees from countries with Ebola outbreaks to assure culturally appropriate follow-up upon arrival.