The Who, How, and Why of DGMQ
DGMQ prevents the spread of disease, protecting people and helping keep America and our world healthy. . . so you can focus on your world.
INTRODUCTION TO DGMQ
Watch this video with a few welcoming words about DGMQ, a division of CDC, from DGMQ Director, Dr. Martin Cetron
Protecting the health of communities in a globally mobile world
For over 50 years, the Centers for Disease Control and Prevention (CDC) has focused on controlling, containing, and eliminating diseases that know no borders. Today, globalization makes it easier to move people and goods across the world in a short time. But signs and symptoms of diseases still may take days, weeks, or even years to appear. CDC’s Division of Global Migration and Quarantine (DGMQ) focuses on activities that lessen the public health risks of rapid global travel because diseases and outbreaks can quickly cross international borders.
- One million people travel to the United States every day.
- Americans take 75 million trips each year.
- 320 million travelers arrive in the United States through more than 300 ports of entry each year.
Read more in our 2 page PDF “Keeping Borders Safe”pdf icon.
To reduce morbidity and mortality among immigrants, refugees, travelers, expatriates, and other globally mobile populations, and to prevent the introduction, transmission, and spread of communicable diseases through regulation, science, research, preparedness, and response.
DGMQ meets the challenges of maintaining public health security in a globally mobile world through activities that include protecting public health in US communities, at US borders, and for Americans traveling or living abroad.
DGMQ plays a critical public health role. We maintain health security by preventing the introduction, transmission, and spread of infectious diseases into the United States.
Protecting public health at US ports of entry by rapidly responding to sick travelers who arrive in the United States, alerting travelers about disease outbreaks, and restricting the importation of animals and products that may carry disease.
Keeping Americans healthy during travel and while living abroad by reducing illness and injury among US residents traveling internationally or living abroad through alerts, recommendations, education, and support – based on the best science – to travelers and healthcare providers.
Ensuring the health of individuals coming to live and work in the United States by overseeing the mandatory health screenings for all immigrants and refugees entering the United States, as well as overseas vaccination and parasite treatment programs.
Partnering to protect the health of US communities along the US-Mexico border by working with state, local, and Mexican public health institutions to detect, notify, investigate, and respond to reports of illness and infectious disease among residents and travelers in US communities along the US-Mexico border.
WHO . . . DOES DGMQ SERVE?
Globally Mobile Populations
Globally mobile people may travel across a single country or from country to country. This movement can increase their risk of exposure to uncommon infectious diseases and can spread those diseases to different parts of the world. DGMQ monitors emerging health threats around the world and the ways in which these threats affect mobile populations and their communities, including
- Binational Populations
- Immigrants, Refugees, and Migrants
- Travelers and Expats
DGMQ works with populations who travel, live, and work around the United States and Mexico border because of the health conditions and risks that the two countries share. The movement of people and products between the US and Mexico creates a binational environment for preventing and controlling diseases spread through food and water, from insects or animals, and between people.
Mexico is the top destinationexternal icon for US residents traveling internationally (39% of all foreign travel), and Mexican residents visiting the United States represent almost 25% of all international visitors.
DGMQ is focused on binational public health issues, such as
- Infectious diseases affecting both countries, including outbreaks among people who have traveled between the United States and Mexico
- Diseases associated with importing and distributing products within North America
- Identification and referral of people with infectious conditions who are traveling back and forth between the United States and Mexico
Immigrants, Refugees, and Migrants
DGMQ assesses the health of people coming to live and work in the United States while also protecting the health of communities they join. DGMQ provides the technical instructions to physicians who conduct required medical screenings for immigrants, refugees, and migrants before they are admitted to the United States. During these required medical exams, individuals receive vaccinations as well as treatment needed to ensure that certain health conditions are treated before their arrival.
DGMQ works to improve the health of immigrants, US-bound refugees, and migrants through programs that
- Track disease outbreaks to learn about diseases of concerns in immigrants and refugees. For example, with tuberculosis and vaccine-preventable diseases, figure out how and where they spread and how to stop them from spreading
- Develop guidelines to respond to disease outbreaks and other health events affecting US-bound immigrants and refugees
- Build capacity for healthcare partners to diagnose and treat diseases and strengthen international partnerships that also build this capacity
- Develop guidelines for clinicians who care for immigrants and refugees after they arrive in the United States
Today, around the world, DGMQ partners with
Travelers and Expats
Every year, more and more Americans travel internationally – to vacation, do business, study, volunteer, live abroad, and visit friends and family. DGMQ encourages travelers to be proactive about their health, prepared, and protected no matter where they go. When traveling to new places, people may encounter unfamiliar disease risks. To prevent illness, DGMQ provides guidance for travelers and clinicians who specialize in travel medicine. Helpful resources include health information tailored to specific destinations, recommended vaccines and medicines, and considerations for special populations.
- DGMQ health advisory messages at US international airports can reach nearly 300,000 arriving international travelers every day.
- The United States has 20 quarantine stations that protect public health at major US international airports, land borders, and seaports.
- Every year, 300 million travelers arrive in the United States through more than 320 ports of entry pdf icon[PDF – 2 pages].
HOW . . . DOES DGMQ SERVE GLOBALLY MOBILE POPULATIONS?
Keeping Americans Safe and Healthy Through Federal Regulations
As seen in recent years, disease outbreaks such as Zika and Ebola can rapidly cross national borders and pose direct threats to the United States. With millions of people traveling by air, land, and sea each year, DGMQ meets the challenges of protecting people’s health in the United States through public health regulations.
Why do we need this authority?
People are able to travel around the world faster and more easily than ever before, creating health risks and potential global consequences. Our regulatory authority allows DGMQ to prevent the spread of infectious diseases into and throughout the United States.
What do DGMQ’s regulations do?
The regulations give DGMQ the ability to:
- Develop medical screening protocols for physicians throughout the world who conduct medical examinations of immigrants and refugees before their admission into the United States.
- Restrict the importation of certain items brought into the United States that may pose threats to public health. These items include many animals, items made from those animals, and some human remains.
- Our 20 quarantine stations, located at the busiest ports of entry around the country, are an important domestic “line of defense” against the spread of infectious diseases into and throughout the United States. DGMQ and its partners, such as US Customs and Border Protection and local emergency medical services, evaluate travelers entering the United States for signs of serious communicable diseases.
International Health Regulations
DGMQ collaborates with other countries to prevent serious public health threats from spreading beyond a single country’s border to other parts of the world. Through the International Health Regulationsexternal icon, 196 countries have agreed to build public health capacities to prevent, detect, and respond to emerging disease threats and outbreaks.
A Journey Through DGMQ
DGMQ’s day-to-day operations protect the health of people who live, work, and travel to the United States. Let’s follow the journey of Makena, an immigrant to the United States, to explore DGMQ’s role in her family’s journey and life after their arrival.
Makena is a 29-year-old mother of three from Kenya who is waiting for a visa to be able to move her family to the United States. Before receiving her visa, Makena is sent to a clinic in Kenya where she and her children undergo medical screening before they can travel to the United States.
DGMQ seeks to identify and treat diseases overseas to prevent the spread of diseases into the United States. DGMQ develops medical screening protocols and trains physicians overseas to conduct medical exams and screening for immigrants and refugees before they come to the United States.
Following her family’s medical screening, Makena is granted a visa. She flies to the United States with her children to start a new life in Houston, a city in Texas with a large population of Kenyan immigrants. Upon landing at the major international airport in Houston, Makena hands a US Customs and Border Protection officer a copy of her family’s medical screening report, allowing them to enter the United States.
DGMQ partners with Customs and Border Protection to check that anyone immigrating to the United States from another country has the proper medical screenings and vaccinations. DGMQ’s quarantine staff receive the medical screening documentation to share with local health departments in order to ensure that immigrants continue to receive care.
Makena moves into an apartment complex in Houston where she and her children transition into their new lives and daily routines. At the complex, she befriends Roland and Melinda and their two young boys, who are planning a trip to Mexico to visit their relatives. Roland and Melinda are concerned because they are thinking of trying to conceive and have seen news stories about Zika. After doing a little research, Melinda shares her concerns with Makena and considers whether her family should travel to Mexico at this time.
DGMQ identifies risks that may harm the health and safety of international travelers, including those who travel between the United States and Mexico. The United States and Mexico share a land border of nearly 2,000 miles. Infectious diseases such as Zika, tuberculosis, influenza, and measles affect both countries. DGMQ addresses these health concerns along the border through binational partnerships with state and local public health agencies in the United States and Mexico.
DGMQ also monitors disease outbreaks around the world to communicate the most up-to-date travel health recommendations that travelers like Roland and Melinda can use to better plan and prepare for trips. Through the Travelers’ Health website, DGMQ provides clinicians and travelers with international travel advice, including vaccine recommendations and requirements.
Makena’s oldest daughter is in 6th grade and goes to school with Roland and Melinda’s son. The flu season has been particularly severe this year, and many children have been hospitalized. Makena, Roland, Melinda, and their children have all received flu vaccinations. Soon after winter break, several schools close for a week because so many students in the schools have the flu.
DGMQ works to prevent the spread of infectious diseases like flu using nonpharmaceutical interventions (NPIs), or strategies that don’t rely on vaccines, antivirals, or other medicines – for example, washing hands and coughing into elbows. School closures are an example of NPIs that DGMQ might recommend for communities in the case of particularly dangerous flu outbreaks. DGMQ’s Community Mitigation Guidelines pdf icon[PDF – 36 pages] help local health departments make decisions to prevent the spread of pandemic flu.
DGMQ in Action
Preventing the Spread of Disease in Travelers
DGMQ focuses on reducing illness and injury in US residents traveling internationally and living abroad. By providing the most up-to-date health information on their destinations, DGMQ helps travelers stay healthy before, during, and after their trips. DGMQ provides international travel health advice, including vaccine recommendations and requirements, behavioral precautions, and advice for specific events abroad.
Amid a yellow fever outbreak in Brazil, DGMQ worked with the US Food and Drug Administration to make an imported yellow fever vaccine (Sanofi Pasteur’s Stamaril) available in the United States and avert a vaccine shortage. The Stamaril vaccine is available in nearly 250 clinics in all US states and territories. DGMQ’s proactive planning and coordinated response ensured US travelers had access to yellow fever vaccine to protect them when they visited countries where yellow fever is still a risk.
DGMQ’s Day-to-Day Activities
- Analyzes disease spread to communicate to the public changing disease risks at destinations throughout the world
- Creates and updates travel notices to inform travelers and clinicians about current health issues and protective measures related to specific destinations
- Updates the CDC Health Information for International Travel (or the CDC Yellow Book) which is a major medical reference, providing the most current and comprehensive travel health guidelines for physicians
Instituting Tuberculosis Safeguards
Nearly one quarter of the world’s population is infected with tuberculosis (TB) bacteria. DGMQ has tools to prevent TB importation into the United States. Coordination between the United States and other countries about patients with TB improves treatment outcomes for people crossing international borders.
Since the implementation of enhanced overseas TB screening starting in 2007, there has been a decrease in TB among foreign-born people in the United States. By detecting and treating TB to cure people overseas, overseas screening of immigrants and refugees can reduce US healthcare costs.
DGMQ’s Day-to-Day Activities
- Collaborates with overseas physicians who perform pre-departure medical screenings for immigrants and refugees headed for the United States. TB screening is a required part of the medical exam.
- Improves TB care by using the CureTB program to connect globally mobile patients with the care they need across the globe. The program also educates patients individually on TB to increase their likelihood of completing treatment.
In the Event of a Crisis . . .
DGMQ prevents the importation and spread of infectious diseases into the United States through its regulatory authority. This authority allows DGMQ to focus on public health preparedness as well as respond to health emergencies. Quarantine station staff have the critical job of responding to sick travelers moving through ports of entry. They also monitor certain cargo that might harbor communicable disease – for example, dogs, human tissues, as well as monkeys and other nonhuman primates. With this infrastructure, DGMQ is prepared to expand these services in emergency responses that may require additional activities at ports of entry.
For the past 50 years, DGMQ’s comprehensive quarantine system has been on the front line of public health to protect the United States from communicable disease threats, both foreign and domestic.
DGMQ’s Day-to-Day Activities
Protects public health with the support of 20 quarantine stations located at the busiest US international airports, land borders, and seaports, as well as covering over 300 ports of entry across the United States. For example, quarantine stations
- Respond to sick travelers who arrive in the United States
- Restrict the importation of animals and products that may carry diseases
- Send lifesaving drugs on the next flight to hospitals caring for patients with diseases such as malaria, botulism, or diphtheria.
- Alert travelers at airports about disease outbreaks abroad and steps they can take to protect themselves and others.
DGMQ’s daily work – including the quarantine station network and traveler education – equips DGMQ to respond to public health emergencies. DGMQ is uniquely positioned and prepared to respond during a major public health emergency by enhancing its normal operations and activities. DGMQ’s ability to coordinate with its network of partners to identify and manage potential health threats, allows the division to prevent disease importation. This network also helps us respond quickly to any infectious disease outbreak that threaten the health of people throughout the world. Keeping people healthy abroad also keeps Americans healthy. Stopping outbreaks where they start and helping countries prevent diseases from spreading across their borders, protects against potential outbreaks in the United States. Here are a few examples of DGMQ’s role in CDC’s efforts to respond to public health emergencies in the United States and around the world.
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The 2014 – 2016 Ebola epidemic in West Africa was one of the most challenging global public health emergencies in recent times. The Ebola outbreak spread to more than nine countries, gave rise to 27,000 suspected cases, and led to more than 11,000 deaths. As part of CDC’s emergency response, DGMQ focused on health screening, monitoring, and outreach to travelers after their trips to West Africa. DGMQ’s quarantine stations at airports throughout the country played a critical role.
DGMQ Emergency Response Activities
- Recommended that Americans avoid all nonessential travel to the three countries most affected by the Ebola epidemic
- Worked with airports and federal authorities to divert passengers coming from countries with Ebola outbreaks to five US airports, thus streamlining response efforts
- Trained US Customs and Border Protection staff at airports to screen people travelling from outbreak countries for signs and symptoms of Ebola or possible exposures
- Developed the CARE (Check and Report Ebola) program to help travelers monitor and report health concerns for 21 days after they left a country with Ebola outbreaks. DGMQ and US Customs and Border Protection distributed CARE Kits to these travelers, providing them with tools and information to help them successfully complete the required monitoring.
During 2015-2016, the Zika virus emerged as the first major infectious disease discovered in the last 50 years to be linked to serious birth defects. Many areas in the United States have a type of mosquito that can become infected with Zika virus and then spread it to people. As part of CDC’s emergency response efforts, DGMQ focused on traveler outreach, particularly for pregnant travelers and their partners. DGMQ’s quarantine stations in areas potentially affected by Zika (US continent and territories) enhanced activities to reduce the risk of the disease’s spread, relying heavily on building partnerships with local governments and organizations.
- Posted 57 travel notices with information on how to prevent spread of Zika before, during, and after travel
- Increased traveler outreach through interactive maps, risk assessment tools and text messaging systems.
- Developed extensive airport messaging for travelers, targeting pregnant travelers and travelers whose partners were pregnant
- Partnered with the US Olympic Committee to provide targeted traveler communication materials and conduct risk analyses that predicted which countries were at greatest risk of Zika importation from Brazil following the 2016 Olympic and Paralympic Games
- Focused on areas of the United States that were at higher risk of Zika spreading, such as the US-Mexico border and Puerto Rico, by working with community health workers to alert and teach people who often travel through these areas about their risk for Zika.
The 2009 H1N1 virus caused the first flu pandemic in the United States in more than 40 years, with higher rates of hospitalizations in children and young adults than previous seasons. As part of CDC’s emergency response, DGMQ collaborated with state and local health departments to stop the spread of flu. Recommended strategies included temporarily closing child care centers, schools, places of worship, sporting events, concerts, festivals, conferences, and other settings where people gather, as well as hand washing and staying home when sick.
- Conducted more than 16 investigations throughout the United States and internationally to understand people’s behaviors during flu outbreaks. Investigations involved administering surveys in schools, at ports of entry, and with travelers to the Hajj (the annual Islamic pilgrimage to Mecca, Saudi Arabia), where H1N1 was a potential threat
- Distributed fact sheets, posters, and tool kits about how nonpharmaceutical interventions could reduce the spread of flu in US schools, workplaces, and communities
- Organized an award-winning nationwide public awareness campaign to increase public awareness on ways to prevent the spread of flu during travel. Learn more about this and other accomplishments here.
- Updated the Community Mitigation Guidelines to Prevent Pandemic Influenza – United States, 2017 pdf icon[PDF – 36 pages], to incorporate lessons learned from the H1N1 response. These guidelines serve as a planning tool for local and state health departments in their preparedness efforts for managing any future influenza pandemics.
WHY . . . DGMQ’S WORK MATTERS
You’ve learned the “Who” and the “How” behind DGMQ’s important work of keeping people healthy when they’re on the move. You’ve taken a journey through DGMQ’s primary focus areas and learned about its vast network of public health partners and the impact these partnerships play in the success of DGMQ’s mission. Now, let’s take a look at Why DGMQ’s work matters in an ever-changing public health landscape.
Protecting our health and citizens locally has a global effect. Protecting people and being able to prevent, detect, and respond swiftly to emerging diseases anywhere in the world is an imperative to our own population’s health and safety.
– Dr. Martin Cetron, Director, DGMQ
RESOURCES & TOOLS
Read about recent DGMQ accomplishments in protecting health in a globally mobile world.