Travel Health Network Update: March 2023

Global Health Update

COVID-19 testing requirement rescinded

On March 10, 2023, the Centers for Disease Control and Prevention (CDC) removed the COVID-19 test or recovery documentation requirement for air passengers from the People’s Republic of China to the United States. All non-U.S. permanent residents and immigrants are still required to be fully vaccinated with the primary series of an accepted COVID-19 vaccine to travel to the U.S. by plane.

Increased risk of polio internationally 

Some international destinations are experiencing increased circulation of poliovirus. Review this list to identify all the countries with current circulating poliovirus. Providers should ensure:  

• Infants and children traveling to countries where the risk of getting polio is greater should complete the routine polio vaccine series before departure.
• Unvaccinated adults who are traveling to countries with increased risk of exposure to poliovirus should receive a series of three doses (Two doses separated by 1 to 2 months and a third dose 6 to 12 months after the second dose).
• Incompletely vaccinated adults who have had only one or two doses of polio vaccines and are traveling to countries with increased risk of exposure to poliovirus should get the remaining one or two doses of inactivated polio vaccine (administered at least 4 weeks apart).
• Adults who completed the polio vaccine series as children and are traveling to countries with increased risk of exposure to poliovirus may get a one-time booster dose of inactivated polio vaccine, if they have not yet already.

For guidance on how to talk to adults about polio vaccination, view What Adults in the U.S. should know about Polio. Visit CDC’s Travelers’ Health Notices site to see the most current information about polio across the globe.

In Case You Missed It View and download the new Safe Travel Checklist The Travel Health Network created the Safe Travel Checklist for people to reference before, during, and after their trip. You can save or print the checklist to share it with patients and future travelers to help them stay safe and healthy!

Disease Spotlight: Diphtheria 

Diphtheria is an infection caused by the bacterium Corynebacterium diphtheriae biotype mitis, gravis, intermedius, or belfanti. Diphtheria was a leading cause of childhood death prior to the development of vaccination. Diphtheria cases decreased rapidly in developed nations when the diphtheria-tetanus-pertussis (DTP) vaccine was introduced in 1948.

Who is at risk? 

Children and adults who are not up to date on their vaccinations are at risk for getting diphtheria. Travel, close contact with cattle, and eating raw dairy products are all potential risk factors for infection. Everyone traveling to places where diphtheria infections are common should be up to date on their vaccinations and adults should receive their one-time booster dose before.

What are the symptoms? 

The incubation period for diphtheria is 2 to 5 days and symptoms can and range from mild to severe. Diphtheria can involve almost any mucous membrane and is classified based on the site of disease (respiratory or non-respiratory). The most common sites of infection are the pharynx and tonsils.

Symptoms come on gradually, often beginning with a sore throat and fever. Other symptoms include weakness, difficulty breathing and swallowing, cough, pseudomembrane in the throat and nose, and enlarged lymph nodes in the neck. If severe respiratory infection occurs, there can be damage to the heart and nerves. Learn more in CDC’s Pink Book and view diphtheria photos.

How is it spread? 

Transmission is most often person-to-person through respiratory droplets. Transmission may rarely occur from exposure to infect skin lesions or items soiled with fluids from lesions. Effective antibiotic therapy promptly terminates virulent bacilli shedding. Here are some key questions to consider when assessing suspected respiratory diphtheria cases.

What are the complications?

Cutaneous diphtheria infection rarely results in severe disease.

Most complications of respiratory diphtheria, including death, are attributable to effects of the toxin. The most frequent complications of respiratory diphtheria are myocarditis and neuritis. Other complications include otitis media and respiratory insufficiency due to airway obstruction, especially in infants.

Is there treatment for diphtheria?

The recommended antibiotics for respiratory or cutaneous diphtheria are either erythromycin or penicillin.

Patients who have suspect or confirmed respiratory diphtheria, according to the Council of State and Territorial Epidemiologists case definition, are eligible to receive diphtheria antitoxin (DAT). DAT may also be used in cases of respiratory diphtheria-like illness caused by laboratory-confirmed toxigenic C. ulcerans. A patient’s eligibility for treatment will be determined through discussion between the CDC diphtheria duty officer and the treating clinician. Learn more about requesting DAT from CDC.

Updates From the Travel Health Network

The Travel Health Network is planning a round-table discussion to take place in May 2023. We will host two webinars, one in the early morning and one over the lunch hour, in hopes of reaching as many members as possible. We will discuss travel implications that may occur due to transitioning away from the COVID-19 Public Health Emergency.

Please do not reply directly to this email message. Send questions and inquiries to DHSBCDTravelHealth@dhs.wisconsin.gov.