 This Update is being sent to members of the Wisconsin Travel Health Network.
World Immunization Week (April 23–30)
World Immunization Week, led by the World Health Organization (WHO), promotes the use of vaccines to protect people of all ages against diseases. The 2026 campaign theme "For every generation, vaccines work" reflects the roughly 150 million lives saved by vaccines over the past 50 years. The highlights of the week involve global efforts from WHO, the United Nations International Children's Emergency Fund (UNICEF), and various partners to raise awareness and support vaccination campaigns.
Vaccines are a great success story and have saved millions of lives around the world. Providers are encouraged to use their electronic health records (EHR) and reminder/recall reports in the Wisconsin Immunization Registry (WIR) to ensure patients are up to date on their immunizations.
CDC Travel Health Notices for international travelers
Level 4—Avoid All Travel
None at this time.
Level 3—Reconsider Nonessential Travel
None at this time.
Level 2—Practice Enhanced Precautions
Meningococcal disease in the Democratic Republic of the Congo (3/24/2026)
There is a level 2 travel health notice due to an outbreak of meningococcal disease in the Mangembo Health Zone of Kongo Central Province. The best way to prevent meningococcal disease is to get a meningococcal vaccine.
Yellow fever in Venezuela (3/16/2026)
An increased number of cases of yellow fever have been reported in Venezuela, resulting in a level 2 travel health notice. Yellow fever is a viral disease that can cause jaundice, liver disease, bleeding, and shock. It is spread through the bites of infected mosquitoes. Travelers to affected areas of Venezuela should get vaccinated and take steps to prevent mosquito bites.
Chikungunya in Mayotte (3/10/2026)
There is an outbreak of chikungunya in Mayotte, an island in the Indian Ocean. Travelers should take steps to prevent mosquito bites and seek vaccination if they will be in an area with an active chikungunya outbreak. Pregnant individuals should reconsider travel to the affected areas.
Global polio (3/9/2026)
Some areas in the Middle East, Africa, and Europe have circulating poliovirus. All travelers should make sure they are up to date on their polio vaccines before leaving for a trip.
Level 1—Practice Usual Precautions
Global dengue (3/23/2026)
World cup travel safety
The World Cup is June 11–July 19, 2026, and matches will take place across multiple cities in Canada, the United States, and Mexico. Millions of fans are expected to travel both internationally and throughout the United States. It is crucial for providers to ensure travelers are prepared to keep themselves and those around them safe.
Given the crowded nature of large-scale sporting events, virus transmission could occur more easily. Since fans will arrive from regions with varying vaccine coverage, providers should ensure their patients have all appropriate vaccines before traveling.
While respiratory and vaccine-preventable diseases are top concerns, individuals may also be at risk for foodborne and waterborne illnesses, as well as heat-related illness and dehydration. Remind travelers to stay hydrated, recognize the early signs of heat exhaustion, follow local public health guidance, and learn how to access health care services in host cities. Encourage travelers to seek care if they experience symptoms after returning home, including fever, respiratory, or gastrointestinal illness.
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Wisconsin's declining immunization rates and increased risk of vaccine-preventable disease during travel
The Wisconsin Department of Health Services (DHS) released its annual vaccination rates among children, adolescents, and adults for 2025. The data show Wisconsin’s childhood vaccination rates continued to decrease last year. While nearly seven of every 10 children (66.9%) had the recommended vaccinations at age 24 months, nearly three of every 10 did not. This is a decline of almost 2% from 2024. Alongside the decline in childhood vaccination rates, the 2025 data also show very minor decreases in adolescent vaccines such as the human papillomavirus (HPV) and tetanus, diphtheria, and pertussis (Tdap) vaccines.
As of late March 2026, the Centers for Disease Control and Prevention (CDC) reported 1,575 confirmed measles cases in the United States to date for the year. That number includes 16 measles outbreaks, with Wisconsin being among the states to have reported measles cases. In 2025, the United States saw 2,258 confirmed measles cases, according to the CDC, which is the highest number of cases since 1991.
In Wisconsin, the 2025 measles, mumps, and rubella (MMR) vaccination rate for children at age 24 months was 79.8%, down from 88.2% in 2013. That’s a decrease of 8.4%. Due to the rates falling below 95%, which is needed for herd immunity, there is a higher risk of transmission in the community. An unvaccinated traveler could easily pick up the virus while on vacation, allowing it to spread quickly in their community back home. This is why it is highly encouraged for all travelers to be up to date on their routine immunizations and to get any other necessary vaccines specific to their destination.
Travelers can use the Wisconsin Immunization Registry to check their and their child's vaccine status. Families can access free or low-cost vaccines through programs like Vaccines for Children and Vaccines for Adults. They can also learn more about vaccines on the DHS Get the Facts About Vaccines webpage.
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Disease Spotlight: Multidrug-resistant organisms (MDROs) in patients who receive health care abroad
Background
MDROs are microorganisms that are resistant to one or more classes of antimicrobial agents (antibiotics and antifungals). Infections caused by MDROs are difficult to treat due to limited treatment options and can lead to serious illness or death.
Travel is a risk factor for several MDROs of concern, including Candida auris and carbapenemase-producing organisms (CPOs). Both of these MDROs are most commonly detected among people who are hospitalized in other countries.
Candida auris
Candida auris is a fungal pathogen that is often resistant to antifungal drugs. Candida auris emerged as a serious healthcare-associated infection (HAI) in 2009 in multiple different areas around the world. In-hospital mortality rates from Candida auris infections range from 25% to 70%.
Candida auris has been detected in most of the United States. Wisconsin detected its first case in 2022 and recently surpassed 100 total cases. Several cases of Candida auris in Wisconsin have been detected in patients who received health care abroad. Cases also continue to be identified in patients who have spent time in hospitals or long-term care facilities in other states.
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Carbapenemase-producing organisms
CPOs are bacteria that contain genes that help them destroy antibiotics that would otherwise be used to treat infections. The types of bacteria that are commonly carbapenemase-producers often live harmlessly in the human gastrointestinal tract but can cause severe infections in other parts of the body.
Many of the first cases of CPOs in the United States were in patients who had been hospitalized in other countries. While much of the transmission is now domestic, cases and different carbapenemase mechanisms continue to be identified in patients with hospitalizations abroad. Similarly in Wisconsin, many of our most complicated MDRO cases—those with multi-gene CPOs or those with both Candida auris and a CPO—are identified in patients who have received health care abroad.
Medical tourism
Traveling to another country to receive health care, also known as medical tourism, has implications on the spread of MDROs. In recent years, there have been outbreaks associated with medical tourism. In 2018 and 2019, the CDC investigated an outbreak of VIM carbapenemase-producing Pseudomonas aeruginosa among patients who underwent bariatric surgery in Mexico. Thirty-eight case-patients were identified in 18 states across the United States. VIM (Verona Integron-encoded Metallo-beta-lactamase)-producing Pseudomonas aeruginosa is relatively uncommon in the United States, underscoring the potential for medical tourism to spread highly concerning MDROs.
Preventing transmission
CDC advises travelers that highly-resistant bacteria and fungi have caused disease outbreaks among medical tourists. Infection control practices in other countries may differ from the standard in the United States and may contribute to the transmission of MDROs.
For clinicians, obtaining a patient’s travel and health care abroad history can be useful when identifying potential infections caused by an MDRO. Screening for MDROs is available through the Wisconsin State Lab of Hygiene. Please contact the Wisconsin HAI Prevention Program at DHSWIHAIPreventionProgram@dhs.wisconsin.gov for more information. Also visit the HAI: Reportable MDRO webpage for resources, tools, and guides.
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