Household Health and Safety

FAQs for Health Care Providers

Medical Guidance to Prepare for and Promote Household Health and Safety when Hosting Afghan Refugee Families and Individuals

The purpose of this document is to provide medical guidance on how to keep you, your household members, and the resettling Afghan newcomers safe during this transition. Unlike most refugees who arrive in the U.S., Afghan families left suddenly and unexpectedly to the U.S. During this emergency evacuation phase, they have experienced difficulties that might include over-crowded conditions, lack of access and infrastructure to support hygiene, health and sanitation. The situations they experienced during their displacement may have increased their risk of encountering certain infectious diseases. In addition, different countries have different health risks, and some infections that people may contract in Afghanistan are rare in the U.S.

Many infections can be spread even when people don’t have symptoms. Although the U.S. government has done its best to screen and vaccinate the newcomers en-route, there is a small risk that persons arriving could have a transmissible infectious disease. The good news is the conditions of most concern can be prevented through routine immunization of the host household.

Understanding this, we recommend you take action to minimize any health risks to yourself and household members. These recommendations are for both non-Afghan host families and Afghan host families.

Things you can do include:

• Make sure everyone in your host household is up to date on their routine vaccinations

• If unsure, share this form with your healthcare provider and discuss the recommendations

Vaccinations

Highly recommended vaccinations include:

• Measles, Mumps, and Rubella (MMR)

  • Update for anyone who does not have measles immunity or at least 2 recorded doses of vaccine for all people born after 1957

• Varicella or “Chickenpox” exposure (VAR)

  • Update for anyone born after 1979 without a history of chickenpox, documented positive blood test (“serology”) and who has not had 2 recorded vaccine doses

• Hepatitis A (this is part of routine childhood immunizations and for people who travel internationally, but many adults may not be immune)

  • For adults and children > 1 year of age

  • Update if not immune and not at least 2 recorded doses

  • Avoid having guests move in if < 14 days since the first vaccine

• Polio (IPV)

  • Update in anyone who does not have at least 3 recorded doses

  • Adults who have not had a one-time booster should receive one additional IPV

• Covid -19 vaccine series

  • Complete series and or boosters for all approved ages (currently >12 years)

• Seasonal Influenza

  • For adults and children > 6 months of age

Other routine immunizations should be up to date as per routine recommendations:

• Tetanus, Diphtheria, and Pertussis

  • Update for anyone who does not have a shot recorded with the pertussis component recorded (and a "P" attached to the vaccine name; e.g. TDaP, Tdap)

  • Update anyone who does not have a recorded tetanus vaccine in the past 10 years.

• Hepatitis B

  • Update in anyone who does not have at least 3 recorded doses

Immunocompromised/increased risk

If you or any household members are immunocompromised or have increased risk of infection, we recommend caution when considering hosting a family or individual. Please discuss with your healthcare provider if you or a household member:

• Has a malignancy or are receiving chemotherapy, had a bone marrow or organ transplant, or are taking immunosuppressive medications.

• Has a condition that might weaken the immune system (untreated or poorly controlled HIV, congenital immunodeficiencies).

• Has children < 1 year of age who have not been vaccinated against chicken pox (Varicella) or measles, mumps or rubella, and MMR

• Is pregnant and is not sure they are immune to both chicken pox (varicella) and measles, mumps and rubella (MMR)

Promote hygiene and sanitation

• Keep up with the cleaning and sanitation that you would normally do for yourself

  • Practice good hand washing

  • Clean shared spaces, bathroom and kitchen regularly

  • Wash regularly

• Do not share linens or towels

• Do not share razors or utensils

Promote a trauma aware household

Afghan individuals and families have experienced and are undergoing severe trauma, including physical, emotional, and social stressors. Promoting a household of acceptance, support and safety may assist newcomers to feel more comfortable. This includes providing:

• Essentials of daily living (foods, water, place to sleep, place to bath/shower)

• Space and time for all household members to be alone as they wish

• Encouraging and supportive words or being present (even without words)

• Judgement free space to listen and share concerns

• Connections to other Afghan community members, community centers, religious or faith based organizations, and community resources when possible

• Kid friendly spaces and activities (e.g. toys, games), so kids get a chance to be kids and have time away from family worries. To the extent possible, try to respond to interests the specific kid(s) in your home may have

• Engagement of families in healthy activities that support well-being: nature walks, soccer games, reading, shared cooking or baking sessions

Connect early

Connect to health care early if health concerns arise in you, household members, or resettled refugees. Make a plan about where you will seek care if a need arises suddenly.

On behalf of the Minnesota Afghan Evacuee Health Team:

Contributors

Alice Lehman, MD

Mehria Sayad-Shah, MD

Blain Mamo, MPH

Beth Thielen, MD, PhD

Cindy Howard, MD

William Stauffer, MD