Refugee health underlines need for screening programmes in host countries

Researchers have observed increased prevalence of resistant pathogens or emerging or re-emerging infectious diseases including HIV, tuberculosis, Salmonella, Shigella, scabies and other parasitic infections in refugees and migrants, according to data presented at ECCMID 2016, the annual meeting of the European Society of Clinical Microbiology and Infectious Disease (ESCMID).

At a session dedicated to late-breaking abstracts on refugee health, researchers presented evidence of some of the challenges faced by healthcare services in Denmark, Germany, Switzerland, Norway and Taiwan, as a result of an increase in migration.

A study comparing 405 migrants and 279 Danish-born citizens in Denmark, for example, showed that the incidence of HIV infection among refugees and family-reunified migrants is higher than that of Danish-born individuals.

The highest risk was observed in sub-Saharan Africans and heterosexual cohorts, and refugee and family-reunified migrants were also more likely to seek medical treatment late, further increasing the risk of spreading the infection.

The researchers suggested that migrants are finding it difficult to access HIV testing and call for a more systematic medical reception of newly arrived migrants in recipient countries.

In other research on the prevalence of drug-resistant pathogens at Swiss refugee centres, refugees (irrespective of origin) had colonisation rates that were ten times higher for methicillin-resistant Staphylococcus aureus (MRSA) and five times higher for extended spectrum beta-lactamase (ESBL) compared with the local population.

The researchers also observed that more than a third of refugees from the Middle East were colonised by ESBL compared with less than a quarter in the general refugee population.

We recommend that public health facilities maintain and step up screening programmes

An analysis in Norway showed that the reporting rate of MRSA infections continues to increase in the country, boosted by imported cases, particularly in younger people and those with an immigrant background. The presented data suggests that tourism and immigration may be important drivers for the current rise in MRSA infections.

In Germany, a screening of 20,312 stool samples taken at refugee centres in Thuringia showed that in 2015 one in every 300 refugees carried Salmonella or Shigella, while a study from Taiwan identified 2,080 cases of tuberculosis in immigrant workers between 2011 and 2014. Immigrant workers from South East Asian countries, where tuberculosis is highly endemic, had a two-fold higher risk for TB than domestic residents.

Winfried Kern, Programme Director of ECCMID, commenting on the significance of the results, said: 'Healthcare services across the world are facing a number of new challenges as a result of recent mass migration. Refugees may carry both, resistant pathogens and microbes causing the emergence or re-emergence of infectious diseases that have become less prevalent in host countries. These include methicillin-resistant Staphylococcus aureus, HIV and TB. Infectious diseases carried and transmitted by travellers and migrants increase the disease burden.

'We recommend that public health facilities maintain and step up screening programmes and put the appropriate precautions and procedures in place to most effectively protect migrants and domestic populations in host countries.'

For a full programme of the oral presentations at ECCMID 2016, click here.