Divergent approaches in the vaccination of recently arrived migrants to Europe: a survey of national experts from 32 countries, 2017

Abstract

BackgroundMigrants within the European Union and European Economic Area (EU/EEA) may be underimmunised and lack documentation on previous vaccinations. We investigated approaches to vaccination in recently arrived adult and child migrants, and guideline availability and implementation. Methods: Between March and May 2017, a national vaccination expert from every EU/EEA country and Switzerland completed an electronic questionnaire. We used descriptive analyses to calculate percentages, and framework analysis to synthesise free-text responses. Results: We approached 32 countries (response rate 100%). Although 28 experts reported vaccination guidance at national level, specific guidelines for recently arrived migrants were only available in six countries and not consistently implemented. Twenty-three countries administered vaccinations during on-arrival health checks. Most experts recommended multiple vaccination opportunities be made available: at point of entry (n = 13) or at holding level (reception centres, migrant camps, detention centres) (n = 21). In 30 countries, child migrants without evidence of previous vaccination were re-vaccinated according to the national schedule. Diphtheria-pertussis-tetanus and polio vaccinations were given to migrant children in all countries, measles-mumps-rubella (MMR) in 31 countries, hepatitis B vaccination in 25. Low levels of catch-up vaccination were reported in adult migrants, with only 13 countries offering MMR and 10 countries charging fees. Conclusion: Existing guidance is often not migrant-specific and may not be applied in practice; clarification is needed on which vaccines should be given. Strategies are needed specifically for catch-up vaccination in adult migrants. Vaccinations should be offered in multiple settings, free of charge, with sufficient guidance and training provided to front-line healthcare professionals.

Mass migration to Europe: an opportunity for elimination of hepatitis B virus?

“…These concerns were also shared in a survey among vaccination experts of 32 EU member states. 53 The respondents underpinned the need for EU-level guidelines on vaccination and indicated that vaccination should be offered primarily at the point of entry or at the holding level (eg, reception centres and migrant camps). Accordingly, future actions should focus on a systemic and tailored approach to address these challenges and provide adequate protection for migrants and refugees.…”

Children on the Move

“…The high burden of vaccine-preventable diseases among migrant children compared with non-migrant children underscores the need for timely vaccination in this vulnerable population [76][77][78][79][80]. Despite the recommendations for age-appropriate vaccinations for migrant children with absent or uncertain immunization records, studies have shown that migrants in the EU are not up to date on vaccinations [81,82]. A cohort study from Denmark showed that 30% of asylum-seeking children were not up to date on vaccinations in accordance with national guidelines [17].…”

Infectious Diseases among Refugee Children

“…The high burden of vaccine-preventable diseases among migrant children compared with non-migrant children underscores the need for timely vaccination in this vulnerable population [76][77][78][79][80]. Despite the recommendations for age-appropriate vaccinations for migrant children with absent or uncertain immunization records, studies have shown that migrants in the EU are not up to date on vaccinations [81,82]. A cohort study from Denmark showed that 30% of asylum-seeking children were not up to date on vaccinations in accordance with national guidelines [17].…”