Increasing prevalence of infectious diseases in asylum seekers at a tertiary care hospital in Switzerland

Abstract

ObjectiveThe increasing number of refugees seeking asylum in Europe in recent years poses new challenges for the healthcare systems in the destination countries. The goal of the study was to describe the evolution of medical problems of asylum seekers at a tertiary care centre in Switzerland.MethodsAt the University Hospital Basel, we compared all asylum seekers during two 1-year time periods in 2004/05 and 2014/15 concerning demographic characteristics and reasons for referrals and hospitalizations.ResultsHundred ninety five of 2’544 and 516 of 6’243 asylum seekers registered at the national asylum reception and procedure centre Basel were referred to the University Hospital Basel in 2004/05 and 2014/15, and originated mainly from Europe (62.3%, mainly Turkey) and Africa (49.1%, mainly Eritrea), respectively. Median age was similar in both study periods (26.9 and 26.2 years). Infectious diseases in asylum seekers increased from 22.6% to 36.6% (p<0.001) and were the main reasons for hospitalizations (33.3% of 45 and 55.6% of 81 hospitalized patients, p = 0.017) in 2004/05 compared to 2014/15. The leading infectious diseases in hospitalized patients were tuberculosis (n = 4) and bacterial skin infections (n = 2) in 2004/05; Malaria (n = 9), pneumonia (n = 6), Chickenpox (n = 5), other viral infections (n = 5) and bacterial skin infections (n = 5) in 2014/15. Infectious diseases like malaria, cutaneous diphtheria, louseborne-relapsing fever or scabies were only found in the second study period. Almost one third of the admitted asylum seekers required isolation precautions with median duration of 6–9.5 days in both study periods.ConclusionsThe changing demography of asylum seekers arriving in Switzerland in the current refugee crisis has led to a shift in disease patterns with an increase of infectious diseases and the re-emergence of migration-associated neglected infections. Physicians should be aware of these new challenges.

A Review of Scabies: An Infestation More than Skin Deep

“…Within Europe, there is an increasing population of refugees seeking asylum, often those displaced from areas of Africa or the Middle East due to conflict. These are vulnerable populations, and individuals are at risk of contracting a number of important infectious diseases, in addition to scabies, which frequently coexist [41]. A recent observational study of scabies outbreaks, in residential and nursing care homes in south-east England, showed that the clinical presentation of scabies in this elderly population differs from the classic descriptions with which clinicians are familiar.…”

The public health control of scabies: priorities for research and action

“…Recognized examples include disadvantaged Indigenous populations within Australia, New Zealand and Canada, 26,60-62 imprisoned 63,64 and homeless populations, 65 and among groups seeking asylum within Europe. [66][67][68] Scabies is a disease of poverty and inequity and it is likely that sub-populations with higher burdens would be found in many otherwise high-income settings. 69 Institutional scabies outbreaks result in considerable morbidity, stigma and healthcare cost in high-income settings.…”

Understanding Refugees' Health

“…56,58 Pneumonia and skin infections were commonly identified infectious diseases leading to ED consultations and admission to hospital in European centers. 63 However, chronic infections are particularly important. Tuberculosis has a much higher incidence in newly arrived asylum seekers, especially from Eritrea and Pakistan, than in the native European population.…”

“…Isolation precautions were indicated in almost one-third of the patients. 63 However, rare parasitic diseases like neurocysticercosis were also found in refugees from Burma presenting with severe occipital headache at an ED in the United States. 65 A further concern with chronic health issues is the emergence of multiresistant bacteria in refugees from the Middle East.…”