Interventions to Improve Vaccination Uptake and Cost Effectiveness of Vaccination Strategies in Newly Arrived Migrants in the EU/EEA: A Systematic Review

Abstract

Newly arrived migrants to the EU/EEA (arrival within the past five years), as well as other migrant groups in the region, might be under-immunised and lack documentation of previous vaccinations, putting them at increased risk of vaccine-preventable diseases circulating in Europe. We therefore performed a systematic review conforming to PRISMA guidelines (PROSPERO CRD42016045798) to explore: (i) interventions that improve vaccine uptake among migrants; and (ii) cost-effectiveness of vaccination strategies among this population. We searched MEDLINE, Embase, CINAHL, and Cochrane Database of Systematic Reviews (CDSR) between 1 January 2006 to 18 June 2018. We included three primary intervention studies performed in the EU/EEA or high-income countries and one cost effectiveness study relevant to vaccinations in migrants. Intervention studies showed small but promising impact only on vaccine uptake with social mobilization/community outreach, planned vaccination programs and education campaigns. Targeting migrants for catch-up vaccination is cost effective for presumptive vaccination for diphtheria, tetanus, and polio, and there was no evidence of benefit of carrying out pre-vaccination serological testing. The cost-effectiveness is sensitive to the seroprevalence and adherence to vaccinations of the migrant. We conclude that scarce but direct EU/EEA data suggest social mobilization, vaccine programs, and education campaigns are promising strategies for migrants, but more research is needed. Research should also study cost effectiveness of strategies. Vaccination of migrants should continue to be a public heath priority in EU/EEA.

Vaccination campaign strategies in recently arrived migrants: experience of an Italian reception centre

“…The knowledge of the level of migrant immunization coverage [19] and the effective improvement of vaccination strategies (such as a strong collaboration with the local vaccine services and vaccinations provided in the asylum seekers centre upon arrival), are two of the key approaches to establish prevention policies and limit the risk of outbreaks in host countries.…”

Infectious Diseases among Refugee Children

“…The reported outbreak of measles among Somali children in Minnesota who were not up to date on measles-mumps-rubella (MMR) vaccinations due to safety concerns (erroneous link to autism) highlights the need to develop enhanced community outreach and education with families and Somali community leaders to address vaccine hesitancy, provide health education, and improve vaccination rates [86]. Studies with a rigorous study design must be conducted to assess interventions to successfully implement vaccination programs for migrant populations [125,126]. In conflict zones and complex humanitarian emergency settings, the implementation of mass immunization campaigns has resulted in controlling the outbreaks of wild polio virus and circulating vaccine-derived poliovirus infections, suggesting that innovative approaches to vaccinate children on the move are needed [127,128].…”

Current gaps in vaccination coverage: a need to improve prevention and care

“…An equitable access to vaccination is needed to protect these vulnerable groups and to reduce morbidity and mortality. It would also protect the whole community, as the low vaccination coverage among migrants can decrease herd immunity (Hui et al 2018). As there is a high immunization uptake and because migrants are often proactive about their health , there are promising opportunities of successful catch-up vaccination.…”