Meningococcal infections among refugees and immigrants: silent threats of past, present and future

Abstract

Globally, there is an increasing number of international migrants. The majority are forced displaced refugees and children unaccompanied by a caregiver, and have limited access to essential public health interventions. Routine vaccination might be interrupted or be incomplete due to conflict areas with limited public health services or a long-unplanned journey. Refugees and migrants may bring infectious disease risks to their country of destination and may be exposed to new risk factors during transit or at their destination. There are lessons learned strategies among refugees and asylum seekers in different countries (vaccination campaign during outbreak, maintain vaccination systems for refugees and medical screening and/or vaccination on arrival) against vaccine-preventable diseasesother than meningococcal infections. Since the 1980s, invasive meningococcal disease (IMD) has been reported as a critical healthcare issue in places of humanitarian crisis such as Thailand and African's meningitis belt. Refugees and migrants are at increased risk of IMD compared with the overall population due to sero-epidemiology in their country of origin, specific characteristics of the IMD, and a number of contacts during the journey. Recently, IMD cases due to serogroups X and W have been reported and are an emerging health threat for persons arriving from Africa to refugee camps in Italy. There have been sporadic case reports of IMD due to serogroup B in Turkey; however, there has not yet been increased disease activity in this population and no outbreaks have been observed. Outbreaks of IMD in refugee camps have been and could be successfully controlled through the implementation of timely and high-coverage vaccination campaigns, and individual cases of IMD can be treated with antibiotics. Research is needed to determine the prevalence of meningococcal carriage and serogroup distribution among refugees and migrants to inform vaccine recommendations. There is no official recommendation for meningococcal vaccination of refugees. Further strategies for prevention and treatment of human immunodeficiency virus, tuberculosis and antibiotic resistance among refugees are directly related to potential prevention methods for IMD. Meningococcal vaccines have been administered only to risk groups in most host countries Thus, further strategies for the definition of new/emerging risk factors for IMD would be helpful to guide vaccine implementation for refugees and immigrants.

Genomic characterization of invasive meningococcal X isolates from Brazil, 1992–2022

“…Humanitarian crises and conflicts are resulting in an increase in the deprived population with difficulty accessing health services. Migrants, refugees, and asylum seekers are reported to have an increased risk condition for infectious disease transmission, including IMD (Dinleyici and Borrow, 2020 ). Despite being a global movement, the increase in the number of international migrants was not associated with any of the recent MenX IMD cases reported in our study.…”

Immunisation status of UK-bound refugees between January, 2018, and October, 2019: a retrospective, population-based cross-sectional study

“…The low coverage found for vaccinations recommended (meningococcal, H influenzae, varicella, and rotavirus vaccines) by the UK Refugee Technical Instructions to be given in crowded conditions should also be considered, as outbreaks of these diseases have occurred in the past two decades in refugees in Europe. 8,9,33 These vaccinations are often not covered by national schedules, suggesting increased emphasis could be put on these vaccines as part of pre-departure vaccination programmes or novel pathways developed to deliver them to high-risk populations on arrival.…”

Risk factors for invasive meningococcal disease: a retrospective analysis of the French national public health insurance database

“…We have attempted to identify low socioeconomic status through the proxy variables of CMU-C status and the SDI, but this is clearly only an indirect and partial approach to this important issue. Finally, certain high-risk social groups, such as migrants 32 and the homeless, may not even be present in the SNDS , as well as patients who died before reaching hospital. Independently of the database itself, matching of controls to cases may not be perfect due to the presence of unidentified confounding variables.…”