Microbiological screenings for infection control in unaccompanied minor refugees: the German Armed Forces Medical Service’s experience

Abstract

BackgroundThe German Military Medical Service contributed to the medical screening of unaccompanied minor refugees (UMRs) coming to Germany in 2014 and 2015. In this study, a broad range of diagnostic procedures was applied to identify microorganisms with clinical or public health significance. Previously, those tests had only been used to screen soldiers returning from tropical deployments. This instance is the first time the approach has been studied in a humanitarian context.MethodsThe offered screenings included blood cell counts, hepatitis B serology and microscopy of the stool to look for protozoa and worm eggs as well as PCR from stool samples targeting pathogenic bacteria, protozoa and helminths. If individuals refused certain assessments, their decision to do so was accepted. A total of 219 apparently healthy male UMRs coming from Afghanistan, Egypt, Somalia, Eritrea, Syria, Ghana, Guinea, Iran, Algeria, Iraq, Benin, Gambia, Libya, Morocco, Pakistan, and Palestine were assessed. All UMRs who were examined at the study department were included in the assessment.ResultsWe detected decreasing frequencies of pathogens that included diarrhoea-associated bacteria [Campylobacter (C.) jejuni, enteropathogenic Escherichia (E.) coli (EPEC), enterotoxic E. coli (ETEC), enteroaggregative E. coli (EAEC), enteroinvasive E. coli (EIEC)/Shigella spp.), Giardia (G.) duodenalis, helminths (comprising Schistosoma spp., Hymenolepis (H.) nana, Strongyloides (S.) stercoralis] as well as hepatitis B virus. Pathogenic microorganisms dominated the samples by far. While G. duodenalis was detected in 11.4% of the assessed UMRs, the incidence of newly identified cases in the German population was 4.5 cases per 100,000 inhabitants.ConclusionsWe conclude that the applied in-house PCR screening systems, which have proven to be useful for screening military returnees from tropical deployments, can also be used for health assessment of immigrants from the respective sites. Apparently healthy UMRs may be enterically colonized with a broad variety of pathogenic and apathogenic microorganisms. Increased colonization rates, as shown for G. duodenalis, can pose a hygiene problem in centralized homes for asylum seekers.

Extended screening for infectious diseases among newly arrived asylum seekers from Africa and Asia, Verona province, Italy, April 2014 to June 2015

“…Helminthic infections can also potentially cause serious health consequences for infected individuals, however, person-to-person transmission does not represent an issue and treatment is comparatively straight forward. Like our study, other studies reported high prevalence of some helminths targeted by the screening of asymptomatic individuals [ 14 , 25 ]. While the implementation of screening activities for these infections sometimes faces obstacles, such as refusal to supply biological samples and test limitations (low sensitivity of stool examination in case of Schistosoma spp.…”

Public health response to large influx of asylum seekers: implementation and timing of infectious disease screening

“…The observed HBsAg seroprevalence of 1.4% was lower as compared to majority of previous studies among asylum seeker in Europe [ 17 , 18 , 20 , 25 – 28 , 31 ]. A hepatitis B seroprevalence study among adult asylum seekers from Middle-East and Horn of Africa in the Netherlands in 2016 concluded a lower HBsAg prevalence of approximately 1% as compared to our study [ 32 ].…”

Morbidity profile and sociodemographic characteristics of unaccompanied refugee minors seen by paediatric practices between October 2014 and February 2016 in Bavaria, Germany

“…Therefore a high overall morbidity of 87.7% with at least one clinical diagnosis or suspicious laboratory result was seen in this cohort, which is relatively high compared to data from Berlin where 56.6% had no pathological finding [ 22 ]. A study on microbiological screening in Hamburg, Germany found pathogenic and non-pathogenic microorganisms in apparently healthy URM [ 23 ], while in Western Australia over 90% of the participants in a voluntary health assessment were referred to special, multidisciplinary paediatric health clinics [ 24 ]. The majority of the resulting health care needs in this refugee population are known to general practitioners in Germany.…”