National immunization strategies targeting migrants in six European countries

Abstract

Over the last three years an unprecedented flow of migrants arrived in Europe. There is evidence that vaccine preventable diseases have caused outbreaks in migrant holding centres. These outbreaks can be favored by a combination of factors including low immunization coverage, bad conditions that migrants face during their exhausting journey and overcrowding within holding facilities. In 2017, we conducted an online survey in Croatia, Greece, Italy, Malta, Portugal and Slovenia to explore the national immunization strategies targeting irregular migrants, refugees and asylum seekers. All countries stated that a national regulation supporting vaccination offer to migrants is available. Croatia, Italy, Portugal and Slovenia offer to migrant children and adolescents all vaccinations included in the National Immunization Plan; Greece and Malta offer only certain vaccinations, including those against diphtheria-tetanus-pertussis, poliomyelitis and measles-mumps-rubella. Croatia, Italy, Malta and Portugal also extend the vaccination offer to adults. All countries deliver vaccinations in holding centres and/or community health services, no one delivers vaccinations at entry site. Operating procedures that guarantee the migrants' access to vaccination at the community level are available only in Portugal. Data on administered vaccines is available at the national level in four countries: individual data in Malta and Croatia, aggregated data in Greece and Portugal. Data on vaccination uptake among migrants is available at national level only in Malta. Concluding, although diversified, strategies for migrant vaccination are in place in all the surveyed countries and generally in line with WHO and ECDC indications. Development of procedures to keep track of migrants' immunization data across countries, development of strategies to facilitate and monitor migrants' access to vaccinations at the community level and collection of data on vaccination uptake among migrants should be promoted to meet existing gaps.

High ratio of measles-specific IgG/IgM associated with nodular pneumonia in vaccinated individuals

“…Migrants, refugees, and international travelers may import diseases, and outbreaks may occur (Chen et al, 2010;Nakken et al, 2018). There is a need to develop strategies to facilitate and monitor such individuals at high risk of developing infectious diseases, and provide access to vaccinations (Kinsman et al, 2018;Giambi et al, 2018).…”

Impact of the Refugee Crisis on the Greek Healthcare System: A Long Road to Ithaca

“…It was demonstrated that diseases that can be prevented by vaccination cause flare-ups in reception and holding centers [39,42,43,44,45,46,47,48]. Outbreaks are generally more severe in refugee camps [48].…”

“…It was demonstrated that diseases that can be prevented by vaccination cause flare-ups in reception and holding centers [39,42,43,44,45,46,47,48]. Outbreaks are generally more severe in refugee camps [48]. Sharing dormitories, a lack of accessible toilet facilities, poor hygiene conditions, undernourishment, and limited access to medical care were reported as factors contributing to the increased susceptibility to disease [35,49].…”

“…Children and the elderly are undoubtedly particularly vulnerable [50,51,52]. In addition, overcrowding in holding/detention centers or refugee camps may contribute to the rapid spread of communicable diseases, such as influenza, varicella, tuberculosis, measles, and meningococcal disease [16,17,39,42,43,44,45,46,47,48,49]. It is predicted that the complication rates for influenza in this setting will be double those in the general population [53].…”

“…Measles and polio vaccinations are generally awarded the highest priority [48,49,53,54]. In the same year, the European Centre for Disease Prevention and Control (ECDC) emphasized that assessment of vaccination status should be considered as a fundamental part of the general health assessment offered to asylum seekers upon arrival [48,50]. Until recently, there were no screening programs for asylum seekers arriving in Greece [32].…”