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

Tiittala, Paula; Tuomisto, Karolina; Puumalainen, Taneli; Lyytikäinen, Outi; Ollgren, Jukka; Snellman, Olli; Helve, Otto

doi:10.1186/s12889-018-6038-9

Cited by 17 publications

(15 citation statements)

References 25 publications

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“…Our findings show that many migrants accessing emergency services may be missing out on screening for infectious diseases, aligning with previous research and discourse from other EU/EEA countries, despite agreement that it is beneficial [ 10 , 38 , 54 , 55 ]. Routine testing for new entrants from high-incidence countries is recommended for LTBI, HIV, and hepatitis B and C in a range of clinical and community settings [ 22 , 23 , [56] , [57] , [58] ].…”

Section: Discussionsupporting

confidence: 89%

Delivering multi-disease screening to migrants for latent TB and blood-borne viruses in an emergency department setting: A feasibility study

Hargreaves

Nellums

Johnson

et al. 2020

Travel Medicine and Infectious Disease

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Background Screening for latent tuberculosis infection (LTBI) in migrants is important for elimination of tuberculosis in low-incidence countries, alongside the need to detect blood-borne infections to align with new guidelines on migrant screening for multiple infections in European countries. However, feasibility needs to be better understood. Methods We did a feasibility study to test an innovative screening model offering combined testing for LTBI (QuantiFERON), HIV, hepatitis B/C in a UK emergency department, with two year follow-up. Results 96 economic migrants, asylum seekers and refugees from 43 countries were screened (46 [47.9%] women; mean age 35.2 years [SD 11.7; range 18–73]; mean time in the UK 4.8 years [SD 3.2; range 0–10]). 14 migrants (14.6%) tested positive for LTBI alongside HIV [1], hepatitis B [2], and hepatitis C [1] Of migrants with LTBI, 5 (35.7%) were successfully engaged in treatment. 74 (77.1%) migrants reported no previous screening since migrating to the UK. Conclusion Multi-disease screening in this setting is feasible and merits being further tested in larger-scale studies. However, greater emphasis must be placed on ensuring successful treatment outcomes. We identified major gaps in current screening provision; most migrants had been offered no prior screening despite several years since migration, which holds relevance to policy and practice in the UK and other European countries.

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Section: Discussionsupporting

confidence: 89%

Delivering multi-disease screening to migrants for latent TB and blood-borne viruses in an emergency department setting: A feasibility study

Hargreaves

Nellums

Johnson

et al. 2020

Travel Medicine and Infectious Disease

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“…During the peak of immigration in 2015/2016, thus far unprecedented numbers of refugees and asylum seekers were a challenge for receiving health care systems [10]. In this context, screening for tuberculosis (TB) offered the opportunity to provide appropriate treatment of this severe infectious disease [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…TB-prevalence ranged from 0.26 to 0.05% in a study by Herzmann et al, including screening results from 4, both rural and metropolitan centers in Germany 2015 [19] but difficulties with the arrangement of follow up examinations were reported. The need for data collection and analysis in order to improve screening algorithms has been addressed by several authors [9,10,[16][17][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis screening during the 2015 European refugee crisis

et al. 2020

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Background: The purpose of our study was to describe and evaluate management, performance and results of Tuberculosis (TB)-screening among refugees and asylum seekers in a rural area in Germany in 2015.Methods: Refugees or asylum seekers, staying in shared-accommodation are obligated to participate on screening chest X-ray (CXR) in order to screen for signs of potentially infectious pulmonary TB (German Protection against Infection Act and German Asylum Procedure Act). n = 705 individuals underwent screening chest X-ray (CXR) to detect pulmonary TB in September and October 2015 on site. One experienced radiologist interpreted and reported each CXR within 24 h after the enrollment in the screening program and results were sent to the local Public Health Department for potential further medical care. Image abnormalities suggestive for TB were defined according to established radiographic criteria such as pleural effusion, cavitation, consolidation, fibrous scarring or calcification. Only in case of TB-suggestive findings on CXR, further diagnostics were arranged (pulmonological examination, follow-up CXR, sputum culture, interferon-gamma release assay, bronchoscopy). Follow-up data was collected in collaboration with the local Public Health Department. Descriptive statistics were calculated using GraphPad Prism software.Results: n = 637 CXR examinations (90%) did not show abnormal findings, n = 54 CXR (8%) showed incidental findings, and n = 14 CXR (2%) were suspicious for acute TB. Of these, n = 14 individuals, eight underwent further TB diagnostics. Active TB was confirmed in one individual (0.001% of the screening cohort). Conclusions:Our cohort reflects current immigrations statistics in Europe and illustrates an overall low TB prevalence amongst individuals entering Germany in 2015. However, our findings support the improvement of diagnostic algorithms.

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“…In contrast, the prevalence of HBV was less amongst undocumented women in this study than what Wendland et al [17] had found (6,5 %; N=92). In addition, this study showed that undocumented pregnant women had higher prevalence of HIV and HBV compared with asylum seekers in Finland (HIV: 0,3 %; n=45, HBV: 1,6 %; n=275) [41] and higher prevalence of HIV and syphilis compared with asylum seekers in Italy (HIV: 1,6 %; n=5, syphilis: 0,7 %; n=2) [42].…”

Section: Screening Of Infectionsmentioning

confidence: 65%

Maternal health care utilization and the obstetric outcomes of undocumented women in Finland – a retrospective register-based study

Tasa

Holmberg

Sainio

et al. 2020

Preprint

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Background: Undocumented pregnant women constitute a vulnerable group of people who lack equal access to pregnancy care. Previous research has shown that undocumented migrants encounter difficulties in accessing health services, the onset of prenatal care is delayed, and women have an increased risk for infectious diseases. The aim of this study was to describe the use of maternal health care services and the obstetric outcomes of undocumented women in Helsinki, in addition to comparing the results with all pregnant women in Finland.Methods: The study was a retrospective register-based study consisting of data collected between 2014 to 2018 from the electronic medical records of the public maternity clinic and maternity hospital in Helsinki, Finland. The study population consists of 62 individual pregnancies of undocumented women. The results of the study were compared with national data on parturients and deliveries (N=47,274 women) and with prenatal screening tests for infectious diseases (N=51,447 [HIV, HBV], N=51,446 [syphilis]) (relative risk, RR with 95 % CI).Results: The majority (91 %) of the undocumented women attended public prenatal care. However, four women received no prenatal care and three women were denied access to care. Undocumented women entered prenatal care later and had fewer visits compared with all pregnant women. The majority (71 %) of the undocumented women received inadequate prenatal care as the number of visits was less than eight. Of the study population, 5 % (3/61) tested positive for HIV, 3 % (2/61) for HBV, and 2 % (1/62) for syphilis. The prevalence of HIV (RR 62, 95 % CI 20–195), HBV (RR 16, 95 % CI 4–63), and syphilis (RR 20, 95 % CI 3–145) were higher amongst undocumented women compared with all pregnant women.Conclusions: Undocumented women entered prenatal care later than recommended. Most women received inadequate prenatal care and some of them did not receive prenatal care at all. The prevalence of infectious diseases was higher and the coverage of prenatal screenings deficient amongst undocumented pregnant women.

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

Cited by 17 publications

References 25 publications

Delivering multi-disease screening to migrants for latent TB and blood-borne viruses in an emergency department setting: A feasibility study

Delivering multi-disease screening to migrants for latent TB and blood-borne viruses in an emergency department setting: A feasibility study

Tuberculosis screening during the 2015 European refugee crisis

Maternal health care utilization and the obstetric outcomes of undocumented women in Finland – a retrospective register-based study

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