Vaccinations in migrants and refugees: a challenge for European health systems. A systematic review of current scientific evidence

Abstract

The decline of immunization rates in countries of origin of migrants and refugees, along with risky conditions during the journey to Europe, may threaten migrants' health. We performed a systematic review of the scientific literature in order to assess the frequency of vaccine preventable diseases, and vaccination coverage among migrants and refugees in Europe. To this end, Medline and Cochrane databases were considered. After the screening and the selection process, 58 papers were included in the review. We focused on the following vaccinepreventable diseases: hepatitis B, measles, rubella, mumps, tetanus, poliomyelitis, pertussis, diphtheria, meningitis, and varicella. The results were presented as a qualitative synthesis. In summary, several studies highlighted that migrants and refugees have lower immunization rates compared to European-born individuals. Firstly, this is due to low vaccination coverage in the country of origin. Then, several problems may limit migrants' access to vaccination in Europe: (i) migrants are used to move around the continent, and many vaccines require multiple doses at regular times; (ii) information on the immunization status of migrants is often lacking; (iii) hosting countries face severe economic crises; (iv) migrants often refuse registration with medical authorities for fear of legal consequences and (v) the lack of coordination among public health authorities of neighboring countries may determine either duplications or lack of vaccine administration. Possible strategies to overcome these problems include tailoring immunization services on the specific needs of the target population, developing strong communication campaigns, developing vaccination registers, and promoting collaboration among public health authorities of European Countries. Background and aims

Travel-Related Typhoid Fever: Narrative Review of the Scientific Literature

“…Migrants from low income countries represent a vulnerable population group at highest risk of respiratory, vector-and food-borne diseases owing to the higher circulation of microorganisms in their country of origin. Moreover, the higher risk could depend on long periods of stay in the country of origin, often in remote rural areas where the healthcare infrastructures are poor, and on close contact with the local population, as well as on consumption of local food and water [21]. Frequent travels from/to high incidence countries increase the probability of acquiring infections, such as those caused by Mycobacterium tuberculosis, HIV, Plasmodium spp., and Salmonella spp.…”

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

“…Migrants and refugees are especially vulnerable, as shown in the study of Masters et al (2018): They have a lower vaccination coverage than the host community (Mipatrini et al 2017). Indeed, they face several barriers to adequate vaccination (e.g., socioeconomic inequalities, Kien et al 2017).…”

“…Indeed, they face several barriers to adequate vaccination (e.g., socioeconomic inequalities, Kien et al 2017). They have a reduced immunization rate, similar to the one of their country of origin and they lack access to immunization service delivery (Mipatrini et al 2017). As a consequence, they are unvaccinated or under-vaccinated, as masterly shown by Masters et al (2018).…”

Who is responsible for the vaccination of migrants in Europe?

“…Undocumented migrants may also be excluded from catch-up vaccination because of significant barriers to healthcare and a lack of entitlement to free statutory health services 1,13 , with 10 (31%) of EU/EEA countries we surveyed reporting that they were charging undocumented migrants for vaccinations. 8 Existing data show that newly arrived migrants to Europe have lower rates of vaccine coverage than the host populations on arrival, and may have an uncertain vaccination status, including incomplete vaccination history and/or missing documentation of previous vaccinations 1,4,5,7,[12][13][14] ; concerns echoed in minority mobile groups such as the Roma community. Outbreaks of infectious diseases such as measles and hepatitis A have been documented specifically in non-EU migrant populations in Europe 5,15-17 .…”