Empfehlungen zur infektiologischen Versorgung von Flüchtlingen im Kindes- und Jugendalter in Deutschland: Stellungnahme der Deutschen Gesellschaft für Pädiatrische Infektiologie, der Gesellschaft für Tropenpädiatrie und Internationale Kindergesundheit und des Berufsverbandes der Kinder- und Jugendärzte

[Infectious diseases in migrants]

The current influx of refugees and the high rate of immigration increase the prevalence and impact of infectious diseases in Europe. Infections may be detected at first contact, as a result of systematic screening or as part of general medical care. Diagnosis and treatment require special expertise and, in some cases, special precautions. The spectrum of imported infections is determined by the countries of origins of the migrants and the circumstances associated with their escape to Germany. In this article, diagnosis and treatment of the most important infectious diseases will be presented. As far as infectious diseases are concerned, refugees and migrants are not a threat to the host population, but instead have to be perceived and cared for as a highly vulnerable group.

Infektiologische Versorgung minderjähriger Flüchtlinge am Beispiel der Ukraine

Hintergrund

Bis Anfang Juni 2022 sind ca. 300.000 Kinder und Jugendliche aus der Ukraine im deutschen Ausländerzentralregister registriert worden.

Die vorliegenden Handlungsempfehlungen sollen die Grundlage für eine evidenzbasierte und zielgerichtete infektiologische Versorgung minderjähriger Flüchtlinge am Beispiel der Ukraine schaffen.

Ziele

Die Handlungsempfehlungen sollen medizinisches Personal in der Versorgung minderjähriger Flüchtlinge aus der Ukraine unterstützen, um

1. einen unvollständigen Impfschutz frühzeitig zu erkennen und zu vervollständigen;

2. übliche Infektionskrankheiten zu diagnostizieren und zu behandeln;

3. in Deutschland seltene Infektionskrankheiten frühzeitig zu erkennen und zu therapieren.

Material und Methoden

Die Handlungsempfehlungen wurden als durch die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) koordinierte Leitlinie der Stufe 1 verfasst und an die Situation Flucht aus der Ukraine angepasst.

Die Empfehlungen wurden durch eine repräsentativ zusammengesetzte Expertengruppe der beteiligten Fachgesellschaften im informellen Konsens erarbeitet und final von den Vorständen der Fachgesellschaften offiziell verabschiedet.

Ergebnisse

Es werden Empfehlungen für den Umfang der Anamnese und der körperlichen Untersuchung minderjähriger Flüchtlinge, angepasst an die Situation Flucht aus der Ukraine, ausgesprochen. Für alle minderjährigen Flüchtlinge werden die Bestimmung eines Differenzialblutbilds sowie Untersuchungen auf Tuberkulose, Hepatitis B und C sowie eine Human-Immunodeficiency-Virus(HIV)-Infektion empfohlen.

Zur raschen Vervollständigung des Impfstatus wird eine alters- und Indikationsbezogene Priorisierung einzelner Impfungen vorgenommen.

Diskussion

Angesichts anhaltend hoher Flüchtlingszahlen nicht nur aus der Ukraine ist eine weitere Professionalisierung der medizinischen Versorgung minderjähriger Flüchtlinge notwendig. Hierzu sollten die notwendigen strukturellen und personellen Rahmenbedingungen geschaffen werden.

[Updated recommendations on the treatment of infectious diseases in refugees in childhood and adolescence in Germany (situation as of 30 March 2022), registered as S1 guidelines (AWMF-Register Nr. 048-017)]

Background

Based on 190,000 applications for asylum, Germany remains a top destination for refugees and asylum seekers in Europe. The updated recommendations are considered evidence-based and targeted guidelines for the diagnosis and prevention of infectious diseases in underage refugees and asylum seekers.

Objective

The objective of these recommendations is to guide medical staff in the care of minor refugees, in particular to:1. assure early recognition and completion of incomplete vaccination status,2. diagnose and treat common infectious diseases,3. recognize and treat imported infectious diseases that are considered uncommon to the German healthcare system.

Material and methods

The recommendations have been formally written to be published as AWMF S1 guidelines.This includes a representative expert panel appointed by several professional societies, and formal adoption of the recommendations by the board of directors of all societies concerned.

Results

Recommendations are given for the medical evaluation of minor refugees, including medical history and physical examination. A blood count as well as screening for tuberculosis and hepatitis B should be offered to all minor refugees. In addition, screening for other infectious diseases like hepatitis C, HIV or schistosomiasis should be considered depending on age and country of origin. Vaccinations are recommended based on both age and country of origin.

Conclusion

As thousands of minor refugees continue to seek shelter in Germany every year, professional health care with adequate financial support needs to be established to ensure an appropriate medical treatment of this particularly vulnerable population.

High diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of adolescent pulmonary tuberculosis

Background

The microbiological diagnosis of pulmonary tuberculosis (Tb) in a pediatric population is hampered by both low pathogen burden and noncompliance with sputum sampling. Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been found useful for the evaluation of mediastinal pathologies in adults, for children, sparse data are available. Here, we have evaluated EBUS-TBNA as a diagnostic procedure in children and adolescents with suspected pulmonary Tb.

Methods

In this retrospective analysis, we reviewed the charts of unaccompanied refugee minors (URM) who were admitted between January 2016 and July 2018 and who, during their initial medical screening upon arrival in Germany, were found to have abnormal radiological pulmonary and mediastinal findings and/or immunological results indicative of Tb. For each patient, basic sociodemographic data, clinical features and data on diagnostic procedures performed were assessed. These included imaging, immunodiagnostic tests and microbiological data derived from sputum, bronchoalveolar lavage, EBUS-TBNA, bronchoscopy and pleural fluid sampling. All patients who underwent invasive sampling procedures were included in the study.

Results

Out of 42 URM with suspected Tb, 34 fulfilled the study’s inclusion criteria. Ages ranged from 14 to 17 years. All were of African origin, with 70.0% coming from Somalia, Eritrea and Ethiopia. Among the 21 patients for whom EBUS-TBNA was performed, the diagnostic yield was high: 66.7% positive results (MTb detected either by acid-fast stain, culture or PCR in 4.8, 42.9 and 61.9% of samples, respectively). Multidrug-resistant MTb was found in two patients from Somalia. No complications were associated with the procedure. Overall, pulmonary Tb was diagnosed in 29 patients (85.3%), miliary Tb in two patients (5.9%) and latent Tb in three patients (8.8%).

Conclusions

EBUS-TBNA is a sensitive and safe method with high diagnostic yield in the evaluation of pediatric patients with mediastinal pathology and suspected Tb.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06413-z.

Medical care for migrant children in Europe: a practical recommendation for first and follow-up appointments

Between 2015 and 2017, an estimated 200,000 to 400,000 children were seeking asylum each year in EU/EEA countries. As access to high-quality health care is important, we collected and compared current recommendations across Europe for a consensus recommendation on medical care for migrant (asylum-seeking and refugee) children. Existing recommendations were collected from published literature and identified through national representatives from paediatric societies of 31 EU/EEA countries through the European Academy of Paediatrics (EAP). Recommendations were systematically extracted and collected in a database. Those mentioned in at least one recommendation were evaluated for inclusion, and evidence on recommendations was specifically identified in literature searches focused on recent evidence from Europe. For eight EU/EEA countries, a national recommendation was identified. Growth and development, vision and hearing impairment, skin and dental problems, immunisations, anaemia, micronutrient deficiency, helminths, hepatitis B and C, human immunodeficiency virus, malaria, schistosomiasis, syphilis, tuberculosis, mental health disorder and sexual health were most frequently mentioned and therefore selected for inclusion in the recommendation.Conclusion: The current document includes general recommendations on ethical standards, use of interpreters and specific recommendations for prevention or early detection of communicable and non-communicable diseases. It may serve as a tool to ensure the fundamental right that migrant children in Europe receive a comprehensive, patient-centred health care.

[Frequent infectious diseases in migrants]

The current influx of refugees and the high rate of immigration increase the rate and impact of infectious diseases in Europe. Infections can be detected at the initial examination of arriving refugees as a result of systematic screening or within the framework of general medical care. Diagnosis and treatment require special expertise and in some cases special precautions. The spectrum of infections is determined by the country of origin of migrants and the conditions experienced on fleeing to Germany. In this article the diagnostics and treatment of the most important infections are presented. As far as infections are concerned refugees and migrants do not represent a threat to the general population but instead have to be perceived as a highly vulnerable group.

Screening for infectious diseases among asylum seekers newly arrived in Germany in 2015: a systematic single-centre analysis

OBJECTIVES

During the migrant crisis in 2015, Germany was the largest single recipient of new asylum seekers in Europe. The German asylum law requires a screening examination for certain infectious diseases in asylum seekers upon arrival. The aim of this work was to analyse the rate of certain infectious diseases among asylum seekers screened at a reception centre in Southern Germany.

STUDY DESIGN

Retrospective medical record review.

METHODS

Medical records of 2602 asylum seekers screened by a local public health authority in Germany in 2015 were systematically analysed.

RESULTS

The majority of screened subjects came from Afghanistan and Syria. The mean age was 22.1 (±12.0) years. The majority of subjects were male (75.4%). Most individuals were of normal weight or overweight, more subjects were obese than underweight. A total of 78 (3.9%) individuals were infected with hepatitis B and eight (0.4%) with HIV. In 31 cases, chest radiographs suggested active tuberculosis (1.6%), which was confirmed in four cases (0.2%). The physical examination uncovered 44 (1.7%) cases of scabies, nine (0.3%) cases of lice, eight (0.3%) of upper respiratory tract infections, two (0.1%) of varicella and 13 (0.5%) of other skin infections.

CONCLUSIONS

In the majority of subjects none of the screened infectious diseases were found. No evidence was found that the overall prevalence of certain infectious diseases screened for in the present analysis was considerably higher than in previous migration studies.

Prevalence of Multidrug-Resistant Organisms in Hospitalized Pediatric Refugees in an University Children's Hospital in Germany 2015-2016

OBJECTIVE To determine the prevalence of multidrug-resistant organisms (MDROs) colonizing in pediatric refugees admitted to a University Children Hospital in Germany. DESIGN Retrospective observational study. SETTING General pediatric and pediatric surgery units. PATIENTS In Germany, recommendations for MDRO screening of pediatric refugees were recently published. According to these and institutional recommendations, all hospitalized pediatric refugees were screened for MDROs between October 2015 and March 2016. METHODS Using electronic surveillance data, we performed a chart review to identify the prevalence of MDROs among and the clinical diagnoses of pediatric refugees. RESULTS Among 325 patients hospitalized for various causes, most frequently gastroenteritis (30.9%), MDROs were detected in 33.8%. Most of these patients were colonized with multidrug-resistant Gram-negative (MRGN) bacteria (113 isolates), mostly 2MRGN/ESBL (87 isolates); some patients were colonized with methicillin-resistant Staphylococcus aureus (MRSA, 22 isolates); and 1 patient was colonized with vancomycin-resistant enterococci (VRE). Among 110 refugee patients, we detected single colonization with an MDRO in 84 patients (76.4%), co-colonization with 2 pathogens in 23 patients (20.9%), and triple colonization in 3 patients (2.7%). However, infections with MDROs occurred in only 3.6% of pediatric refugees. The peak of positive MDRO screening results in 2015 correlated with an increased hospitalization rate. CONCLUSION Implementation of infection control measures among pediatric refugees is challenging. Due to the high frequency of MDROs in these patients, current screening, isolation, and treatment strategies may have to be adapted. Infect Control Hosp Epidemiol 2016;1-5.