1
|
Hobart C, Pescarini JM, Evans L, Adil HS, Adil ST, Deal A, Carter J, Matthews PC, Hargreaves S, Sanchez Clemente N. Hepatitis B infection and immunity in migrant children and pregnant persons in Europe: a systematic review and meta-analysis. J Travel Med 2024; 31:taae094. [PMID: 38990201 PMCID: PMC11298050 DOI: 10.1093/jtm/taae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/24/2024] [Accepted: 07/10/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The WHO's global hepatitis strategy aims to achieve viral hepatitis elimination by 2030. Migrant children and pregnant persons represent an important target group for prevention strategies. However, evidence on the burden of chronic hepatitis B (CHB) infection and the factors affecting its incidence is lacking. METHODS EMBASE, Global Health, Global Index Medicus, Web of Science and Medline were searched for articles in any language from 1 January 2012 to 8 June 2022. Studies reporting CHB prevalence, disease severity, complications and/or prevention strategies, including vaccination, prevention of vertical transmission and access to care/treatment for migrant children and pregnant migrants, were included. Pooled estimates of CHB prevalence and hepatitis B vaccination (HBV) coverage among migrant children were calculated using random effects meta-analysis. FINDINGS 42 studies were included, 27 relating to migrant children and 15 to pregnant migrants across 12 European countries, involving data from 64 773 migrants. Migrants had a higher incidence of CHB than host populations. Among children, the pooled prevalence of CHB was higher for unaccompanied minors (UAM) (5%, [95% CI: 3-7%]) compared to other child migrants, including internationally adopted children (IAC) and refugees (1%, [95% CI: 1-2%]). Region of origin was identified as a risk factor for CHB, with children from Africa and pregnant migrants from Africa, Eastern Europe and China at the highest risk. Pooled estimates of HBV vaccine coverage were lower among UAM (12%, [95% CI: 3-21%]) compared to other child migrants (50%, [95% CI: 37-63%]). CONCLUSION A range of modifiable determinants of HBV prevalence in migrant children and pregnant persons were identified, including sub-optimal screening, prevention and continuum of care. There is a need to develop evidence-based approaches in hepatitis care for these groups, thereby contributing towards global viral hepatitis elimination goals.
Collapse
Affiliation(s)
- Carla Hobart
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Julia M Pescarini
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Rua Waldemar Falcão, 121, Candeal - Salvador/BA CEP: 40296-710, Bahia, Brazil
| | - Laith Evans
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Haleema S Adil
- University College London Medical School, 74 Huntley St, London WC1E 6DE, UK
| | - Shehzhore T Adil
- University College London Medical School, 74 Huntley St, London WC1E 6DE, UK
| | - Anna Deal
- Migrant Health Research Group, Institute for Infection and Immunity, St. George’s University London, Cranmer Terrace, London SW17 0RE, UK
| | - Jessica Carter
- Migrant Health Research Group, Institute for Infection and Immunity, St. George’s University London, Cranmer Terrace, London SW17 0RE, UK
| | - Philippa C Matthews
- The Francis Crick Institute, HBV Elimination Laboratory, 1 Midland Road, London NW1 1AT, UK
- Division of Infection and Immunity, University College London, Gower Street, London WC1E 6BT, UK
- Department of Infectious Diseases, University College London Hospital, Euston Road, London NW1 2BU, UK
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St. George’s University London, Cranmer Terrace, London SW17 0RE, UK
| | - Nuria Sanchez Clemente
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, Cranmer Terrace, London SW17 0RE, UK
- Migrant Health Research Group, Institute for Infection and Immunity, St. George’s University London, Cranmer Terrace, London SW17 0RE, UK
| |
Collapse
|
2
|
Rubio Maturana C, Guerrero M, Casas Claramunt M, Ayala-Cortés SN, López V, Martínez-Vallejo P, Treviño B, Sulleiro E, Esperalba J, Rando A, Pou D, Aznar ML, Bosch-Nicolau P, Salvador F, Oliveira-Souto I, Molina I, Serre-Delcor N. Seroprevalence status of vaccine-preventable diseases in migrants living in shelter centers in Barcelona, Spain. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024:S2529-993X(24)00152-7. [PMID: 38902155 DOI: 10.1016/j.eimce.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/14/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Almost 281 million people were living in a foreign country in 2022, and more than 100 million were displaced because of war conflicts and human right violations. Vaccination coverage of infectious diseases in migrants from some disadvantaged settings could be lower than reception countries populations, consequently seroprevalence studies and better access to vaccination could contribute to reducing these differences. METHODS A descriptive retrospective cross-sectional study was conducted including migrants, living ≤5 years in the reception country and ≥16 years old, who requested a medical exam between January 1st, 2020 and January 31st, 2021. Seroprevalence assessment was performed, and vaccination was offered to those individuals without immunity to hepatitis B, hepatitis A, varicella, measles, mumps, and rubella. RESULTS A total of 315 migrants were attended during the study period. Immunity protection at arrival was 252/296 (85.1%) for measles, 274/295 (92.9%) for rubella, 257/296 (86.8%) for mumps, 264/295 (89.5%) for varicella, 267/313 (85.3%) for hepatitis A, and 104/300 (34.6%) for hepatitis B. The final immunity protection after full vaccination schedules was 278/296 (93.9%) for measles, 287/295 (97.3%) for rubella, 274/296 (92.6%) for mumps, 276/295 (93.6%) for varicella, 280/313 (89.5%) for hepatitis A, and 139/300 (46.3%) for hepatitis B. CONCLUSIONS The vaccination intervention has increased immunity rates for the studied diseases in the attended migrants in our center, however, such interventions should be maintained to reach local population immunization levels. Moreover, the collaboration between shelter and reference specialized health centers is fundamental to implement such vaccination programs.
Collapse
Affiliation(s)
- Carles Rubio Maturana
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Univesitat Autònoma de Barcelona, Spain.
| | | | - Maria Casas Claramunt
- EAP d'Alcarràs, ICS Lleida, Spain; Centre Vacunacions Internacional Lleida, ICS Lleida, Spain
| | - Susana Nuria Ayala-Cortés
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Victoria López
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Patricia Martínez-Vallejo
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Univesitat Autònoma de Barcelona, Spain
| | - Begoña Treviño
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Sulleiro
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Univesitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Juliana Esperalba
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Univesitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Ariadna Rando
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Univesitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Diana Pou
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Luisa Aznar
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Pau Bosch-Nicolau
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Salvador
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Inés Oliveira-Souto
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Israel Molina
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Núria Serre-Delcor
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
3
|
Saseetharran A, Hiebert L, Gupta N, Nyirahabihirwe F, Kamali I, Ward JW. Prevention, testing, and treatment interventions for hepatitis B and C in refugee populations: results of a scoping review. BMC Infect Dis 2023; 23:866. [PMID: 38071291 PMCID: PMC10709891 DOI: 10.1186/s12879-023-08861-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND AIMS Refugees are at higher risk for hepatitis B (HBV) and hepatitis C (HCV), but often face unique healthcare barriers to vaccination, testing, and treatment. This scoping review aimed to identify and characterize HBV and HCV prevention and care services serving refugee populations globally. METHODS A literature search was conducted on Embase, Cochrane, and PubMed databases. Research studies published in English between January 2010 to July 2022 describing an HBV or HCV prevention, testing, or treatment intervention for refugees were included. RESULTS There were a total of 69 articles reporting viral hepatitis prevalence, implementation of services, or economic modelling. Of the 38 implementation studies, 14 were stand-alone HBV and/or HCV interventions, while 24 studies included HBV and/or HCV in an intervention targeting multiple infectious diseases and/or parasitic infections. Interventions commonly included a testing (n = 30) or referral (n = 24) component. Frequently reported features to promote program accessibility included bilingual services (n = 25), community partnerships (n = 21), and multidisciplinary staff members (n = 18), such as cultural and/or linguistic mediators, community health workers, community health leaders, lay health workers, local health staff, members of the refugee community, and social workers. The most commonly reported challenge was the transience of refugees (n = 5). Twenty studies noted funding sources, of which twelve reported governmental funding (not including national health insurance) and eight reported that refugees received national health insurance. CONCLUSIONS This is the first scoping review to characterize the types of hepatitis prevention, screening, and treatment interventions serving refugee populations globally. Published experiences of HBV and HCV services for refugee populations remain limited. Additional efforts are needed to disseminate models of hepatitis interventions for refugees to ensure access to care for this key population. To achieve hepatitis elimination globally, best practices must be identified and shared to expand access to hepatitis services for refugee populations.
Collapse
Affiliation(s)
- Ankeeta Saseetharran
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA.
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
| | - Neil Gupta
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
| | | | | | - John W Ward
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
| |
Collapse
|
4
|
Treviño B, Zarzuela F, Oliveira-Souto I, Maturana CR, Serre-Delcor N, Aznar ML, Pou D, Goterris L, Salvador F, Bosch-Nicolau P, Rubio JM, Ruiz E, Molina I, Sulleiro E. Unexpected Loa loa Finding in an Asymptomatic Patient From The Gambia: A Case Report. Open Forum Infect Dis 2023; 10:ofad338. [PMID: 37484898 PMCID: PMC10358219 DOI: 10.1093/ofid/ofad338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
A 17-year-old asymptomatic male from The Gambia presented for a routine health examination after migration to Spain. Laboratory diagnosis confirmed the presence of Loa loa microfilariae. This unusual finding emphasizes the importance of screening in newly arrived migrants and the need of an extended anamnesis including migratory route and previous travels.
Collapse
Affiliation(s)
- Begoña Treviño
- Vall d’Hebron-Drassanes International Health Unit, Infectious Diseases Department, Vall d’Hebron University Hospital, International Health Programme of Catalan Health Institute (PROSICS) Barcelona, Centres, Services and Reference Units (CSUR) Imported Tropical Diseases, Barcelona, Spain
- Centre for Biomedical Research Network on Infectious Diseases, Madrid, Spain
| | - Francesc Zarzuela
- Vall d’Hebron-Drassanes International Health Unit, Microbiology Department, Vall d’Hebron University Hospital, International Health Programme of Catalan Health Institute (PROSICS) Barcelona, Centres, Services and Reference Units (CSUR) Imported Tropical Diseases, Barcelona, Spain
| | - Inés Oliveira-Souto
- Correspondence: Inés Oliveira-Souto, MD, PhD, Unidad de Salud Internacional Vall d’Hebron-Drassanes, Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d’Hebron, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain ()
| | - Carles Rubio Maturana
- Vall d’Hebron-Drassanes International Health Unit, Microbiology Department, Vall d’Hebron University Hospital, International Health Programme of Catalan Health Institute (PROSICS) Barcelona, Centres, Services and Reference Units (CSUR) Imported Tropical Diseases, Barcelona, Spain
| | - Núria Serre-Delcor
- Vall d’Hebron-Drassanes International Health Unit, Infectious Diseases Department, Vall d’Hebron University Hospital, International Health Programme of Catalan Health Institute (PROSICS) Barcelona, Centres, Services and Reference Units (CSUR) Imported Tropical Diseases, Barcelona, Spain
- Centre for Biomedical Research Network on Infectious Diseases, Madrid, Spain
| | - Maria L Aznar
- Vall d’Hebron-Drassanes International Health Unit, Infectious Diseases Department, Vall d’Hebron University Hospital, International Health Programme of Catalan Health Institute (PROSICS) Barcelona, Centres, Services and Reference Units (CSUR) Imported Tropical Diseases, Barcelona, Spain
- Centre for Biomedical Research Network on Infectious Diseases, Madrid, Spain
| | - Diana Pou
- Vall d’Hebron-Drassanes International Health Unit, Infectious Diseases Department, Vall d’Hebron University Hospital, International Health Programme of Catalan Health Institute (PROSICS) Barcelona, Centres, Services and Reference Units (CSUR) Imported Tropical Diseases, Barcelona, Spain
- Centre for Biomedical Research Network on Infectious Diseases, Madrid, Spain
| | - Lidia Goterris
- Vall d’Hebron-Drassanes International Health Unit, Microbiology Department, Vall d’Hebron University Hospital, International Health Programme of Catalan Health Institute (PROSICS) Barcelona, Centres, Services and Reference Units (CSUR) Imported Tropical Diseases, Barcelona, Spain
| | - Fernando Salvador
- Vall d’Hebron-Drassanes International Health Unit, Infectious Diseases Department, Vall d’Hebron University Hospital, International Health Programme of Catalan Health Institute (PROSICS) Barcelona, Centres, Services and Reference Units (CSUR) Imported Tropical Diseases, Barcelona, Spain
- Centre for Biomedical Research Network on Infectious Diseases, Madrid, Spain
| | - Pau Bosch-Nicolau
- Vall d’Hebron-Drassanes International Health Unit, Infectious Diseases Department, Vall d’Hebron University Hospital, International Health Programme of Catalan Health Institute (PROSICS) Barcelona, Centres, Services and Reference Units (CSUR) Imported Tropical Diseases, Barcelona, Spain
- Centre for Biomedical Research Network on Infectious Diseases, Madrid, Spain
| | - José M Rubio
- Centre for Biomedical Research Network on Infectious Diseases, Madrid, Spain
- Microbiology National Centre, Carlos III Health Institute, Madrid, Spain
| | - Edurne Ruiz
- Vall d’Hebron-Drassanes International Health Unit, Microbiology Department, Vall d’Hebron University Hospital, International Health Programme of Catalan Health Institute (PROSICS) Barcelona, Centres, Services and Reference Units (CSUR) Imported Tropical Diseases, Barcelona, Spain
| | - Israel Molina
- Vall d’Hebron-Drassanes International Health Unit, Infectious Diseases Department, Vall d’Hebron University Hospital, International Health Programme of Catalan Health Institute (PROSICS) Barcelona, Centres, Services and Reference Units (CSUR) Imported Tropical Diseases, Barcelona, Spain
- Centre for Biomedical Research Network on Infectious Diseases, Madrid, Spain
| | | |
Collapse
|
5
|
Moonen CPB, den Heijer CDJ, Dukers-Muijrers NHTM, van Dreumel R, Steins SCJ, Hoebe CJPA. A systematic review of barriers and facilitators for hepatitis B and C screening among migrants in the EU/EEA region. Front Public Health 2023; 11:1118227. [PMID: 36875381 PMCID: PMC9975596 DOI: 10.3389/fpubh.2023.1118227] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction Hepatitis B and C are a threat to public health. Screening of high-risk groups, such as migrants from high-endemic areas, enables early identification and treatment initiation. This systematic review identified barriers and facilitators for hepatitis B and C screening among migrants in the European Union/European Economic Area (EU/EEA). Methods Following PRISMA guidelines, databases PubMed, Embase via Ovid, and Cochrane were searched for English articles published between 1 July 2015 and 24 February 2022. Articles were included, not restricted to a specific study design, if they elaborated on HBV or HCV screening in migrant populations from countries outside Western Europe, North America, and Oceania, and residing in EU/EEA countries. Excluded were studies with solely an epidemiological or microbiological focus, including only general populations or non-migrant subgroups, or conducted outside the EU/EEA, without qualitative, quantitative, or mixed methods. Data appraisal, extraction, and quality assessment were conducted and assessed by two reviewers. Barriers and facilitators were categorized into seven levels based on multiple theoretical frameworks and included factors related to guidelines, the individual health professional, the migrant and community, interaction, the organization and economics, the political and legal level, and innovations. Results The search strategy yielded 2,115 unique articles of which 68 were included. Major identified barriers and facilitators to the success of screening related to the migrant (knowledge and awareness) and community level (culture, religion, support) and the organizational and economic level (capacity, resources, coordinated structures). Given possible language barriers, language support and migrant sensitivity are indispensable for facilitating interaction. Rapid point-of-care-testing is a promising strategy to lower screening barriers. Discussion The inclusion of multiple study designs provided extensive insight into barriers, strategies to lower these barriers, and facilitators to maximize the success of screening. A great variety of factors were revealed on multiple levels, therefore there is no one-size-fits-all approach for screening, and initiatives should be adopted for the targeted group(s), including tailoring to cultural and religious beliefs. We provide a checklist of facilitators and barriers to inform adapted interventions to allow for optimal screening impact.
Collapse
Affiliation(s)
- Chrissy P B Moonen
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Casper D J den Heijer
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Nicole H T M Dukers-Muijrers
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Ragni van Dreumel
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
| | - Sabine C J Steins
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
| | - Christian J P A Hoebe
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| |
Collapse
|
6
|
Health and Vaccination Status of Unaccompanied Minors After Arrival in a European Border Country: A Cross-sectional Study (2017-2020). Pediatr Infect Dis J 2022; 41:872-877. [PMID: 36102691 DOI: 10.1097/inf.0000000000003670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unaccompanied and separated children (UASC) are a high-risk group for infectious diseases and information on their vaccination status is scarce. Different approaches are used to screen newly arrived minors in Europe. The aim of this study was to describe the health status and serological protection against different vaccine-preventable diseases among UASC to inform public health decision-making. METHODS Retrospective study of all UASC seen at an international health reference center in Barcelona (Spain) between January 2017 and February 2020. Screening results were analyzed using binary logistic regression with adjustment for symptoms, geographic origin, and time since arrival. RESULTS We studied 289 UASC (88.9% males; median age, 17 years). At least one infection was diagnosed in 136 minors (47.1%). There was a high prevalence of intestinal parasites (22.8%), latent tuberculosis infection (22.5%), and hepatitis B (5.2%), even in asymptomatic individuals, and especially among UASC from sub-Saharan Africa (odds ratio, 2.5; 95% confidence interval, 1.5-4.0, P < 0.001). We did not observe a significant association between clinical symptoms and the presence of infection or differences in the prevalence of different infections according to number of months since arrival. Protection against hepatitis B virus (36%), measles (80%), and varicella (83%) was suboptimal. CONCLUSIONS Our results highlight the importance of screening and vaccination programs for UASC arriving in Europe, especially border countries. Protocols should be adjusted according to geographic origin. Absence of symptoms does not necessarily rule out infection, highlighting the importance of screening in asymptomatic minors. These programs are a public health priority and should not be neglected during the current COVID-19 pandemic.
Collapse
|
7
|
Klas J, Grzywacz A, Kulszo K, Grunwald A, Kluz N, Makaryczew M, Samardakiewicz M. Challenges in the Medical and Psychosocial Care of the Paediatric Refugee-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10656. [PMID: 36078371 PMCID: PMC9517743 DOI: 10.3390/ijerph191710656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND After the invasion of Ukraine, neighbouring countries were forced to find systemic solutions to provide medical care to those fleeing the war, including children, as soon as possible. In order to do this, it is necessary to know the communication problems with refugee minors and find proposals for their solutions. METHODS A systematic review of the literature from 2016 to 2022 was conducted according to PRISMA criteria. RESULTS Linguistic diversity and lack of professional readiness of teachers are the main constraints hindering the assistance of refugee children in schools. Problems during hospitalization include lack of continuity of medical care and lack of retained medical records. Solutions include the use of the 3C model (Communication, Continuity of care, Confidence) and the concept of a group psychological support program. CONCLUSIONS In order to provide effective assistance to refugee minors, it is necessary to create a multidisciplinary system of care. It is hoped that the lessons learned from previous experiences will provide a resource to help refugee host countries prepare for a situation in which they are forced to provide emergency assistance to children fleeing war.
Collapse
|
8
|
Ekezie W, Awwad S, Krauchenberg A, Karara N, Dembiński Ł, Grossman Z, del Torso S, Dornbusch HJ, Neves A, Copley S, Mazur A, Hadjipanayis A, Grechukha Y, Nohynek H, Damnjanović K, Lazić M, Papaevangelou V, Lapii F, Stein-Zamir C, Rath B. Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review. Vaccines (Basel) 2022; 10:1038. [PMID: 35891201 PMCID: PMC9324407 DOI: 10.3390/vaccines10071038] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/30/2022] [Accepted: 06/14/2022] [Indexed: 01/27/2023] Open
Abstract
Vaccination has a significant impact on morbidity and mortality. High vaccination coverage rates are required to achieve herd protection against vaccine-preventable diseases. However, limited vaccine access and hesitancy among specific communities represent significant obstacles to this goal. This review provides an overview of critical factors associated with vaccination among disadvantaged groups in World Health Organisation European countries. Initial searches yielded 18,109 publications from four databases, and 104 studies from 19 out of 53 countries reporting 22 vaccine-preventable diseases were included. Nine groups representing the populations of interest were identified, and most of the studies focused on asylum seekers, refugees, migrants and deprived communities. Recall of previous vaccinations received was poor, and serology was conducted in some cases to confirm protection for those who received prior vaccinations. Vaccination coverage was lower among study populations compared to the general population or national average. Factors that influenced uptake, which presented differently at different population levels, included health service accessibility, language and vaccine literacy, including risk perception, disease severity and vaccination benefits. Strategies that could be implemented in vaccination policy and programs were also identified. Overall, interventions specific to target communities are vital to improving uptake. More innovative strategies need to be deployed to improve vaccination coverage among disadvantaged groups.
Collapse
Affiliation(s)
- Winifred Ekezie
- Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany; (W.E.); (S.A.)
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK
- College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
| | - Samy Awwad
- Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany; (W.E.); (S.A.)
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
- Stanford University, Palo Alto, CA 94305, USA
| | - Arja Krauchenberg
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
- European Parents Association, 1000 Brussels, Belgium
| | - Nora Karara
- Young European Academy of Paediatrics, 1000 Brussels, Belgium;
- Evangelical Hospital Queen Elisabeth Herzberge, 10365 Berlin, Germany
| | - Łukasz Dembiński
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Zachi Grossman
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Stefano del Torso
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Hans Juergen Dornbusch
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Ana Neves
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Sian Copley
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Artur Mazur
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Adamos Hadjipanayis
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Yevgenii Grechukha
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, FI-00271 Helsinki, Finland;
| | - Kaja Damnjanović
- Faculty of Philosophy, University of Belgrade, 11000 Beograd, Serbia;
| | - Milica Lazić
- Faculty of Philosophy, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Vana Papaevangelou
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Fedir Lapii
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | | | - Barbara Rath
- Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany; (W.E.); (S.A.)
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
| | | |
Collapse
|
9
|
Manfredi L, Sciannameo V, Destefanis C, Prisecaru M, Cossu G, Gnavi R, Macciotta A, Catalano A, Pepe RR, Sacerdote C, Ricceri F. Health status assessment of a population of asylum seekers in Northern Italy. Global Health 2022; 18:57. [PMID: 35659014 PMCID: PMC9164173 DOI: 10.1186/s12992-022-00846-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/02/2022] [Indexed: 11/11/2022] Open
Abstract
Background Since 2011 Italy has faced an extraordinary increase in migrants arrivals, mainly from the Mediterranean route, one of the world’s most dangerous journeys. The purpose of the present article is to provide a comprehensive picture of the migrants' health status in the "T. Fenoglio" centre, Settimo Torinese (Turin, Italy). Methods A retrospective cross-sectional study was conducted using data collected from June 2016 to May 2018 on adult migrants (over 18 years old) from Africa, Middle East and South East Asia (Bangladesh, Cambodia, India, Nepal). Data was collected through the migrants' medical records. Descriptive statistics were performed on socio-demographic variables. The diagnosed diseases were anonymously registered and classified according to the International Classification of Primary Care (ICPC-2). Conditional Inference Trees were used to perform a descriptive analysis of the sample and to detect the covariates with the strongest association with the variables Disease on arrival, Disease after arrival, ICPC on arrival and ICPC after arrival. Results Analyzed observations were 9 857. 81.8% were men, median age was 23 (Interquartile range: 20.0–27.4). 70.3% of the sample came from Sub-Saharan Africa. 2 365 individuals (24%) arrived at the centre with at least one disease. On arrival, skin (27.71%), respiratory (14.46%), digestive (14.73%) and generic diseases (20.88%) were the most frequent. During the stay respiratory diseases were the most common (25.70%). The highest probability of arriving with a disease occurred in 2018 and during the period September–November 2016, in particular for people from the Horn of Africa. During this period and also in the first half of 2017, skin diseases were the most reported. In seasons with lower prevalence of diseases on arrival the most common disease code was generic for both men and women (usually fever or trauma). Conclusions This study provides information on the diverse diseases that affect the asylum seekers population. In our sample, the Horn of Africa was the most troubled area of arrival, with severe conditions frequently reported regarding skin diseases, in particular scabies. 2018 was the most critical year, especially for migrants from the Horn of Africa and Sub-Saharan Africa. During the stay at the camp, the prevalence of respiratory diseases increased. However, skin diseases remained the main issue for people from the Horn of Africa. Overall, the most reported diseases in the sample were dermatological, respiratory, digestive and generic diseases, both on arrival and during the stay. A better understanding of the health status of asylum seekers is an important factor to determine a more efficient reception and integration process and a better allocation of economic resources in the context of migrants' health care. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-022-00846-0.
Collapse
Affiliation(s)
- Luca Manfredi
- Unit of Epidemiology, Regional Health Service ASLTO3, Via Sabaudia 164, 10095, Grugliasco, TO, Italy.
| | - Veronica Sciannameo
- Department of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Marta Prisecaru
- Degree in Strategy and Policy, University of Turin, Turin, Italy
| | - Giorgia Cossu
- Degree in Strategy and Policy, University of Turin, Turin, Italy
| | - Roberto Gnavi
- Unit of Epidemiology, Regional Health Service ASLTO3, Via Sabaudia 164, 10095, Grugliasco, TO, Italy
| | - Alessandra Macciotta
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Alberto Catalano
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città Della Salute E Della Scienza University-Hospital, Turin, Italy
| | - Fulvio Ricceri
- Unit of Epidemiology, Regional Health Service ASLTO3, Via Sabaudia 164, 10095, Grugliasco, TO, Italy.,Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| |
Collapse
|
10
|
van Boetzelaer E, Fotso A, Angelova I, Huisman G, Thorson T, Hadj-Sahraoui H, Kremer R, Kuehne A. Health conditions of migrants, refugees and asylum seekers on search and rescue vessels on the central Mediterranean Sea, 2016-2019: a retrospective analysis. BMJ Open 2022; 12:e053661. [PMID: 35017249 PMCID: PMC8753406 DOI: 10.1136/bmjopen-2021-053661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study will contribute to the systematic epidemiological description of morbidities among migrants, refugees and asylum seekers when crossing the Mediterranean Sea. SETTING Since 2015, Médecins sans Frontières (MSF) has conducted search and rescue activities on the Mediterranean Sea to save lives, provide medical services, to witness and to speak out. PARTICIPANTS Between November 2016 and December 2019, MSF rescued 22 966 migrants, refugees and asylum seekers. PRIMARY AND SECONDARY OUTCOME MEASURES We conducted retrospective data analysis of data collected between January 2016 and December 2019 as part of routine monitoring of the MSF's healthcare services for migrants, refugees and asylum seekers on two search and rescue vessels. RESULTS MSF conducted 12 438 outpatient consultations and 853 sexual and reproductive health consultations (24.9% of female population, 853/3420) and documented 287 consultations for sexual and gender-based violence (SGBV). The most frequently diagnosed health conditions among children aged 5 years or older and adults were skin conditions (30.6%, 5475/17 869), motion sickness (28.6%, 5116/17 869), headache (15.4%, 2 748/17 869) and acute injuries (5.7%, 1013/17 869). Of acute injuries, 44.7% were non-violence-related injuries (453/1013), 30.1% were fuel burns (297/1013) and 25.4% were violence-related injuries (257/1013). CONCLUSION The limited testing and diagnostics capacity of the outpatient department, space limitations, stigma and the generally short length of stay of migrants, refugees and asylum seekers on the ships have likely led to an underestimation of morbidities, including mental health conditions and SGBV. The main diagnoses on board were directly related to journey on land and sea and stay in Libya. We conclude that this population may be relatively young and healthy but displays significant journey-related illnesses and includes migrants, refugees and asylum seekers who have suffered significant violence during their transit and need urgent access to essential services and protection in a place of safety on land.
Collapse
Affiliation(s)
| | - Adolphe Fotso
- Medical Department, Medecins Sans Frontieres, Tripoli, Libya
| | - Ilina Angelova
- Medical Department, Medecins Sans Frontieres, Tripoli, Libya
| | - Geke Huisman
- Medical Department, Medecins Sans Frontieres, Tripoli, Libya
| | - Trygve Thorson
- Public Health Department, Medecins Sans Frontieres, Amsterdam, The Netherlands
| | | | - Ronald Kremer
- Public Health Department, Medecins Sans Frontieres, Amsterdam, The Netherlands
| | - Anna Kuehne
- Public Health Department, Medecins Sans Frontieres, Berlin, Germany
- Manson Unit, Medecins Sans Frontieres, London, UK
| |
Collapse
|
11
|
Serre-Delcor N, Oliveira I, Moreno R, Treviño B, Hajdók E, Esteban E, Murias-Closas A, Denial A, Evangelidou S. A Cross-Sectional Survey on Professionals to Assess Health Needs of Newly Arrived Migrants in Spain. Front Public Health 2021; 9:667251. [PMID: 34409005 PMCID: PMC8365167 DOI: 10.3389/fpubh.2021.667251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
Abstract
Heightened conflicts and lack of safety due to reasons related to economic, social, ethnic, religious, sexual orientation, political, or nationality matters have increased migratory movements during the last, few decades. Unfortunately, when migrants arrive in new territories, they can face many barriers. For example, in Spain, some migrants have difficulties in accessing health services. The main objective of this study was to describe, from the perspective of social and healthcare professionals, health needs and barriers faced among migrants who recently arrived in Spain when accessing the health system. To accomplish this aim, we carried out a cross-sectional descriptive study using a newly created self-administered questionnaire. Statistical analysis was done using the SPSS 23.00® program. Survey collection was from April 2018 to October 2018, and the cohort comprised a total of 228 professionals. Most participants were females (76%), with an average age of 35 years [interquartile range (IQR) 29.8-43.0]. The most represented profession in the cohort was physician (48%), followed by social care professionals (32%), nursing (11%), and other (8%). Of these individuals, 61% stated having either little or limited knowledge of international migrant health rights, and 94% believed migrants must overcome barriers to receive health services. The four most reported barriers were as follows: language, cultural differences, administrative issues, and fear of being undocumented. Additionally, by order of importance, professionals viewed mental health disorders and infectious diseases as the most common contributors to disease burden in this group. The four most popular strategies implemented by professionals to improve healthcare access further for migrants included intercultural competency training for professionals; access to community health agents; access to translators; and development of health system navigation skills among those newly arrived. Study results suggest that governments should make greater efforts to provide social and healthcare professionals with more effective tools that overcome communication barriers and cultural competence training modules.
Collapse
Affiliation(s)
- Núria Serre-Delcor
- Tropical Medicine and International Health Unit Drassanes-Vall d'Hebron, PROSICS (International Health Program ot the Catalan Health Institute), Department of Infectious Diseases, Hospital Vall d'Hebron, Institut Català de la Salut, Barcelona, Spain
| | - Inés Oliveira
- Tropical Medicine and International Health Unit Drassanes-Vall d'Hebron, PROSICS (International Health Program ot the Catalan Health Institute), Department of Infectious Diseases, Hospital Vall d'Hebron, Institut Català de la Salut, Barcelona, Spain
| | - Ruben Moreno
- Vall d'Hebron Research Institute, Infectious Diseases Group, Barcelona, Spain
| | - Begoña Treviño
- Tropical Medicine and International Health Unit Drassanes-Vall d'Hebron, PROSICS (International Health Program ot the Catalan Health Institute), Department of Infectious Diseases, Hospital Vall d'Hebron, Institut Català de la Salut, Barcelona, Spain
| | - Eva Hajdók
- Vall d'Hebron Research Institute, Infectious Diseases Group, Barcelona, Spain
| | - Esperanza Esteban
- Vall d'Hebron Research Institute, Infectious Diseases Group, Barcelona, Spain
| | - Adrià Murias-Closas
- Vall d'Hebron Research Institute, Infectious Diseases Group, Barcelona, Spain
| | - Abdallah Denial
- Vall d'Hebron Research Institute, Infectious Diseases Group, Barcelona, Spain
| | - Stella Evangelidou
- Vall d'Hebron Research Institute, Infectious Diseases Group, Barcelona, Spain
| |
Collapse
|
12
|
Support and Emotional Well-Being of Asylum Seekers and Refugees in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228365. [PMID: 33198150 PMCID: PMC7697546 DOI: 10.3390/ijerph17228365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 12/16/2022]
Abstract
Although the world’s forcibly displaced population reached 79.5 million in 2019, their difficult situations and the issues they struggle with remain practically invisible in Spanish society. Therefore, it seems necessary to provide greater insight into an invisible reality to improve the refugees’ situation. The present cross-sectional study aims to draw a general profile of refugees’ and asylum seekers’ main characteristics in Spain and their well-being. A total of 186 refugees living in Spain participated. An ad-hoc questionnaire was administered to obtain data regarding sociodemographic profile, language skills, and social and institutional support. A standardized instrument, SPANE, was used to measure well-being. It can be seen that healthcare, followed by legal aid, are the easiest to access. On the other hand, finding a job, having money, and finding housing are the most difficult. In general, it seems possible to say that the refugees present more positive feelings than negative ones, which implies a positive emotional balance, although the average score obtained for emotional balance is quite far from the highest possible score. We consider this to be a pivotal first step which can provide useful information for the further design of aid strategies to improve this vulnerable group’s situation.
Collapse
|
13
|
DONISI ALESSANDRA, GERNA LAURA, FIETTA TOMMASO, GRECCHI CECILIA. Screening approach among newly arrived asylum seekers: experience in a primary health care setting in Piacenza, Emilia Romagna, Northern Italy. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E445-E450. [PMID: 33150232 PMCID: PMC7595074 DOI: 10.15167/2421-4248/jpmh2020.61.3.1528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/30/2020] [Indexed: 12/03/2022]
Abstract
In the last ten years the number of asylum seekers has increased in all of Europe. Our Migrants Health Unit in Piacenza, Emilia Romagna, Italy, is designated to provide primary health care for migrants without a regular permit of stay and, since 2015, is the reference center for asylum-seekers in our Province. Aim of this study is to describe the results of the screening for infectious diseases performed in asylum seekers from January 2015 to December 2015. For any asylum seekers referred to our Centre, we recorded demographical data and we offered screening for HIV, HBV, HCV, syphilis and active tuberculosis (TB). Descriptive statistics were used to analyze the characteristics of the cohort. In 2015, 316 asylum seekers accessed to our Centre. Of them, the majority were men (N= 275; 87,03%). Africa was the most represented geographical area (221, 69,94%), followed from Asia (95, 30.06%). The median age was 25,4 years. 301 patients underwent chest X-Ray, that resulted negative in 262 cases (87%). HBsAg testing proved to be positive in 17 (5,3%) cases. The screening test for HCV, HIV and syphilis resulted respectively positive in 1.9%, 0.3% and 1.6%.
Collapse
Affiliation(s)
- ALESSANDRA DONISI
- Migration Health Unit, Department of Primary Health Care, AUSL Piacenza, Italy
| | - LAURA GERNA
- Infectious Diseases Unit, General Hospital of Piacenza, Italy
| | - TOMMASO FIETTA
- Migration Health Unit, Department of Primary Health Care, AUSL Piacenza, Italy
| | - CECILIA GRECCHI
- Migration Health Unit, Department of Primary Health Care, AUSL Piacenza, Italy
| |
Collapse
|
14
|
Salvador F, Treviño B, Bosch-Nicolau P, Serre-Delcor N, Sánchez-Montalvá A, Oliveira I, Sulleiro E, Aznar ML, Pou D, Sao-Avilés A, Molina I. Strongyloidiasis screening in migrants living in Spain: systematic review and meta-analysis. Trop Med Int Health 2020; 25:281-290. [PMID: 31758828 DOI: 10.1111/tmi.13352] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To provide information regarding the prevalence of strongyloidiasis among migrants coming from Strongyloides stercoralis-endemic areas who reside in Spain. METHODS Systematic review of the literature and meta-analysis of studies showing prevalence of S. stercoralis infection among migrants from Latin America, Africa, Eastern Europe, Asia and Oceania who reside in Spain. We included articles published until 30 April 2019 without language restriction. The keywords used for the search included 'Strongyloides stercoralis', 'strongyloidiasis', 'Spain', 'screening' and 'migrants'. RESULTS Twenty-four studies were included in the review and meta-analysis, comprising 12 386 screened people. Eleven studies (7020 patients) evaluated the presence of S. stercoralis infection only through investigation of larvae in faeces, showing an overall prevalence of 1% (95%CI 1-1%). Thirteen studies (5366 patients) used a serological test, showing an overall prevalence of 14% (95%CI 11-17%). Strongyloidiasis seroprevalence was 20% (95%CI 15-24%) among migrants from sub-Saharan Africa, 14% (95%CI 10-18%) among those from Latin America and 8% (95%CI 5-11%) among migrants from North Africa. CONCLUSIONS Migrants coming from strongyloidiasis-endemic areas living in Spain had a high S. stercoralis infection prevalence, particularly those from sub-Saharan Africa and Latin America. This population should be screened using serology as the most sensitive test for S. stercoralis infection. This could be easily implemented at primary care level.
Collapse
Affiliation(s)
- Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Begoña Treviño
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Pau Bosch-Nicolau
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Núria Serre-Delcor
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Inés Oliveira
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Mª Luisa Aznar
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Diana Pou
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Augusto Sao-Avilés
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| |
Collapse
|
15
|
Peralta-Gallego L, Gené-Badia J, Gallo P. Effects of undocumented immigrants exclusion from health care coverage in Spain. Health Policy 2018; 122:1155-1160. [PMID: 30193979 DOI: 10.1016/j.healthpol.2018.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 08/02/2018] [Accepted: 08/22/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND In 2012 the Spanish government passed Royal Decree-Law 16/2012 (RDL) aimed at containing public expenditure in response to the economic crisis. This RDL redefined just who would be entitled to public health care. As a result, a large proportion of undocumented immigrants in Spain were excluded from basic publicly financed health care with access only being granted under particular circumstances (emergency care, maternal care, children under 18, asylum seekers and victims of human trafficking). AIM The aims of this paper are to identify the specific traits of this policy, review its impact on health and health care access, and to evaluate its economic impact. RESULTS Most political parties and health professional groups opposed the RDL, and a large number of Spanish regions either declined to apply it or opted to apply it partially. To date, the RDL has had a considerable impact on the access of undocumented immigrants to public health care, with evidence suggesting that approximately 870,000 people have been excluded. A slight increase in infectious diseases has been reported, albeit not as high as originally predicted, and recent evidence points to an increase in mortality among this population subgroup. CONCLUSIONS Regional legislation favouring the coverage of undocumented immigrants might have acted as a counterweight and thus contained the negative health effects in this population subgroup. But the Constitutional Court invalidated all regional arrangements obliging regions to comply with the RDL.
Collapse
Affiliation(s)
| | | | - Pedro Gallo
- Department of Sociology, University of Barcelona, Spain
| |
Collapse
|