The online version of this article (https://doi.org/10.1186/s12916-018-1125-4) contains supplementary material, which is available to authorized users.
The UK, like a number of other countries, has a refugee resettlement programme. External factors, such as higher prevalence of infectious diseases in the country of origin and circumstances of travel, are likely to increase the infectious disease risk of refugees, but published data is scarce. The International Organization for Migration carries out and collates data on standardised pre-entry health assessments (HA), including testing for infectious diseases, on all UK refugee applicants as part of the resettlement programme. From this data, we report the yield of selected infectious diseases (tuberculosis (TB), HIV, syphilis, hepatitis B and hepatitis C) and key risk factors with the aim of informing public health policy.
We examined a large cohort of refugees (n = 18,418) who underwent a comprehensive pre-entry HA between March 2013 and August 2017. We calculated yields of infectious diseases stratified by nationality and compared these with published (mostly WHO) estimates. We assessed factors associated with case positivity in univariable and multivariable logistic regression analysis.
The number of refugees included in the analysis varied by disease (range 8506–9759). Overall yields were notably high for hepatitis B (188 cases; 2.04%, 95% CI 1.77–2.35%), while yields were below 1% for active TB (9 cases; 92 per 100,000, 48–177), HIV (31 cases; 0.4%, 0.3–0.5%), syphilis (23 cases; 0.24%, 0.15–0.36%) and hepatitis C (38 cases; 0.41%, 0.30–0.57%), and varied widely by nationality. In multivariable analysis, sub-Saharan African nationality was a risk factor for several infections (HIV: OR 51.72, 20.67–129.39; syphilis: OR 4.24, 1.21–24.82; hepatitis B: OR 4.37, 2.91–6.41). Hepatitis B (OR 2.23, 1.05–4.76) and hepatitis C (OR 5.19, 1.70–15.88) were associated with history of blood transfusion. Syphilis (OR 3.27, 1.07–9.95) was associated with history of torture, whereas HIV (OR 1521.54, 342.76–6754.23) and hepatitis B (OR 7.65, 2.33–25.18) were associated with sexually transmitted infection. Syphilis was associated with HIV (OR 10.27, 1.30–81.40).
Testing refugees in an overseas setting through a systematic HA identified patients with a range of infectious diseases. Our results reflect similar patterns found in other programmes and indicate that the yields for infectious diseases vary by region and nationality. This information may help in designing a more targeted approach to testing, which has already started in the UK programme. Further work is needed to refine how best to identify infections in refugees, taking these factors into account.
Additional file 1: Supplementary material. (DOCX 69 kb)12916_2018_1125_MOESM1_ESM.docx
Additional file 2: Supporting tables: logistic regression analysis. Table S1. Testing yield and logistic regression analysis of the TB test cohort† (outcome = active TB). Table S2. Testing yield and logistic regression analysis of the HIV test cohort† (outcome = HIV positive). Table S3. Testing yield and logistic regression analysis of the syphilis test cohort† (outcome = syphilis positive). Table S4. Testing yield and logistic regression analysis of the hepatitis B test cohort† (outcome= hepatitis B positive). Table S5. Testing yield and logistic regression analysis of the hepatitis C test cohort† (outcome: hepatitis C positive). (DOCX 62 kb)12916_2018_1125_MOESM2_ESM.docx
United Nations, Department of Economic and Social Affairs PD. International Migration Report 2015: Highlights. 2016. http://www.un.org/en/development/desa/population/migration/publications/migrationreport/docs/MigrationReport2015_Highlights.pdf. Accessed 25 July 2018.
Eurostat. Migration and Migrant Population Statistics. 2017. http://ec.europa.eu/eurostat/statistics-explained/index.php/Migration_and_migrant_population_statistics. Accessed 25 July 2018.
Eurostat. Population and Population Change Statistics. 2017. http://ec.europa.eu/eurostat/statistics-explained/index.php/Population_and_population_change_statistics. Accessed 25 July 2018.
International Organization for Migration. Global Migration Trends Factsheet. IOM's Global Migration Data Analysis Centre (GMDAC). 2015;13:45. http://gmdac.iom.int/global-migration-trends-factsheet. Accessed 25 July 2018.
UK Visas and Immigration. Guidance: Gateway Protection Programme. 2010. https://www.gov.uk/government/publications/gateway-protection-programme-information-for-organisations/gateway-protection-programme. Accessed 25 July 2018.
Refugee Council. Refugee Resettlement: The Facts. 2017. https://www.refugeecouncil.org.uk/what_we_do/refugee_services/resettlement_programme/refugee_resettlement_the_facts. Accessed 25 July 2018.
UK Home Office. Syrian Vulnerable Persons Resettlement Scheme (VPRS) Guidance for Local Authorities and Partners. 2017. Available online: https://www.gov.uk/government/publications/syrian-vulnerable-person-resettlement-programme-fact-sheet. Accessed 25 July 2018.
National Audit Office. The Syrian Vulnerable Persons Resettlement Programme. 2016. https://www.nao.org.uk/wp-content/uploads/2016/09/The-Syrian-Vulnerable-Persons-Resettlement-programme.pdf. Accessed 25 July 2018.
Home Office, The Rt Hon James Brokenshire MP and RHM. New Scheme Launched to Resettle Children at Risk. 2016. https://www.gov.uk/government/news/new-scheme-launched-to-resettle-children-at-risk. Accessed 25 July 2018.
UK Home Office. National Statistics: Asylum. Immigration Statistics 2017. https://www.gov.uk/government/publications/immigration-statistics-october-to-december-2016/asylum#data-tables. Accessed 25 July 2018.
UK Visas and Immigration. Health protocol: pre-entry health assessments for UK-bound refugees. Published 18 September 2017. Available from: https://www.gov.uk/government/publications/pre-entry-health-assessments-guidance-for-uk-refugees. Accessed 25 July 2018.
Norredam M, Agyemang C, Hoejbjerg Hansen OK, Petersen JH, Byberg S, Krasnik A, et al. Duration of residence and disease occurrence among refugees and family reunited immigrants: test of the “healthy migrant effect” hypothesis. Trop Med Int Heal. 2014;19:958–67. http://doi.wiley.com/10.1111/tmi.12340 CrossRef
World Health Organization. Antenatal Care Attendees who were Positive for Syphilis, Data by Country. 2016. http://apps.who.int/gho/data/node.main.A1359STI?lang=en. Accessed 25 July 2018.
World Health Organization. Prevalence of HIV Among Adults Aged 15–49, Estimates by Country. 2015. http://apps.who.int/gho/data/view.main.22500?lang=en. Accessed 25 July 2018.
Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2:161–76. CrossRef
World Health Organization. WHO TB Prevalence Estimates. 2014. http://www.who.int/tb/country/data/download/en/. Accessed 20 Jul 2016.
StataCorp. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP; 2013.
Cookson ST, Abaza H, Clarke KR, Burton A, Sabrah NA, Rumman KA, et al. Impact of and response to increased tuberculosis prevalence among Syrian refugees compared with Jordanian tuberculosis prevalence: case study of a tuberculosis public health strategy. Confl Health. 2015;9:18. CrossRefPubMedPubMedCentral
World Health Organization. Global Tuberculosis Report 2016. World Health Organization. 2016. Available at: http://apps.who.int/medicinedocs/documents/s23098en/s23098en.pdf. Accessed 25 July 2018.
Ismail SA, Abbara A, Collin SM, Orcutt M, Coutts AP, Maziak W, et al. Communicable disease surveillance and control in the context of conflict and mass displacement in Syria. Int J Infect Dis. 2016;47:15–22. https://doi.org/10.1016/j.ijid.2016.05.011. CrossRefPubMed
Meier V, Artelt T, Cierpiol S, Gossner J, Scheithauer S. Tuberculosis in newly arrived asylum seekers: A prospective 12 month surveillance study at Friedland, Germany. Int J Hyg Environ Health. 2016;219:811–5. https://doi.org/10.1016/j.ijheh.2016.07.018. CrossRefPubMed
Mockenhaupt FP, Barbre KA, Jensenius M, Larsen CS, Barnett ED, Stauffer W, et al. Profile of illness in Syrian refugees: a GeoSentinel analysis, 2013 to 2015. Euro Surveill. 2016;21:1–5. CrossRef
de Vries G, Gerritsen RF, van Burg JL, Erkens CGM, van Hest NA, Schimmel HJ, van Dissel JT. Tuberculosis among asylum-seekers in the Netherlands: a descriptive study among the two largest groups of asylum-seekers. Ned Tijdschr Geneeskd. 2016;160:D51. https://www.ncbi.nlm.nih.gov/pubmed/26980468. Accessed 25 July 2018.
Aldridge RW, Zenner D, White PJ, Williamson EJ, Muzyamba MC, Dhavan P, et al. Tuberculosis in migrants moving from high-incidence to low-incidence countries : a population-based cohort study of 519 955 migrants screened before entry to England, Wales, and Northern Ireland. Lancet. 2016;388:2510–8. https://doi.org/10.1016/S0140-6736(16)31008-X. CrossRefPubMedPubMedCentral
Burgazli KM, Mericliler M, Sen C, Tuncay M, Nayir B, Sinterhauf K, et al. The prevalence of hepatitis B virus (HBV) among turkish immigrants in Germany. Eur Rev Med Pharmacol Sci. 2014;18(6):869–74. https://www.ncbi.nlm.nih.gov/pubmed/24706312. Accessed 25 July 2018.
Ay P, Torunoglu MA, Com S, Çipil Z, Mollahaliloǧlu S, Erkoç Y, et al. Trends of hepatitis B notification rates in Turkey, 1990 to 2012. Euro Surveill. 2013;18(47)
Greenaway C, Ma AT, Kloda LA, Klein M, Cnossen S. The seroprevalence of hepatitis C antibodies in immigrants and refugees from intermediate and high endemic countries : a systematic review and meta-analysis 2015;1–19.
UK Visas and Immigration; The Rt Hon Mark Harper. UK Tuberculosis Technical Instructions. 2013. https://www.gov.uk/government/publications/uk-tuberculosis-technical-instructions. Accessed 25 July 2018.
Public Health England. Guidance: The Complete Routine Immunisation Schedule. Immunisation. 2017. https://www.gov.uk/government/publications/the-complete-routine-immunisation-schedule. Accessed 25 July 2018.
World Health Organization. Global hepatitis report 2017. World Health Organization. 2017. ISBN: 978-92-4-156545-5. http://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/. Accessed 25 July 2018.
UNHCR. UNHCR Resettlement Handbook: Country chapter - United Kingdom. 2018. http://www.unhcr.org/40ee6fc04.html. Accessed 25 July 2018.
UNHCR. Procedural Standards for Refugee Status Determination under UNHCR’ s Mandate Procedural Standards for RSD under UNHCR’ s Mandate. 2005
- Infectious disease testing of UK-bound refugees: a population-based, cross-sectional study
Alison F. Crawshaw
Kolitha P. Wickramage
- BioMed Central
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