, Volume 45, Issue 2, pp 157–164 | Cite as

Tetanus and diphtheria immunity in refugees in Europe in 2015

  • Alexandra JablonkaEmail author
  • Georg M. N. Behrens
  • Marcus Stange
  • Christian Dopfer
  • Ulrike Grote
  • Gesine Hansen
  • Reinhold Ernst Schmidt
  • Christine Happle
Original Paper



Current political crises in the Middle East and economic discrepancies led millions of people to leave their home countries and to flee to Western Europe. This development raises unexpected challenges for receiving health care systems. Although pan-European initiatives strive for updated and optimized vaccination strategies, little data on immunity against vaccine-preventable diseases in the current refugee population exist.


We quantified serum IgG against tetanus and diphtheria (TD) in n = 678 refugees currently seeking shelter in six German refugee centers.


Reflecting current migration statistics in Europe, the median age within the cohort was 26 years, with only 23.9 % of female subjects. Insufficient IgG levels without long-term protection against tetanus were found in 56.3 % of all refugees. 76.1 % of refugees had no long-term protection against diphtheria. 47.7 % of subjects needed immediate vaccination against tetanus, and 47.7 % against diphtheria. For both diseases, an age-dependent decline in protective immunity occurred.


We observed a considerably low rate of tetanus-protected refugees, and the frequency of diphtheria-immune refugees was far from sufficient to provide herd immunity. These findings strongly support recent intentions to implement and enforce stringent guidelines for refugee vaccination in the current crisis.


Vaccination Refugee Tetanus Diphtheria Immunity Asylum Vaccine-preventable diseases 



European Union


Immunoglobulin G


Tetanus, diphtheria


Vaccine-preventable diseases


World Health Organization


United Nations High Commissioner for Refugees


United Nations Children’s Fund



The authors would like to thank all doctors and medical personnel involved in medical care of the refugees for their exceptional work. We would furthermore like to thank Christian Berger, Don-Philipp Dratschke, Matthias Joachim, Jean-Luc Kruppa, Henrick Langner, Bianca Schnake, Arne Steinbrück and Kai Zaengel for the organization of medical care, Annika Hampel for data processing and Torsten Bergemann of Nexave for the extraction from the electronic database.

Compliance with ethical standards

Conflict of interest

None to specify.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Clinical Immunology and RheumatologyHannover Medical SchoolHannoverGermany
  2. 2.German Center for Infection ResearchHannoverGermany
  3. 3.Department of Paediatric KidneyLiver and Metabolic Diseases, Hannover Medical SchoolHannoverGermany
  4. 4.Department of Pedatric Pneumology, Allergology and NeonatologyHannover Medical SchoolHannoverGermany
  5. 5.German Center for Lung Research, BREATHHannoverGermany
  6. 6.Department of Hematology, Hemostasis, Oncology and Stem Cell TransplantationHannover Medical SchoolHannoverGermany

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