Notifiable infectious diseases in refugees and asylum seekers: experience from a major reception center in Munich, Germany
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In 2016, the number of refugees worldwide reached 65.6 million. So far, only limited data are available on the health status of refugees and asylum seekers (RAs). Especially, notifiable infectious diseases (NIDs) carry the risk of outbreaks in communal accommodations hosting RAs.
We conducted a monocentric retrolective cross-sectional study including 15,137 RAs treated in a special health care unit for RAs located in the major reception center in Munich from November 2014 to October 2016. Altogether 811 RAs with NIDs according to sections 6 and 7 of the German Infection Protection Act or with other infections relevant in the setting of a communal accommodation (RIDs) could be identified.
The gender and age distribution was generally comparable to that of refugees in Germany. However, patients from East Africa and Nigeria were significantly overrepresented. NIDs/RIDs were dominated by cases of tuberculosis, hepatitis B, and vaccine-preventable and parasitic diseases. Significant risk factors included country of origin (COI) and age for hepatitis B, age for hepatitis C, gender and age for HIV, and COI, gender and age for tuberculosis and ectoparasitosis. Calculated prevalences of hepatitis B, hepatitis C, and HIV were mostly below those of the COI. Incidences of tuberculosis were mostly strongly elevated.
COI, gender, and age have an impact on the occurrence of NIDs/RIDs. Early vaccinations and improved hygiene could be effective in preventing NIDs/RIDs in communal accommodations. Screening, prompt therapy, and infection protection measures are necessary to prevent the transmission of diseases.
KeywordsRefugee Asylum seeker Infectious diseases Tuberculosis Hepatitis B Human immunodeficiency virus
The authors thank REFUDOCS-Verein zur medizinischen Versorgung von Flüchtlingen, Asylsuchenden und deren Kindern e.V. for providing the data. This paper is the result of the doctoral thesis of S.M. The authors have no support or funding to report.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
This study has been approved by the ethics committee of the Ludwig-Maximilians-University (LMU), Munich, Germany and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
- 1.United Nations High Commissioner for Refugees. Global Trends 2016. 2017. http://www.unhcr.org/5943e8a34.pdf. Accessed 17 Dec 2017.
- 2.Federal Office for Migration and Refugees (BAMF). Migration report of the Federal Office for Migration and Refugees (BAMF) on behalf of the Federal Government 2015. Federal Ministry of the Interior (BMI), Berlin. 2016. https://www.bmi.bund.de/SharedDocs/downloads/DE/publikationen/2016/migrationsbericht-2015.pdf?__blob=publicationFile&v=4. Accessed 24 Mar 2018.
- 3.Schneider C, Mohsenpour A, Joos S, Bozorgmehr K. Health status of and health-care provision to asylum seekers in Germany: protocol for a systematic review and evidence mapping of empirical studies. Syst Rev. 2014;3:139. https://doi.org/10.1186/2046-4053-3-139.CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Bradby H, Humphris R, Newall D, Phillimore J. WHO Health Evidence Network Synthesis Reports. Public Health Aspects of Migrant Health: A Review of the Evidence on Health Status for Refugees and Asylum Seekers in the European Region. Copenhagen: WHO Regional Office for Europe Copyright (c) World Health Organization 2015; 2015.Google Scholar
- 5.Federal Office for Migration and Refugees (BAMF). Current figures on asylum. Issue: December 2015. 2016. http://www.bamf.de/SharedDocs/Anlagen/DE/Downloads/Infothek/Statistik/Asyl/aktuelle-zahlen-zu-asyl-dezember-2015.pdf?__blob=publicationFile. Accessed 30 May 2017.
- 6.Federal Office for Migration and Refugees (BAMF). Current figures on asylum. Issue: December 2016. 2017. https://www.bamf.de/SharedDocs/Anlagen/DE/Downloads/Infothek/Statistik/Asyl/aktuelle-zahlen-zu-asyl-dezember-2016.pdf?__blob=publicationFile. Accessed 30 May 2017.
- 8.Robert Koch Institute. Notifiable infectious diseases in asylum seekers in Germany submitted to the Robert Koch Institute—October 2017. 2017. https://www.rki.de/DE/Content/Gesundheitsmonitoring/Gesundheitsberichterstattung/GesundAZ/Content/A/Asylsuchende/Inhalt/meldepflichtige_Infektionskrankheiten_bei_Asylsuchenden.pdf?__blob=publicationFile. Accessed 17 Dec 2017.
- 10.World Health Organization. Refugees and migrants: common health problems. n.d. http://www.euro.who.int/__data/assets/pdf_file/0005/293270/Migration-Health-Key-Issues-.pdf?ua=1&ua=1. Accessed 25 Mar 2018.
- 13.European Centre for Disease Prevention and Control. Infectious diseases of specific relevance to newly-arrived migrants in the EU/EEA, p. 2. 2015b. http://ecdc.europa.eu/en/publications/Publications/Infectious-diseases-of-specific-relevance-to-newly-arrived-migrants-in-EU-EEA.pdf. Accessed 30 May 2017.
- 16.United Nations. Methodology: Standard country or area codes for statistical use (M49). Countries or areas/geographical regions. n.d. https://unstats.un.org/unsd/methodology/m49/. Accessed 25 Mar 2018.
- 19.World Health Organization. Prevalence of HIV among adults aged 15 to 49. 2017. http://apps.who.int/gho/data/node.main.622?lang=en. Accessed 21 June 2017.
- 20.Joint United Nations Programme on HIV/AIDS (UNAIDS). Nigeria: HIV and AIDS estimates 2015. n.d. http://www.unaids.org/en/regionscountries/countries/nigeria/. Accessed 21 June 2017.
- 21.World Health Organization. Malaria: Reported indigenous confirmed cases. 2015. http://apps.who.int/gho/data/node.main.A1364?lang=en. Accessed 21 June 2017.
- 22.World Health Organization. Tuberculosis Incidence: Data by country. 2017. http://apps.who.int/gho/data/view.main.57040ALL?lang=en. Accessed 21 June 2017.
- 23.van Berlaer G, Bohle Carbonell F, Manantsoa S, de Béthune X, Buyl R, Debacker M, Hubloue I. A refugee camp in the centre of Europe: clinical characteristics of asylum seekers arriving in Brussels. BMJ Open. 2016;6:e013963. https://doi.org/10.1136/bmjopen-2016-013963.CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Ravensbergen SJ, Lokate M, Cornish D, Kloeze E, Ott A, Friedrich AW, et al. High prevalence of infectious diseases and drug-resistant microorganisms in asylum seekers admitted to hospital; no carbapenemase producing enterobacteriaceae until september 2015. PLoS One. 2016;11:e0154791. https://doi.org/10.1371/journal.pone.0154791.CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Federal Office for Migration and Refugees (BAMF). Asylum statistics of 2015. 2016. https://www.proasyl.de/wp-content/uploads/2015/12/2015_HKL_AntragsEntscheidungsstatistik.pdf. Accessed 13 June 2017.
- 27.Federal Office for Migration and Refugees (BAMF). Asylum statistics of 2016. 2017. https://www.proasyl.de/wp-content/uploads/2015/12/Asylantrage-und-Entscheidungen-2016.pdf. Accessed 13 June 2017.
- 28.Robert Koch Institute. Notifiable infectious diseases in asylum seekers in Germany submitted to the Robert Koch Institute—2015. 2016. https://www.landtag.nrw.de/Dokumentenservice/portal/WWW/dokumentenarchiv/Dokument/MMV16-3729.pdf;jsessionid=33DF2BEE1BA1FB429AC4BA7CE41F813D.ifxworker. Accessed 15 June 2017.
- 29.Robert Koch Institute. Notifiable infectious diseases in asylum seekers in Germany submitted to the Robert Koch Institute—2016. 2017. http://docplayer.org/40443138-Dem-robert-koch-institut-uebermittelte-meldepflichtige-infektionskrankheiten-bei-asylsuchenden-in-deutschland.html. Accessed 25 Mar 2018.
- 30.Halder G, Kerschel J. Tuberculosis in asylum seekers—data from Munich 2015. Hyg Med. 2016;41:D179–82.Google Scholar
- 31.Organisation for Economic Co-operation and Development (OECD). Finding their Way—The Labour Market Integration of Refugees in Germany. 2017. https://www.oecd.org/berlin/publikationen/Arbeitsmarktintegration-von-Fluechtlingen-in-Deutschland-2017.pdf. Accessed 1 June 2017.
- 33.Coppola N, Alessio L, Gualdieri L, Pisaturo M, Sagnelli C, Caprio N, et al. Hepatitis B virus, hepatitis C virus and human immunodeficiency virus infection in undocumented migrants and refugees in southern Italy, January 2012 to June 2013. Euro Surveill. 2015;20:30009. https://doi.org/10.2807/1560-7917.ES.2015.20.35.30009.CrossRefPubMedGoogle Scholar
- 34.Joint United Nations Programme on HIV/AIDS (UNAIDS). Country factsheets Nigeria 2016: HIV and AIDS Estimates. n.d. http://aidsinfo.unaids.org/?did=5581277ae9beccab3bd5a44e&r=world&t=2016&tb=q&bt=undefined&ts=0,0&qla=C&qls=NGA. Accessed 3 Aug 2017.
- 37.Werber D, Hoffmann A, Santibanez S, Mankertz A, Sagebiel D. Large measles outbreak introduced by asylum seekers and spread among the insufficiently vaccinated resident population, Berlin, October 2014 to August 2015. Euro Surveill. 2017;22:30599. https://doi.org/10.2807/1560-7917.ES.2017.22.34.30599.PubMedCentralGoogle Scholar
- 38.Hörmansdorfer S, Ackermann N, Berger A, Bischoff H, Bengs K, Rieder G, et al. Infectiological status of asylum seekers and refugees in Bavaria. Hyg Med. 2016;41:D160–4.Google Scholar
- 39.Chernet A, Utzinger J, Sydow V, Probst-Hensch N, Paris DH, Labhardt ND, et al. Prevalence rates of six selected infectious diseases among African migrants and refugees: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis. 2017;37:605-19. https://doi.org/10.1007/s10096-017-3126-1.CrossRefPubMedGoogle Scholar
- 43.Brodhun B, Altmann D, Hauer B, Fiebig L, Haas W. Nationwide analysis in detail. In: Robert Koch Institute, editor. Report on the Epidemiology of Tuberculosis in Germany—2015. Berlin: Robert Koch Institute; 2016. p. 19–63.Google Scholar
- 46.European Centre for Disease Prevention and Control. Communicable disease risks associated with the movement of refugees in Europe during the winter season. 2015a. http://ecdc.europa.eu/en/publications/Publications/refugee-migrant-health-in-european-winter-rapid-risk-assessment.pdf. Accessed 23 May 2017.