Abstract
Information regarding the prevalence of infectious diseases (IDs) in child and adolescent refugees in Europe is scarce. Here, we evaluate a standardized ID screening protocol in a cohort of unaccompanied refugee minors (URMs) in a municipal region of southwest Germany. From January 2016 to December 2017, we employed a structured questionnaire to screen a cohort of 890 URMs. Collecting sociodemographic information and medical history, we also performed a standardized diagnostics panel, including complete blood count, urine status, microbial stool testing, tuberculosis (TB) screening, and serologies for hepatitis B virus (HBV) and human immunodeficiency virus (HIV). The mean age was 16.2 years; 94.0% were male, and 93.6% originated from an African country. The most common health complaints were dental problems (66.0%). The single most frequent ID was scabies (14.2%). Of the 776 URMs originating from high-prevalence countries, 7.7% and 0.4% tested positive for HBV and HIV, respectively. Nineteen pathogens were detected in a total of 119 stool samples (16.0% positivity), with intestinal schistosomiasis being the most frequent pathogen (6.7%). Blood eosinophilia proved to be a nonspecific criterion for the detection of parasitic infections. Active pulmonary TB was identified in 1.7% of URMs screened. Of note, clinical warning symptoms (fever, cough >2 weeks, and weight loss) were insensitive parameters for the identification of patients with active TB. Study limitations include the possibility of an incomplete eosinophilia workup (as no parasite serologies or malaria diagnostics were performed), as well as the inherent selection bias in our cohort because refugee populations differ across Europe. Our study found that standardized ID screening in a URM cohort was practicable and helped collection of relevant patient data in a thorough and time-effective manner. However, screening practices need to be ameliorated, especially in relation to testing for parasitic infections. Most importantly, we found that only a minority of infections were able to be detected clinically. This underscores the importance of active surveillance of IDs among refugees.
Highlights
In 2015, the European Union began experiencing a significant influx in refugees, especially from Africa and Asia
Of the 776 unaccompanied refugee minor (URM) originating from high-prevalence countries, 7.7% and 0.4% tested positive for hepatitis B virus (HBV) and human immunodeficiency virus (HIV), respectively
Our study found that standardized infectious disease (ID) screening in a URM cohort was practicable and helped collection of relevant patient data in a thorough and time-effective manner
Summary
In 2015, the European Union began experiencing a significant influx in refugees, especially from Africa and Asia. Because the endemicities of many infectious diseases (IDs) vary globally, it seems reasonable to screen refugees for IDs that may be more prevalent in those coming from low- and middle-income countries. This includes infections with Mycobacterium tuberculosis, hepatitis B virus (HBV), human immunodeficiency virus (HIV), and parasitic diseases. The chronic and oligosymptomatic course of many IDs found in migrants leads to delays in diagnosis—delays compounded by language and cultural barriers, as well as by limited access to care For these reasons, these diseases require active screening. We evaluate a standardized ID screening protocol in a cohort of unaccompanied refugee minors (URMs) in a municipal region of southwest Germany
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