Screening for Infectious Diseases on Arrival and Integrated Healthcare for Refugees and Asylum Seekers During the First Months After Arrival

Abstract

Germany’s experiences during the arrival of a large number of refugees in 2015 and 2016 have revealed a substantial need for coordinated and integrated healthcare. This includes evidence-based management and prevention of infectious diseases on arrival, easily accessible healthcare during the time after arrival and good integration into regular healthcare afterwards. While there is no evidence of the major transmission of infectious diseases from arriving refugees to the general population, the risk of transmission within groups of refugees, in particular in combination with crowded living conditions and the compounding effect of previous flight experience, is relevant. Screening for infectious diseases can identify only a proportion of infectious diseases and needs to take into account the dynamics of the risks associated with the different periods of flight/migration. In Germany, initial chest X-ray screening for pulmonary tuberculosis among adults by local health authorities is the only infectious disease screening that is uniformly applied across all states and counties. Apart from this screening, practices vary across different regions and states due to the non-existence of overall recommendations. We give an overview of existing evidence and guidelines on infectious disease screening of refugees for tuberculosis, HIV and hepatitis B & C and describe the practical experience of an integrated healthcare model for arriving refugees in Freiburg, including the management (although not initial screening) of infectious diseases. We also present an argument for screening to be integrated into the regular provision of healthcare during the first few months after arrival beyond just a one-off chest X-ray.