Screening for schistosomiasis among Eritrean refugees: a public health priority

Abstract

Abstract Issue From 2014 to 2020, 24 422 Eritrean refugees arrived in Switzerland. After they applied for asylum in a federal centre, asylum seekers are allocated to the 26 Swiss cantons, among them Geneva. In the University hospitals of Geneva, the Programme Santé Migrants (PSM) is dedicated to ambulatory care for refugees. Problem 30% of the PSM outpatients are Eritrean. After their arrival in Geneva, asylum seekers get a medical evaluation. We noticed that the Eritrean's health status was poor, due to their long and hazardous migratory journey. Some had a hypereosinophilia and their helminthiasis serologies were positive for schistosomiasis (Schs). We decided to implement a protocol to screen and treat Eritrean patients for Schs. Highlighting this infection among this population was important because: it is a chronic disease which can lead to severe consequences if untreated; 42% of the Swiss refugees are Eritreans; in Switzerland, Praziquantel (PZQ), the treatment of Schs, is not distributed and not refunded by medical insurances. However, our hospital's pharmacy can import PZQ. We analysed 158 medical records of Eritrean patients, to see if the screening protocol was applied. Results Among the 158 patients records 72 were women. Mean age 27. 118 (74.7%) of 158 got a Schs serology. 62 (52.5%) were positive or borderline (PB). 29.6% patients with PB had a hypereosinophilia (HE) > 0.5 G/l, and 59% had HE > 5%. None of the negative had HE > 0.5G/l. 44/62 PB had a stools examination and Schs eggs were present among 61% of the P and 18% of the B. 44 (71%) of the 62 PB got a PZQ treatment. Among not treated, 33% were pregnant women. Lessons 25% of patients did not get the protocol. Electronic warning in the electronic files could help, especially in hospitals with large residents turn over. More than 50% of Eritrean patients had a positive or borderline Schs serology. The treatment (PZQ) is easy to take and effective, but not easily accessible and not free in Switzerland. Key messages Schistosomiasis is a frequent disease among Eritrean migrants. Systematic screening should be implemented among them with quality controls. If positive, they should have access to the treatment. European countries should adapt their drug licences and access to treatment to the diversity of the population, taking into account the epidemiology of diseases in the countries of origin.