Abstract
ObjectivesAsylum seekers to Europe may come from war-torn countries where health systems have broken down, and there is evidence that asylum-seeking children have low coverage of childhood vaccinations, as well as uptake of immunisations in host countries. Such gaps in immunisation have important implications for effective national vaccination programmes. How we approach vaccination in children and adults entering Western Europe, where as a group they face barriers to health services and screening, is a growing debate; however, there are limited data on the vaccination status of these hard-to-reach communities, and robust evidence is needed to inform immunisation strategies. The aim of this study was to explore the vaccination status and needs of asylum-seeking children and adolescents in Denmark. Study designWe conducted a retrospective data analysis of anonymised patient records for asylum-seeking children and adolescents extracted from the Danish Red Cross database. MethodsWe retrospectively searched the Danish Red Cross database for children and adolescents (aged 3 months–17 years) with active asylum applications in Denmark as of October 28, 2015. Data were extracted for demographic characteristics, vaccination status and vaccinations needed by asylum-seeking children presenting to Red Cross asylum centres for routine statutory health screening. ResultsWe explored the vaccination status and needs of 2126 asylum-seeking children and adolescents. About 64% of the study population were male and 36% were female. Eight nationalities were represented, where 33% of the total of children and adolescents were not immunised in accordance with Danish national guidelines, while 7% were considered partly vaccinated, and 60% were considered adequately vaccinated. Afghan (57% not vaccinated/unknown) and Eritrean (54% not vaccinated/unknown) children were the least likely to be vaccinated of all nationalities represented, as were boys (37% not vaccinated/unknown) compared with girls (27% not vaccinated/unknown) and children and adolescents aged between 12 and 17 years (48% not vaccinated/unknown) compared with 6- to 11-year olds (26%) and 0- to 5-year olds (22%). The health screenings resulted in 1328 vaccinations. The most commonly needed vaccines were diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b, (DTaP/IPV/Hib) which comprised 49% of the vaccines distributed, followed by the pneumococcal vaccine (Prevnar) (28%) and measles, mumps and rubella (MMR) vaccine (23%). ConclusionsThe finding that nearly one-third of asylum-seeking children and adolescents in Denmark were in need of further vaccinations highlights the gaps in immunisation coverage in these populations. These results point to the need to improve access to health services and promote national vaccine programmes targeted at these communities to facilitate vaccination uptake and increase immunisation coverage to reduce the risk of preventable infectious diseases among asylum-seeking children.
Highlights
A record number of 1.2 million first-time asylum seekers were registered in Europe in 2015;1 of whom, 21,225 applied for asylum in Denmark, an increase of 43% between 2014 and 2015
In light of the clear impetus to improve the provision of preventative care to these hard-to-reach populations, the approach to immunisations in migrants we report here in Denmark may serve as a model for other European countries for routine health checks and the provision of vaccinations to migrant children
Significant disparities in vaccination status and needs were found between different groups of asylum-seeking children and adolescents
Summary
A record number of 1.2 million first-time asylum seekers were registered in Europe in 2015;1 of whom, 21,225 applied for asylum in Denmark, an increase of 43% between 2014 and 2015. Various studies have shown that migrant populations present different patterns of infectious diseases and healthrelated behaviours than local-born populations.[2,3] Simultaneously, the limited immunisation programmes in countries of origin for asylum seekers in Europe (e.g. due to conflict or insufficient health service infrastructure4) have led to outbreaks of vaccine-preventable diseases in host countries in Europe, especially among young children.[5] Poor living conditions before, during and after migration, barriers to accessing timely and appropriate health care (including for vaccination and screening for infectious diseases in host countries6) and limited health infrastructure in many countries of origin ( in the context of conflict) meant that very few of the children included in this study had documentation of their vaccinations on arrival. Very limited information was available on children's vaccination status and needs
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