Increasing rates of migration to Europe and the UK have led to concerns that these populations may be contributing to the burden of infectious diseases such as tuberculosis or antibiotic resistance (AMR). However, there is limited evidence regarding the impact of migrants on the epidemiology of such diseases, associated risk factors, and strategies to reduce the burden of these infectious diseases among migrants and in the wider population.
In order to strengthen the evidence-base in this area, our research group carried out a number of studies recently to examine epidemiological patterns and risk factors in these groups. In our systematic review and meta-analysis on AMR in migrants to Europe (The Lancet Infectious Diseases, 2018), we found that the evidence indicates that antibiotic resistant infections are acquired by migrants after they arrive in Europe in the community in high-migrant settings, such as refugee camps and transit centres where living conditions, sanitation, and access to appropriate care are poor.
We also carried out a systematic review on the effectiveness of current approaches to migrant screening for infectious diseases in the EU, such as tuberculosis, HIV, and hepatitis B and C (The Lancet Infectious Diseases, 2018), finding high levels of acceptability in migrant populations, but low coverage and significant barriers to accessing care.
The acceptability of care and persisting barriers to accessing such care was also evident when we investigated treatment adherence for multidrug resistant tuberculosis among migrants (BMC Medicine, 2017), in which we showed that – contrary to medical perception – rates of adherence were comparable among migrant and native-born patients, but that adherence rates for both groups were below even modest international targets.
The low screening coverage and challenges to successfully completing treatment identified in these pieces of work may in part be due to inconsistencies in the provision of care for migrants for infectious diseases such as tuberculosis across Europe, and limited evidence on efficient or effective packages of services for the prevention, diagnosis, treatment and care of tuberculosis among refugees and migrants, which we identified in a Health Evidence Network Synthesis for the World Health Organisation.
There is a clear need to strengthen the evidence-base on strategies to improve the detection and treatment of infectious diseases in migrant populations. This is essential to prevent poorer health outcomes in these communities, and protect the wider public health, and we are undertaking a number of intervention studies at present.
Publications
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Nellums, LB et al. Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis. The Lancet Infectious Diseases 2018:18(7):796-811. doi: 10.1016/S1473-3099(18)30219-6.
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Hargreaves, S, et al. How effective are current approaches to migrant screening for infectious diseases in the EU? A systematic analysis. The Lancet Infectious Diseases. 2018:18(9):e259-e271. doi: 10.1016/S1473-3099(18)30117-8.
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Rustage, K, et al. MDR-TB treatment adherence among migrants: A systematic review and meta-analysis. BMC Medicine. 2018: 16: 27. doi: 10.1186/s12916-017-1001-7
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Hargreaves, S, et al. What constitutes an effective and efficient package of services for the prevention, diagnosis, treatment, and care of tuberculosis among refugees and migrants in the WHO European region? Themed Issues on Migration and Health, VIII. Health Evidence Network Synthesis Report, No. 56. Copenhagen: WHO Regional Office for Europe; 2018. ISBN-13: 978-92-890-5310-5.