MIGRATION AND SHIFT IN DISEASE DISTRIBUTION Flashcards
% of the world’s population residing in a nation different than the one in which they were born?
cca 2% (more than 200 million people)
MIGRATION AND SHIFT IN DISEASE DISTRIBUTION?
Migrant populations have had a critical role in the spread of infectious diseases since ancient times. Examples range from biblical plagues, the importation of smallpox into Mexico, the 1918 influenza pandemic, and the AIDS pandemic, to severe acute respiratory syndrome (SARS), outbreaks of meningococcal meningitis associated with the Hajj, and diseases spread by population movement due to political conflict.
- IF A DISEASE ISN’T ENDEMIC AND HIGHLY CONTAGIOUS LIKE E.G. COVID, THE RISK OF REFUGEES AND MIGRANTS TRANSMITTING IT TO THE HOST POPULATIONS IS LOW
- REFUGEES AND MINGRANTS ARE GENERALLY I GOOD HEALTH, BUT THEY ARE AT RISK OF FALLING SICK IN TRANSITION OR WHILE STAYING IN NEW COUNTRIES DUE TO, E.G. POOR LIVING CONDITIONS, INADEQUATE FOOD AND WATER, INCREASED STRESS, LACK OF INTEGRATION…
It should be highlighted that infectious diseases among migrant populations largely reflect poor living conditions and social marginalization and are therefore likely to remain confined to their communities without spreading to the indigenous people.
Although their overall impact on European epidemiology is substantially negligible, careful surveillance is key, not only to better understand the trends and set priorities for action but also to prevent the potential re-introduction of vector-borne pathogens such as malaria parasites.
STEPS IN MIGRATION
First arrival to the destination country by sea or land
Short- or long-term stay in refugee camps or other reception centres
Resettlement
Stable living in the destination country after resettlement
MIGRANTS’ HEALTH AT FIRST ARRIVAL?
Available evidence points to the fact that infectious diseases are not at all a health priority at hotspots and first arrival sites, where traumatic, obstetric and psychological disorders are most prevalent.
However, a general screening based on a syndromic approach (based on symptoms) for the early identification of the most common communicable conditions should be conducted as soon as possible.
Pulmonary tuberculosis (TB) is among the greatest concerns, or re-activation of infection and the rapid progression to active disease.
Mites (causing scabies) can easily spread among migrants during travel on overcrowded boats or soon after arrival
Food- and water-borne infections such as typhoid fever or acute viral hepatitis A and E
Malaria is generally unusual because most people get to Europe several months after leaving endemic areas
Health of Migrants living in refugee camps and other reception sites?
After first arrival, asylum seekers are often gathered in camps where they reside for weeks or months.
Camps may be crowded, possibly favouring the occurrence of epidemic outbreaks of respiratory or gastrointestinal infections, sometimes caused by incomplete vaccine coverage for preventable diseases.
A search for active TB cases should always be included in the clinical assessment of migrants at this stage
Outbreaks of meningococcal disease are also likely to occur in detention centres (due to overcrowding)
Poor hygiene and food insecurity that often characterize refugee camps also favour the spread of lice and consequently of louse-borne infections such as those due to Bartonella spp. or Borrelia spp.
HEALTH OF MIGRANTS AT RESETTLEMENT
After resettlement, the two major drivers of infections in migrants are represented by:
The prevalence of a given infection in the country of origin,
The marginalization and vulnerability to poverty-related diseases.
The most important infections to be considered for screening, prevention and early care: Chronic viral hepatitis Human immunodeficiency virus (HIV) Other sexually transmitted infections, TB, vaccine-preventable diseases and other chronic parasitic conditions
HEALTH PROBLEMS - MIGRANTS TRVELLING TO THEIR COUNTRY OF ORIGIN?
Once settled in the host country, migrants usually travel back to their country of origin to visit friends and relatives, often bringing with them their children, who may be born in the destination country.
Migrants rarely seek pre-travel advice and this results in a high incidence of illnesses, among which malaria is of utmost importance due to the high case-fatality rate especially in the paediatric population.
More than two-thirds of imported malaria cases in Europe involve those visiting friends and relatives and most of them occur during the summer months, reaching a peak in September.
Individuals travelling to sub-Saharan Africa are at greater risk of acquiring malaria
Pre-travel vaccination for other infections such as hepatitis A and typhoid fever is also essential especially for those travelling to remote rural areas
MODES OF TRANSMISSION OF COMMON INFECTIOUS DISEASES
FOOD BORNE AND WATER BORNE: TRAVELLER’S DIARRHOEA, CHOLERA, CRYPTOSPORIDIOSIS, HEP A & E, TYPHOID, LISTERIOSIS, GIARDIASIS
AIR BORNE: TB, SARS, MUMPS, DIPTHERIA, MEASLES
VECTOR BORNE: MALARIA, YELLOW FEVER, DENGUE, ENCEPHALITIS…
ANIMAL BORNE: RABIES, BRUCELLOSIS, LEPTOSPIROSIS
BLOOD BORNE; HEP B & C, HIV/AIDS, MALARIA
SEXUALLY TRANSMITTED: HEPATITIS, SYPHILIS, HIV/AIDS
SOIL BORNE: ANTHRAX, ASCARIASIS, TRICHURIS, FUNGAL INFECTIONS
RECREATIONAL WATER: SCHISTOMA, PSEUDOMONAS, LEPTOSPIRA, LEGIONELLOSIS, GIARDIA..
- MASS GATHERINGS (E.G. THE HAJJ PILGRIMAGE, ALSO CONTRIBUTE TO DISEASE DEVELOPMENT, E.G. YELLOW FEVER, MENINGITIS, FLU..)
Guiding principles for prevention and control of communicable diseases
Informed decision for prioritized public health policies and action based on the risk analysis and evidence
Adequate public health capacity for preparedness and response
Strengthened disease surveillance systems
Providing equitable and migrant-sensitive health services ensuring continuum of care
Ensuring access to comprehensive health promotion and prevention
