Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug 28;16(1):143.
doi: 10.1186/s12916-018-1125-4.

Infectious disease testing of UK-bound refugees: a population-based, cross-sectional study

Alison F Crawshaw  1 , Manish Pareek  2 , John Were  1 , Steffen Schillinger  3 , Olga Gorbacheva  4 , Kolitha P Wickramage  3 , Sema Mandal  5 , Valerie Delpech  6 , Noel Gill  6 , Hilary Kirkbride  1 , Dominik Zenner  7   8
Affiliations

Infectious disease testing of UK-bound refugees: a population-based, cross-sectional study

Alison F Crawshaw et al. BMC Med. .

Abstract

Background: The UK, like a number of other countries, has a refugee resettlement programme. External factors, such as higher prevalence of infectious diseases in the country of origin and circumstances of travel, are likely to increase the infectious disease risk of refugees, but published data is scarce. The International Organization for Migration carries out and collates data on standardised pre-entry health assessments (HA), including testing for infectious diseases, on all UK refugee applicants as part of the resettlement programme. From this data, we report the yield of selected infectious diseases (tuberculosis (TB), HIV, syphilis, hepatitis B and hepatitis C) and key risk factors with the aim of informing public health policy.

Methods: We examined a large cohort of refugees (n = 18,418) who underwent a comprehensive pre-entry HA between March 2013 and August 2017. We calculated yields of infectious diseases stratified by nationality and compared these with published (mostly WHO) estimates. We assessed factors associated with case positivity in univariable and multivariable logistic regression analysis.

Results: The number of refugees included in the analysis varied by disease (range 8506-9759). Overall yields were notably high for hepatitis B (188 cases; 2.04%, 95% CI 1.77-2.35%), while yields were below 1% for active TB (9 cases; 92 per 100,000, 48-177), HIV (31 cases; 0.4%, 0.3-0.5%), syphilis (23 cases; 0.24%, 0.15-0.36%) and hepatitis C (38 cases; 0.41%, 0.30-0.57%), and varied widely by nationality. In multivariable analysis, sub-Saharan African nationality was a risk factor for several infections (HIV: OR 51.72, 20.67-129.39; syphilis: OR 4.24, 1.21-24.82; hepatitis B: OR 4.37, 2.91-6.41). Hepatitis B (OR 2.23, 1.05-4.76) and hepatitis C (OR 5.19, 1.70-15.88) were associated with history of blood transfusion. Syphilis (OR 3.27, 1.07-9.95) was associated with history of torture, whereas HIV (OR 1521.54, 342.76-6754.23) and hepatitis B (OR 7.65, 2.33-25.18) were associated with sexually transmitted infection. Syphilis was associated with HIV (OR 10.27, 1.30-81.40).

Conclusions: Testing refugees in an overseas setting through a systematic HA identified patients with a range of infectious diseases. Our results reflect similar patterns found in other programmes and indicate that the yields for infectious diseases vary by region and nationality. This information may help in designing a more targeted approach to testing, which has already started in the UK programme. Further work is needed to refine how best to identify infections in refugees, taking these factors into account.

Keywords: Health assessment; Infectious diseases; Migrant health; Refugee health; Refugees.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

All participants whose data was included this study gave consent at the time of data collection for their information to be used by Public Health England and other relevant authorities and agencies. All personal data was anonymised prior to data cleaning and analysis.

Consent for publication

Not applicable.

Competing interests

DZ is head of the Tuberculosis Screening Unit at Public Health England and has shared responsibilities for quality assurance within the UK pre-entry screening programme and contributes to the UK refugee programmes.

SM reports funding for commissioned surveillance reports from a drug manufacturer (Gilead), outside the submitted work. MP reports an institutional grant (unrestricted) for project related to blood-borne virus testing from Gilead Sciences outside the submitted work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram illustrating selection criteria used to identify the study sample
See this image and copyright information in PMC

References

    1. United Nations, Department of Economic and Social Affairs PD. International Migration Report 2015: Highlights. 2016. http://www.un.org/en/development/desa/population/migration/publications/.... Accessed 25 July 2018.
    1. Eurostat. Migration and Migrant Population Statistics. 2017. http://ec.europa.eu/eurostat/statistics-explained/index.php/Migration_an.... Accessed 25 July 2018.
    1. Eurostat. Population and Population Change Statistics. 2017. http://ec.europa.eu/eurostat/statistics-explained/index.php/Population_a.... Accessed 25 July 2018.
    1. International Organization for Migration. Global Migration Trends Factsheet. IOM's Global Migration Data Analysis Centre (GMDAC). 2015;13:45. http://gmdac.iom.int/global-migration-trends-factsheet. Accessed 25 July 2018.
    1. Liu Y, Weinberg MS, Ortega LS, Painter JA, Maloney SA. Overseas screening for tuberculosis in U.S.-bound immigrants and refugees. N Engl J Med. 2009;360:2406–2415. doi: 10.1056/NEJMoa0809497. - DOI - PubMed

Publication types