ECDC Outlines Refugee Health Surveillance Practices

Humans are creatures of habit and our lives are strongly built on routine. Sometimes we may find ourselves straying a bit, but rarely does it become a habit to break from routines.

Unfortunately, some individuals do not have much of a choice when it comes to a daily routine, because the aftermath of war has torn them from their homes, their societies, and even their countries. Refugees wake up one morning and their whole lives have changed. To add insult to injury, many refugees often do not have access to the healthcare services they need in order to stave off infections. While children in Europe often receive routine vaccinations against several preventable diseases, refugee children (some of whom have been displaced for the entirety of their short lives) do not always have that luxury.

According to a recent Euronews article, a stigma exists that incoming refugees pose a health risk to European communities. The article states that this stigma stems from the fact that aid workers, when receiving incoming refugees, wear face masks to protect themselves against infectious diseases that may be lurking amidst these displaced individuals. The reality, according to a European Centre for Disease Prevention and Control (ECDC) document, is that “Migrant populations entering EU/EEA, and particularly children, are at risk of developing infectious diseases in the same way as other EU populations, and in some cases may be more vulnerable.” Furthermore, the ECDC notes, the living conditions these refugees are afforded after entering into European countries may be a factor that plays into the spread of infections among these populations.

In an effort to prevent infection outbreaks, European host countries often have their own established surveillance and health protocols; however, to supplement these protocols, the ECDC recently established practices to help European communities implement “Syndromic Surveillance.” These guidelines are provided to assist in the early detection of public health risks and the prevention of possible outbreaks.

The ECDC recommends implementing a system made up of the following phases: Preparatory, Pilot, and Implementation, in order to assess the risk of possible outbreaks and jump-start prevention. This three-phase system allows for health screening of all refugees based on the geographical locations of origin and visitation; vaccination and other health records review; and recruiting and training healthcare providers on data reporting. In addition, the ECDC stresses that it is imperative that all data be collected in a comprehensive and timely manner.

Following on an earlier report, the ECDC suggests that newly-arrived refugees should be screened for the following infectious diseases, based on country of origin where these diseases are known to be most prevalent:

• Diphtheria
• Typhoid fever
• Cholera
• Hepatitis A, E, B, and C
• Helminthiasis
• Leishmaniasis
• HIV
• Malaria
• Measles
• Tuberculosis
• Rabies

The ECDC also notes that there is a “risk of carriage of multidrug-resistant Gram-negative bacteria,” among refugee populations and aid workers need to be aware of this risk. Additionally, because of some of the living conditions for newly displaced refugees in many European countries, aid workers should be aware that refugees are also at risk of diseases that may be spread by lice or fleas.

In cases of missing healthcare records, refugees should be vaccinated for measles, mumps, and rubella, diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b. Vaccines that should be considered, but are not required, include those for hepatitis B, meningococcal disease, pneumococcal disease, varicella, influenza and tuberculosis.