Life-course vaccinations for migrants and refugees. Drawing lessons from the COVID-19 vaccination campaigns

Covid-19 showed once more, and very evidently, that some disadvantaged subgroups, including mi- grants and refugees (M&Rs), are at higher risk of contracting a disease or suffering from its severe con- sequences in areas with high transmission [1,2]. This may be due to their living conditions, which make physical distancing difficult, and/or to their legal status, which may exclude them from health care services. Additionally, COVID-19 reminded us that M&Rs tend to also have suboptimal vaccination coverage compared to the general population due to several concurrent factors [3,4]: – exclusion from health and vaccination plans and systems, often due to a lack of legal entitlements to health care or due to administrative/residence barriers; – health system barriers due to language, lack of cultural sensitivity, lack of outreach and community engagement capacity, lack of collaboration with civil society organisations, barriers to primary care, and vaccination services access, including vaccination costs; – high mobility of M&Rs; – lack of confidence in the health system and misconceptions about the vaccine. We propose some elements useful for orienting the research agenda and generating debate based on the experience of the COVID-19 pandemic. While M&Rs experienced exclusion due to the pandemic in many contexts, in others, it has been an opportunity not just to maximise coverage, but also to set up, test, and implement new, effective, and replicable approaches in vaccination services

Malaria in an asylum seeker paediatric liver transplant recipient: diagnostic challenges for migrant population

Transplanted patients are particularly exposed to a major risk of infectious diseases due to prolonged immunosuppressive treatment. Over the last decade, the growing migration flows and the transplant tourism have led to increasing infections caused by geographically restricted organisms. Malaria is an unusual event in organ transplant recipients than can be acquired primarily or reactivation following immunosuppression, by transfusion of blood products or through the transplanted organ. We report a rare case of Plasmodium falciparum infection in a liver transplanted two years-old African boy who presented to one Italian Asylum Seeker Center on May 2019. We outlined hereby diagnostic challenges, possible aetiologies of post-transplantation malaria and finally we summarized potential drug interactions between immunosuppressive agents and antimalarials. This report aims to increase the attention to newly arrived migrants, carefully evaluating patients coming from tropical areas and taking into consideration also rare tropical infections not endemic in final destination countries

Baseline haematological and biochemical reference values for healthy male adults from Mali

Introduction: Haematological reference values are very important for diagnostic orientation and treatment decision. The aim of this study was to establish haematological reference values for Malian healthy adults. Methods: A cross-sectional study including 161 male Malians aged between 19 and 54 years old was performed. Median and reference ranges were calculated for haematological and biochemical parameters. Parametric student's t-test was used to determine any statistically significant differences by age, smoker status, body mass index (BMI) and occupation. Ranges were further compared with those reported for other African, Afro-American and Caucasian populations. Results: Increased levels of MCV, MCH, PLT and EOS were found in younger Malians who had abnormal BMI and altered platelets parameters. Notably, significantly lower eosinophil and monocyte counts were observed in Malians compared to Europeans The smoking status did not seem to directly affect RIs. Conclusion: This is the first study to determine normal laboratory parameters in Malian adult males. Our results underscore the necessity of establishing region-specific clinical reference ranges that would allow clinicians and practitioners to manage laboratory tests, diagnosis and therapies. These data are useful not only for the management of patients in Mali, but also to support European and American clinicians in the health management of asylum seekers and migrants from Mali

vaccination campaign strategies in recently arrived migrants experience of an italian reception centre

Introduction: Control of vaccine preventable diseases, while constituting a priority of European health policies, is challenged by migrations from countries with suboptimal levels of immunization coverage. We report here two different types of vaccination campaign strategy in one of the bigger Italian asylum seekers' centres. The vaccination service staff of the local national health institute came monthly during the first three years of observation, while in the last year, the vaccinations were offered directly upon arrival of migrants in the asylum seekers' centre. Methodology: we performed a descriptive cross-sectional study that analysed data collected from the database of the internal healthcare facility and ARVA Target tool, regarding vaccinations performed from 2013 to 2017 in the asylum seekers' centre. Results: In the four years of observation period the asylum seekers centre hosted 3941 migrants. Among them, 85% were vaccinated during their stay, for a total of 4252 vaccinations administered, covering 95% of minors and 85% of adults. During the study period, there was an important increase from an average of 10.5% of migrants vaccinated in the first three years to 66% in the last year, when vaccines were delivered directly upon arrival in the centre. Conclusions: To improve the rate of immunization in migrants, the first requirement is a strong collaboration with the local vaccine services and the second,vaccinations must be carried out when migrants arrive at the asylum seekers' centre, avoiding any delay

Migrants rescued on the Mediterranean Sea route: nutritional, psychological status and infectious disease control

Introduction: North Africa has become a key migratory hub where a large number of migrants attempt the journey by sea from the Libyan coastline to the south of Europe. In this humanitarian disaster scenario, the Mediterranean route has been one of the most used by illegal boats. Methodology: In this report, the state of physical and psychological health of a cluster of Eritrean migrants, escaped from Libya and rescued in the Mediterranean Sea after a shipwreck, was described by epidemiological, clinical and laboratory investigations. Results: Data suggest that despite the majority of the migrants being apparently in good health upon a syndromic surveillance approach, most of them suffered a decline in psychological status as well as severe malnutrition. The emergence of infectious diseases, related to poor living conditions during the journey, is not a rare event. Conclusion: The present report highlights the risks of failures of the syndromic medical approach in the setting of the extremely challenging migration route and underlines migrant frailties consequent to a prolonged journey and long period of detention. These stressors, which can degrade the initial health condition of traveling migrants, can lead to a premature "exhausted migrant effect" that should be carefully investigated in order to avoid the early emergence of diseases related to frailty

Prevalence of intestinal parasitic infections among asylum seekers

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Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy

Introduction: haematological reference values are very important for diagnostic orientation and treatment decision. The aim of this study was to establish haematological reference values for Malian healthy adults. Methods: a cross-sectional study including 161 male Malians aged between 19 and 54 years old was performed. Median and reference ranges were calculated for haematological and biochemical parameters. Parametric student's t-test was used to determine any statistically significant differences by age, smoker status, body mass index (BMI) and occupation. Ranges were further compared with those reported for other African, Afro-American and Caucasian populations. Results: increased levels of MCV, MCH, PLT and EOS were found in younger Malians who had abnormal BMI and altered platelets parameters. Notably, significantly lower eosinophil and monocyte counts were observed in Malians compared to Europeans The smoking status did not seem to directly affect RIs. Conclusion: this is the first study to determine normal laboratory parameters in Malian adult males. Our results underscore the necessity of establishing region-specific clinical reference ranges that would allow clinicians and practitioners to manage laboratory tests, diagnosis and therapies. These data are useful not only for the management of patients in Mali, but also to support European and American clinicians in the health management of asylum seekers and migrants from Mali

Mutilazioni genital femminili. Tradizione, diffusione, complicanze, trattamenti

Centrale al presente studio è il tema della mutilazione degli organi genitali femminili (qui indicata con l’acronimo di MGF), altrimenti nota come infibulazione, una pratica radicata nelle tradizioni e culture di alcune popolazioni asiatiche e africane, rimasta immutata per secoli e protetta da grande riservatezza. Tuttavia, dalla fine del secolo scorso, con le migrazioni verso i paesi occidentali, in Europa la questione delle MGF è salita alla ribalta dell’interesse scientifico e medico, soprattutto a causa delle complicanze osservate nelle donne che ne sono portatrici, al tempo stesso generando una problematica clinica abbastanza frequente. Le MGF riguardano tutte le pratiche che comportano la parziale o totale rimozione degli organi genitali femminili esterni per ragioni non mediche. È una pratica che danneggia la salute e il tessuto genitale femminile, causando interferenze con le naturali funzioni dell’organismo della donna. Inoltre è molto dolorosa e ha effetti sulla salute sia a breve che a lungo termine, tra cui sterilità o problemi durante il parto. Rappresenta una pratica pre-islamica, già in uso nell’antico Egitto e radicata prevalentemente in Africa, dal Mediterraneo alla fascia equatoriale. Attualmente le MGF sono praticate principalmente in 28 paesi dell’Africa sub-sahariana e nello Yemen e si ha certezza di casi di MGF in Kurdistan iracheno, Indonesia, Arabia Saudita, Malesia. A seguito delle migrazioni, oggi si riscontrano casi anche in Europa, Australia, Canada, Nuova Zelanda e Stati Uniti. L’Organizzazione Mondiale della Sanità ha stimato che 130 milioni di donne nel mondo, in anni recenti, siano state sottoposte a tali pratiche e che ogni anno circa 3 milioni di bambine siano a rischio. In Italia le donne che hanno ricevuto tale trattamento sono circa settantamila, al 2014. Si tratta di una pratica caratteristica – con diverse varianti – di società a struttura patriarcale condizionate da dinamiche sociali che costringono le famiglie a perpetuare l’usanza sulle loro figlie al fine di non subire sanzioni sociali e giudizi morali. In queste comunità, specialmente quelle più povere, l’onore familiare, l’educazione e il raggiungimento di una determinata condizione sociale sono necessari alla sopravvivenza, e poiché la castità della donna è al centro dello schema sociale, è difficile per le famiglie, e ancor più per le bambine stesse, sottrarsi alla pratica o decidere spontaneamente di rifiutarla. Come la circoncisione maschile, anche le MGF sono vissute e difese come “usanza popolare”, una normale pratica igienico-religioso-tradizionale. Così, ad esempio, da molti americani di origine islamica o ebraica, la pratica della circoncisione è ritenuta “normale” nei maschi, mentre l’infibulazione, a causa delle possibili gravi complicanze cliniche è giudicata e condannata dall’opinione pubblica occidentale. L’OMS definisce le MGF “…una violazione dei diritti fondamentali delle donne e delle bambine, perché ledono il loro diritto alla salute, alla sicurezza e all’integrità fisica, il diritto a essere libere dalla tortura e da trattamenti crudeli, disumani o degradanti; e anche lo stesso diritto alla vita, qualora la procedura conduca a morte, (16). Tale pratica ha natura discriminatoria e assegna alle bambine e alle donne una posizione di subordinazione all’interno della famiglia e della società tribale” (17). Questa prospettiva trova mille espressioni di rigetto, in Europa come negli Stati Uniti, dove la radice di questa impossibilità ad accettare tali pratiche si può far risalire al discorso di Theodor Roosevelt sullo Stato dell’Unione del 6 gennaio 1941, nel quale il Presidente degli Stati Uniti enunciava la famosa dottrina “delle quattro libertà”: la libertà di parola e di espressione, la libertà di culto, la libertà dal bisogno e quella dalla paura. Per quanto riguarda il presente lavoro, la libertà dalla paura significa adoperarsi per creare un mondo non solo più giusto, ma anche libero dal fardello di rituali antichi, spesso dolorosi e penalizzanti, dei quali sovente – come nel caso delle mutilazioni genitali – sono le donne a pagare il prezzo più alto