Immunization strategies targeting newly arrived migrants in Non-EU countries of the mediterranean basin and black sea

Background: The World Health Organization recommends that host countries ensure appropriate vaccinations to refugees, asylum seekers and migrants. However, information on vaccination strategies targeting migrants in host countries is limited. Methods: In 2015-2016 we carried out a survey among national experts from governmental bodies of 15 non-EU countries of the Mediterranean and Black Sea in order to document and share national vaccination strategies targeting newly arrived migrants. Results: Four countries reported having regulations/procedures supporting the immunization of migrants at national level, one at sub-national level and three only targeting specific population groups. Eight countries offer migrant children all the vaccinations included in their national immunization schedule; three provide only selected vaccinations, mainly measles and polio vaccines. Ten and eight countries also offer selected vaccinations to adolescents and adults respectively. Eight countries provide vaccinations at the community level; seven give priority vaccines in holding centres or at entry sites. Data on administered vaccines are recorded in immunization registries in nine countries. Conclusions: Although differing among countries, indications for immunizing migrants are in place in most of them. However, we cannot infer from our findings whether those strategies are currently functioning and whether barriers to their implementation are being faced. Further studies focusing on these aspects are needed to develop concrete and targeted recommendations for action. Since migrants are moving across countries, development of on-line registries and cooperation between countries could allow keeping track of administered vaccines in order to appropriately plan immunization series and avoid unnecessary vaccinations

Key dimensions for the prevention and control of communicable diseases in institutional settings. a scoping review to guide the development of a tool to strengthen preparedness at migrant holding centres in the EU/EEA

Migrant centres, as other institutions hosting closed or semi-open communities, may face specific challenges in preventing and controlling communicable disease transmission, particularly during times of large sudden influx. However, there is dearth of evidence on how to prioritise investments in aspects such as human resources, medicines and vaccines, sanitation and disinfection, and physical infrastructures to prevent/control communicable disease outbreaks. We analysed frequent drivers of communicable disease transmission/issues for outbreak management in institutions hosting closed or semi-open communities, including migrant centres, and reviewed existing assessment tools to guide the development of a European Centre for Disease Prevention and Control (ECDC) checklist tool to strengthen preparedness against communicable disease outbreaks in migrant centres. Among articles/reports focusing specifically on migrant centres, outbreaks through multiple types of disease transmission were described as possible/occurred. Human resources and physical infrastructure were the dimensions most frequently identified as crucial for preventing and mitigating outbreaks. This review also recognised a lack of common agreed standards to guide and assess preparedness activities in migrant centres, thereby underscoring the need for a capacity-oriented ECDC preparedness checklist tool

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

Factors Influencing the Accuracy of Infectious Disease Reporting in Migrants: A Scoping Review

We conducted a scoping review of literature to improve our understanding of the accuracy of infectious disease monitoring in migrants in the Europe. We searched PubMed for papers relevant to the topic including: case reports, observational and experimental studies, reviews, guidelines or policy documents; published after 1994. We identified 532 papers, 27 of which were included in the review. Legislation and right to access health care influence both the accuracy of rates and risk measures under estimating the at risk population, i.e., the denominator. Furthermore, the number of reported cases, i.e., the numerator, may also include cases not accounted for in the denominator. Both biases lead to an overestimated disease occurrence. Restriction to healthcare access and low responsiveness may cause under-detection of cases, however a quantification of this phenomenon has not been produced. On the contrary, screening for asymptomatic diseases increases ascertainment leading to increased detection of cases. Incompleteness of denominator data underestimates the at-risk population. In conclusion, most studies show a lower probability of under-reporting infectious diseases in migrants compared with native populations

National immunization strategies targeting migrants in six European countries

Over the last three years an unprecedented flow of migrants arrived in Europe. There is evidence that vaccine preventable diseases have caused outbreaks in migrant holding centres. These outbreaks can be favored by a combination of factors including low immunization coverage, bad conditions that migrants face during their exhausting journey and overcrowding within holding facilities. In 2017, we conducted an online survey in Croatia, Greece, Italy, Malta, Portugal and Slovenia to explore the national immunization strategies targeting irregular migrants, refugees and asylum seekers. All countries stated that a national regulation supporting vaccination offer to migrants is available. Croatia, Italy, Portugal and Slovenia offer to migrant children and adolescents all vaccinations included in the National Immunization Plan; Greece and Malta offer only certain vaccinations, including those against diphtheria-tetanus-pertussis, poliomyelitis and measles-mumps-rubella. Croatia, Italy, Malta and Portugal also extend the vaccination offer to adults. All countries deliver vaccinations in holding centres and/or community health services, no one delivers vaccinations at entry site. Operating procedures that guarantee the migrants' access to vaccination at the community level are available only in Portugal. Data on administered vaccines is available at the national level in four countries: individual data in Malta and Croatia, aggregated data in Greece and Portugal. Data on vaccination uptake among migrants is available at national level only in Malta. Concluding, although diversified, strategies for migrant vaccination are in place in all the surveyed countries and generally in line with WHO and ECDC indications. Development of procedures to keep track of migrants' immunization data across countries, development of strategies to facilitate and monitor migrants' access to vaccinations at the community level and collection of data on vaccination uptake among migrants should be promoted to meet existing gaps. The study was conducted in the framework of the CARE (''Common Approach for REfugees and other migrants' health") project (717217/CARE) that received funding from the EU health Programme (2014–2020). info:eu-repo/semantics/publishedVersio

Implementation of the One Health approach to fight arbovirus infections in the Mediterranean and Black Sea Region: Assessing integrated surveillance in Serbia, Tunisia and Georgia

Background In the Mediterranean and Black Sea Region, arbovirus infections are emerging infectious diseases. Their surveillance can benefit from one health inter-sectoral collaboration; however, no standardized methodology exists to study One Health surveillance. Methods We designed a situation analysis study to document how integration of laboratory/clinical human, animal and entomological surveillance of arboviruses was being implemented in the Region. We applied a framework designed to assess three levels of integration: policy/institutional, data collection/data analysis and dissemination. We tested the use of Business Process Modelling Notation (BPMN) to graphically present evidence of inter-sectoral integration. Results Serbia, Tunisia and Georgia participated in the study. West Nile Virus surveillance was analysed in Serbia and Tunisia, Crimea-Congo Haemorrhagic Fever surveillance in Georgia. Our framework enabled a standardized analysis of One Health surveillance integration, and BPMN was easily understandable and conducive to detailed discussions among different actors/institutions. In all countries, we observed integration across sectors and levels except in data collection and data analysis. Data collection was interoperable only in Georgia without integrated analysis. In all countries, surveillance was mainly oriented towards outbreak response, triggered by an index human case. Discussion The three surveillance systems we observed prove that integrated surveillance can be operationalized with a diverse spectrum of options. However, in all countries, the integrated use of data for early warning and inter-sectoral priority setting is pioneeristic. We also noted that early warning before human case occurrence is recurrently not operationally prioritized

What about migrant health? Some studies and research aimed at understanding health inequalities

Background and aim. Migrants are a potentially vulnerable group, and their health condition is influenced not only by the presence/absence of disease, but by some other determinants. The complexity and precariousness that characterize their migratory path, the linguistic and cultural differences, the living condition in hosting centers and the difficult to access health services, could make their health worst. The aim of the PhD research project is to study health status and health determinants, the health policies and practices about migr ants to know the situation and eventually propose some recommendations. Methods. Several projects have been activated, like a Web Survey started in collaboration with the ECDC (European Center for Disease Prevention and Control) and the Venice team (Vaccine European New Integrated Collaboration Effort) with the aim of investigating the policies vaccines offered to migrants in EU and EEA countries. Preliminary results. Twenty five countries of EU and EEA countries filled in the survey and two are finalising. Preliminary analysis shows a homogenous situation regarding legal framework/regulations supporting offer to vaccination: 25 countries offer vaccinations to children / adolescents (24 included it into the national immunization plan-NIP). There is a variability for adults as 14 countries offer vaccination in the NIP, 9 offer only some vaccinations, 2 don’t offer vaccinations. Differences between countries are observed regarding implementation of immunization strategies and recording of migrant’s immunization information data. Conclusions. The results show lack of harmonized strategies and procedures between EU and EEA countries. Given the potential vulnerability and mobility of the target population, it is important for countries to cooperate in order to improve the health of migrants. Studying the different national health policies, their differences and possible uniformity, is a strategic resource to improve the health of migrants

La copertura sanitaria universale nel mondo. Istruzioni per l’uso. Una logica di confronto

Il presente documento fornisce, nella prima parte, un inquadramento e introduzione al concetto della Copertura Sanitaria Universale e del suo monitoraggio per offrire,nella seconda parte, degli strumenti per una maggior fruibilità dei dati per Paese,presentati in appendice,e per la loro comparazion

TOPICAL ISSUE: HIV AND AIDS - IMPACT OF VOLUNTARY COUNSELLING AND TESTING AND HEALTH EDUCATION ON HIV PREVENTION AMONG SECONDARY SCHOOL STUDENTS IN NORTHERN UGANDA

The study aim was to evaluate the impact of Voluntary Counselling and Testing (VCT) and School Health Education (SHE) on HIV/AIDS related knowledge, behaviours and risk perception among secondary school students in Northern Uganda. A post-test only control group study was conducted among 1,312 secondary school students classified as follows: students involved in SHE and VCT (group 1); only in SHE (group 2); in neither VCT nor SHE (group 3, control group). Almost all students are aware of AIDS and condoms and how to prevent HIV infection: abstinence and condom use were the most reported preventive measures. About 60% of those in groups 2 and 3 were sexually active compared to 31% in group 1 (P<0.001). Students of group 3 had earlier sexual debut (median age=15) than those in group 2 (median age=16) (P<0.001). No significant differences in condom use with any type of partner were observed, although students in group 2 were more likely to report consistent condom use. Overall, two-third of the students say they do not feel they are at risk of infection, but almost 70% of them reported no reason. Despite considerable knowledge about AIDS, many students engage in unprotected sex and re thus at risk of infection . Students exposed to VCT and SHE seemed to have safer behaviour, suggesting that these programs should be expanded and further research should be conducted on the effects. SHE could be the appropriate method to reach youth and their families in poor-resources settings, whereas VCT could be the appropriate choice as part of a comprehensive service delivered to the users