Assessing the burden of key infectious diseases affecting migrant populations in the EU/EEA

Technical report
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European Centre for Disease Prevention and Control. Assessing the burden of key infectious diseases affecting migrant populations in the EU/EEA. Stockholm: ECDC; 2014.

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​Migrant health is receiving increasing attention in Europe and is a priority for ECDC. This report presents the main findings of an ECDC project to assess the burden of infectious diseases among migrants in the EU/EEA based on available data for specific diseases: human immunodeficiency virus (HIV), tuberculosis (TB), hepatitis B, hepatitis C, gonorrhoea, syphilis, measles and rubella, malaria and Chagas disease.

Drawing overall conclusions about infectious diseases and migrants in the EU/EEA is challenging, as patterns and trends vary considerably, depending on the disease in question. This is confounded by the diversity of migrants, varying definitions of migrants and the changing patterns of migration both to and within Europe.
Some of the conclusions which became evident from an analysis of the data are that migrant populations in the EU/EEA are disproportionately affected by HIV and TB but not by gonorrhoea or syphilis; that hepatitis B, particularly chronic hepatitis infection, is an issue in migrant populations although definitive conclusions cannot be drawn about the burden of hepatitis C as data on acute and chronic infections are limited; that the lack of information on ‘country of birth’ for measles and rubella cases in TESSy makes it impossible to draw conclusions on the occurrence of measles or rubella among migrants; that some sub-groups of migrants, particularly those visiting malaria-endemic countries of origin, are at high risk of acquiring malaria and that Chagas disease has occurred in Europe as a result of migration from endemic countries in Latin America.

Executive summary

The report ‘Assessing the burden of infectious diseases among migrant populations in the EU/EEA’, finds that at a population level most migrants are healthy, and are only more affected by certain diseases such as HIV and tuberculosis (TB).

For example, migrants represented 40% of reported cases of HIV in the EU/EEA between 2007 and 2011, with growing evidence that some migrant populations are at risk of acquiring HIV infection after arrival in the EU/EEA.

Compared to native-born persons, migrants in the EU are also diagnosed with HIV later and show a poorer clinical outcome. Migrants in many settings across Europe face legal, administrative, cultural and linguistic barriers when they try to get tested for HIV. Which is why more efforts are needed across Europe to achieve a better uptake of testing among this group and address the difference in late diagnosis observed compared to non-migrants.

Although migrant populations are also more affected by TB, with 25% of cases in 2010 occurring among migrants, the report finds that these populations do not increase the risk of TB among native populations. Available data also suggests that multidrug-resistant TB is less common in migrants and that TB disease occurs at a younger age when compared to non-migrants.

This is the first comprehensive report on the burden of infectious diseases among migrants in the EU/EEA that covers; HIV, TB, hepatitis B and C, gonorrhoea, syphilis, measles and rubella, malaria and Chagas disease, taking data from the European Surveillance System.
 
The report highlights the need for better data collection and more research to improve understanding of the epidemiology of infectious diseases among migrants in Europe, and ECDC is currently developing a project which will support Member States with this.