Rapid risk assessment: Louse-borne relapsing fever in the Netherlands, 27 July 2015

Risk assessment
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European Centre for Disease Prevention and Control. Louse-borne relapsing fever in the Netherlands – 24 July, Stockholm, 2015.

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​Following reports from the Netherlands of two cases of louse-borne relapsing fever in asylum seekers coming from Eritrea, ECDC has assessed the risk to Europe. The occurrence of louse-borne relapsing fever in asylum seekers from Eritrea is not unexpected and further importation of cases might occur in the EU among migrants, in particular those sharing routes with migrants from endemic areas. A number of options for the prevention and control of louse-borne relapsing fever are presented.

Executive summary

​The Netherlands reported two cases of louse-borne relapsing fever (LBRF) found in asylum seekers coming from Eritrea. In its risk assessment, ECDC states that this is not unexpected and further importation of cases might occur in the EU among migrants, in particular those sharing routes with migrants from endemic areas. 
Once in the EU, according to the risk assessment, there is a risk of spread from infected individuals to homeless and other vulnerable population groups sharing the same living environment, particularly those in temporary housing in crowded environments.
 
Body lice infestations are linked to low socioeconomic status, over-crowding and poor personal hygiene. Migrants are vulnerable to body lice infestation due to challenging living conditions during migration and also after entry into the EU due to crowded conditions in temporary centres.

Options for prevention and control 
The options presented in the report include: preventing or minimising overcrowding of reception areas for migrants. Also, promoting and enabling adequate hygiene for migrants; checking for signs of lice infestations during medical screening, and carrying out delousing when required.  In addition, the report suggests raising awareness among clinicians of the possibility of LBRF among recently arrived migrants that might have been exposed during their journey, and vulnerable population groups who share the same living environment.

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