Rapid risk assessment: Shigellosis among refugees in the EU, 30 November 2015

Risk assessment
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European Centre for Disease Prevention and Control. Shigellosis among refugees in the EU – 26 November 2015, Stockholm: ECDC; 2015.

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​The current influx of refugees in Europe is increasing the pressure on healthcare and public health systems in the transit and destination countries. Refugees are vulnerable to infectious diseases because of the specific circumstances under which they live and therefore they require special attention.

The occurrence of shigellosis among refugees is not unexpected because shigellosis is endemic in the countries they originate from, as well as in some of the countries they travel through. Furthermore, poor hygiene conditions in refugee reception facilities promote the spread of the disease. Therefore, additional cases may occur in the EU within this vulnerable group.

Executive summary

​More than 80 cases of shigellosis have been diagnosed among refugees in EU countries between July and November this year. These countries include Austria, Greece, Germany, the Netherlands, Finland and Sweden. The occurrence of shigellosis among refugees is not unexpected as the disease is endemic in the countries of origin where people are fleeing from, as well as in some of the countries they travel through. The risk to the general population in Europe remains low.

Transmission of shigellosis often occurs via the faecal-oral route. Person-to-person transmission of Shigella is effective in crowded conditions where it is more difficult to maintain good personal hygiene. Therefore, refugees can be vulnerable to a Shigella infection as personal hygiene is difficult to maintain during travel, and they often encounter overcrowding during their journey and at reception facilities.

Since Shigella is well adapted to low temperatures, and transmission can also occur in the coldest months of the year, the number of shigellosis cases among refugees is unlikely to decrease in the coming months.

The risk to the general population in Europe of being affected by single cases or outbreaks of shigellosis among refugee populations remains low, since factors which contribute to the transmission such as compromised hygiene, overcrowding and limited access to clean water are specific to some refugee reception facilities. However, cleaners of the hosting facilities for incoming refugees, together with other workers and volunteers, should be considered at possible risk to shigellosis.

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