About the project
The susceptibility of refugees to infectious diseases depends on their country of origin as well as the routes and conditions of flight. In most cases, there is a lack of information about the specific medical needs of the respective refugee group. We investigated the prevalence of infectious diseases, immunity to vaccine-preventable diseases and chronic diseases in children, adolescents and adult refugees from Ukraine who arrived in Germany in 2022. The data collected enabled the identification of specific medical needs of these war refugees and the formulation of recommendations for public health and policy stakeholders.
With the help of various social media, we recruited Ukrainian refugees at 13 German locations from September to December 2022. The training and involvement of native-speaking interpreters in the recruitment process and the declaration of informed patient consent were crucial to the success of the project. An antigen test for infection with acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), serologies for a number of vaccine-preventable diseases and interferon-gamma release assays (IGRAs) for tuberculosis (TB) and SARS-CoV-2 were performed. We also analysed personal and family history of chronic diseases, infectious diseases, vaccination status and conditions during the flight.
This study enabled the establishment and validation of a complete infrastructure for the rapid medical examination of a large group of refugees in outpatient and inpatient settings, including shelters and shared accommodation. The concepts developed in NU(M)KRAINE for mobile recruitment and availability of equipment and logistics for diagnostic samples in such settings can be utilised for further development of the NUM, e.g. under new pandemic conditions with lockdown as well as regional public health facilities with responsibility for refugee accommodation.
Numerous infrastructural aspects, such as the interaction with grouping characteristics (refugee groups), the integration of IT-compatible questionnaires in several languages, the training and involvement of native-speaking interpreters in recruitment and informed patient consent, communication via social networks, the involvement and exchange with various regional health authorities under comparable conditions could be implemented. These will be useful in future prospective epidemiological studies. The project partners are currently submitting an EU application in which the aspects and experiences from NU(M)KRAINE will be incorporated into a transnational EU network for infectious diseases.
Highlights
A total of 1,793 refugees (1,401 adults and 392 children/young people) were included. Most participants were female (n=1,307; 72%) and came from eastern or southern Ukraine. The interferon-gamma release assay for tuberculosis was positive in 13% (n=184) of the adults and in 2% (n=7) of the children and was therefore abnormal. The serological immune response was insufficient for measles in about 21% (360/1793) of the participants, for diphtheria in 32% (572/1793) and for hepatitis B in 74% (1,289/1,793).
In conclusion, we found evidence of a low serological response to vaccine-preventable infections and an increased prevalence of latent tuberculosis in Ukrainian refugees. These results should be included in the guidelines for screening and treatment of infectious diseases in migrants and refugees in Germany and Europe. In addition, the low immunity to vaccine-preventable diseases among Ukrainians requires customised communication measures, regardless of their refugee status. These findings can serve as a guide for policy makers and public health professionals.