Comprehensive infectious disease screening in a cohort of unaccompanied refugee minors in Germany from 2016 to 2017: A cross-sectional study


Autoři: Ales Janda aff001;  Kristin Eder aff001;  Roland Fressle aff002;  Anne Geweniger aff001;  Natalie Diffloth aff001;  Maximilian Heeg aff001;  Nadine Binder aff004;  Ana-Gabriela Sitaru aff006;  Jan Rohr aff001;  Philipp Henneke aff001;  Markus Hufnagel aff001;  Roland Elling aff001
Působiště autorů: Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Freiburg, Germany aff001;  Practice for Childhood and Adolescent Medicine, Freiburg, Germany aff002;  Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany aff003;  Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany aff004;  Institute of Digitalization in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Germany aff005;  Center of Laboratory Diagnostics, MVZ Clotten, Freiburg, Germany aff006;  Berta Ottenstein Programme, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany aff007
Vyšlo v časopise: Comprehensive infectious disease screening in a cohort of unaccompanied refugee minors in Germany from 2016 to 2017: A cross-sectional study. PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003076
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003076

Souhrn

Background

Information regarding the prevalence of infectious diseases (IDs) in child and adolescent refugees in Europe is scarce. Here, we evaluate a standardized ID screening protocol in a cohort of unaccompanied refugee minors (URMs) in a municipal region of southwest Germany.

Methods and findings

From January 2016 to December 2017, we employed a structured questionnaire to screen a cohort of 890 URMs. Collecting sociodemographic information and medical history, we also performed a standardized diagnostics panel, including complete blood count, urine status, microbial stool testing, tuberculosis (TB) screening, and serologies for hepatitis B virus (HBV) and human immunodeficiency virus (HIV). The mean age was 16.2 years; 94.0% were male, and 93.6% originated from an African country. The most common health complaints were dental problems (66.0%). The single most frequent ID was scabies (14.2%). Of the 776 URMs originating from high-prevalence countries, 7.7% and 0.4% tested positive for HBV and HIV, respectively. Nineteen pathogens were detected in a total of 119 stool samples (16.0% positivity), with intestinal schistosomiasis being the most frequent pathogen (6.7%). Blood eosinophilia proved to be a nonspecific criterion for the detection of parasitic infections. Active pulmonary TB was identified in 1.7% of URMs screened. Of note, clinical warning symptoms (fever, cough >2 weeks, and weight loss) were insensitive parameters for the identification of patients with active TB. Study limitations include the possibility of an incomplete eosinophilia workup (as no parasite serologies or malaria diagnostics were performed), as well as the inherent selection bias in our cohort because refugee populations differ across Europe.

Conclusions

Our study found that standardized ID screening in a URM cohort was practicable and helped collection of relevant patient data in a thorough and time-effective manner. However, screening practices need to be ameliorated, especially in relation to testing for parasitic infections. Most importantly, we found that only a minority of infections were able to be detected clinically. This underscores the importance of active surveillance of IDs among refugees.

Klíčová slova:

Diagnostic medicine – Europe – Germany – Hepatitis B virus – HIV – Parasitic diseases – Tuberculosis – Eosinophilia


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