Migration and Outbreaks of Vaccine-Preventable Disease in Europe: A Systematic Review

Abstract

AbstractBackgroundMigrant populations (defined as foreign-born) are one of several under-immunised groups in the EU/EEA, yet little is known about how they are affected by outbreaks of vaccine-preventable diseases (VPDs). This information is vital to develop targeted strategies to improve the health of diverse migrant communities and to assess risk factors and correlations with major European peaks in incidence of key VPDs over time.MethodsWe did a systematic review (PROSPERO CRD42019157473; Medline, EMBASE, and Global Health January 2000 to October 2019) adhering to PRISMA guidelines, to identify studies on VPD outbreaks (measles, mumps, rubella, diphtheria, pertussis, polio, hepatitis A,N meningitidis, andH influenzae) in migrants residing in the EU/EEA and Switzerland.Results45 studies were included, reporting on 47 distinct VPD outbreaks across 13 countries (26 [55%] were reported between 2010 and 2020, including 16 [34%] since 2015). Most reported outbreaks involving migrants were of measles (n=24; 6578 total cases), followed by varicella (n=11; 596 cases), hepatitis A (n=7; 1510 cases), rubella (n=3; 487 cases) and mumps (n=2; 295 cases). 19 (40%) of outbreaks, predominantly varicella and measles, were reported in temporary camps or shelters for asylum seekers and refugees. Of 11 varicella outbreaks, 82% were associated with adult migrants. Half of measles outbreaks (n=12) were associated with migrants from Eastern European countries, often involving migrants of Roma ethnicity.ConclusionsMigrants represent one of several under-immunised groups involved in VPD outbreaks in Europe, with adult and child refugees and asylum seekers residing in shelters or temporary camps at particular risk, alongside specific nationality groups. Vulnerability varies by disease, setting, and individual demographics, highlighting the importance of tailoring strategies for implementing catch-up vaccination to specific groups, alongside the strengthening of routine data collection, in order to meet regional and global vaccination targets. Better understanding vaccine uptake and demand issues in migrant groups, and reducing the barriers they face to accessing vaccination services, is urgently needed, with direct implications for COVID-19 vaccine delivery at the current time. Strengthening vaccine delivery to migrant populations will require a greater focus on co-designing vaccine uptake strategies in close collaboration with affected communities.FunderNIHR