Microbes on the move: infectious diseases in asylum seekers: Screening and vaccination policies

Part I - Multidrug-resistant organisms in asylum seekers
In the beginning of 2015, little was known regarding the prevalence of multidrug-resistant organisms (MDROs) in the migrant population. More clarity was needed which screening procedures for infectious diseases and MDRO would be appropriate to meet the healthcare needs of asylum seekers, while at the same time protecting other vulnerable patients in the host country. The first part of this thesis showed a higher prevalence of MDROs in the asylum seeker patient population compared to the general patient population, emphasizing for screening precautions upon admission in the hospitals. Asylum seekers carry these organism significantly longer than expected, indicating for continued screening precautions after arrival.

Part II – Screening and vaccination

The second part of this thesis focuses on the evaluation of screening and vaccination programs in the Netherlands and Europe. A preventive screening programme introduced in Ter Apel, the national reception center for asylum seeekers in the Netherlands, proved to be feasible and effective to reduce the burden of scabies. In addition to screening programmes, vaccination is another relevant tool to reduce the burden of infectious diseases in asylum seekers. All current vaccination policies implemented across Europe were examined and national vaccination experts were asked regarding their priorities en recommendations. These experts reported a considerable variation in vaccination policies across Europe. More clarity is needed on which vaccinations should be prioritized and that strategies or guidance for catch up vaccination are needed. They recommended providing vaccinations in multiple settings, and to be free of charge. Screening and vaccination programmes can be more effectively implemented when asylum seekers and refugees are involved in the development of such policies.