National immunization strategies targeting migrants in six European countries

Over the last three years an unprecedented flow of migrants arrived in Europe. There is evidence that vaccine preventable diseases have caused outbreaks in migrant holding centres. These outbreaks can be favored by a combination of factors including low immunization coverage, bad conditions that migrants face during their exhausting journey and overcrowding within holding facilities. In 2017, we conducted an online survey in Croatia, Greece, Italy, Malta, Portugal and Slovenia to explore the national immunization strategies targeting irregular migrants, refugees and asylum seekers. All countries stated that a national regulation supporting vaccination offer to migrants is available. Croatia, Italy, Portugal and Slovenia offer to migrant children and adolescents all vaccinations included in the National Immunization Plan; Greece and Malta offer only certain vaccinations, including those against diphtheria-tetanus-pertussis, poliomyelitis and measles-mumps-rubella. Croatia, Italy, Malta and Portugal also extend the vaccination offer to adults. All countries deliver vaccinations in holding centres and/or community health services, no one delivers vaccinations at entry site. Operating procedures that guarantee the migrants’ access to vaccination at the community level are available only in Portugal. Data on administered vaccines is available at the national level in four countries: individual data in Malta and Croatia, aggregated data in Greece and Portugal. Data on vaccination uptake among migrants is available at national level only in Malta. Concluding, although diversified, strategies for migrant vaccination are in place in all the surveyed countries and generally in line with WHO and ECDC indications. Development of procedures to keep track of migrants’ immunization data across countries, development of strategies to facilitate and monitor migrants’ access to vaccinations at the community level and collection of data on vaccination uptake among migrants should be promoted to meet existing gaps.     

兵团流动人口医疗保障现状分析

摘要:目的　描述兵团流动人口享有医疗保障的现状,为相关部门制定政策提供参考依据。方法　利用“2013年全国流动人口动态监测”中4000名调查对象的调查问卷。结果　兵团流动人口的职工医保、居民医保、商业医保参保率分别为8.1%、20.9%和3.3%。流动人口医疗保险参保率为28.6%。不同民族、年龄、文化程度、职业、户籍性质、户籍地、流入原因、个人月收入、流动范围、就业身份、居住时间的流动人口的医保参保率有统计学差异（P＜0.05）。结论　兵团流动人口医疗保险的参保率低,需建立完善的兵团流动人群医疗保障体系;不同特征兵团流动人口医保参保率差异较大,需关注重点人群。     

社会融合对流动人口基本公共卫生服务利用的影响分析

目的 通过分析流动人口社会融合及基本公共卫生服务利用的现状,探究社会融合对基本公共卫生服务利用的影响,为改进流动人口基本公共卫生服务利用现状提出建议。 方法 收集2017年全国流动人口卫生计生动态监测数据中流入时间≥6个月的99 494名流动人口的相关数据,对流动人口社会融合及基本公共卫生服务利用现状进行描述性分析,并使用分层logistic回归探究社会融合对基本公共卫生服务利用的影响。结果 在99 494名流动人口中,有36 837人已在流入地建立了健康档案,建档率为37.0%; 75 540人在流入地接受过健康教育,健康教育接受率为75.9%; 社会融合的四个维度中,家庭平均月收入(β= -0.108、-0.085,P<0.001)、家庭平均月支出(β= -0.061、-0.126,P<0.001)、是否有医保(β= 0.349、0.294,P<0.001)、是否在本地参加过工会等组织活动(β= 0.956、0.489,P<0.001)等变量会影响流动人口利用健康档案和健康教育服务。 结论 流动人口的健康档案建立率较低,流动人口健康教育接受情况较好但仍需提升; 流动人口的社会融合情况会影响其利用基本公共卫生服务。     

流动人口就医决策代际差异及其影响因素分析

目的 比较老一代和新生代流动人口就医决策差异及其影响因素,为促进流动人口主动就医提供建议.方法 采用2017年全国流动人口动态监测调查数据,运用x2检验和二元logistic回归方法分析两代流动人口就医决策差异及影响因素.结果 纳入有效样本10042人,新老两代流动人口患病后选择主动就诊的比例分别为58.3％、61.2...     

Blind spots and adverse conditions of care: screening migrants for tuberculosis in France and Germany

Tuberculosis (TB) is an infectious disease that declined significantly throughout the 20(th) century. Large-scale TB screening of entire populations in France and Germany has thus been replaced by active screening of risk-groups, particularly migrants. The article engages with its problems and practices on three levels: by looking at the way information on migrants as an at-risk group is produced through disease surveillance data; by analysing how such at-risk group data influence local screening practices; and by showing which political and medical problems arise in the field. I overturn the discussion about screening and surveillance of migrants as a risk-group by showing that it is not the stigmatisation of migrants through disease risk that is most at stake, but the invisibility of the most vulnerable among them in disease surveillance data and the way restrictive national immigration policies interfere with and subvert local screening and treatment practices targeting them. The aim of my article is to promote a pragmatic sociology of screening, while paying attention to the practical complexities, political conditions and medical ambivalences of screening and follow-up care, especially when the migrant groups concerned are socially, politically and medically vulnerable.     

Responding to diversity: an exploratory study of migrant health policies in Europe

There has been growing international attention to migrant health, reflecting recognition of the need for health systems to adapt to increasingly diverse populations. However, reports from health policy experts in 25 European countries suggest that by 2009 only eleven countries had established national policies to improve migrant health that go beyond migrants' statutory or legal entitlement to care. The objective of this paper is to compare and contrast the content of these policies and analyse their strengths and limitations. The analysis suggests that most of the national policies target either migrants or more established ethnic minorities. Countries should address the diverse needs of both groups and could learn from "intercultural" health care policies in Ireland and, in the past, the Netherlands. Policies in several countries prioritise specific diseases or conditions, but these differ and it is not clear whether they accurately reflect real differences in need among countries. Policy initiatives typically involve training health workers, providing interpreter services and/or 'cultural mediators', adapting organizational culture, improving data collection and providing information to migrants on health problems and services. A few countries stand out for their quest to increase migrants' health literacy and their participation in the development and implementation of policy. Progressive migrant health policies are not always sustainable as they can be undermined or even reversed when political contexts change. The analysis of migrant health policies in Europe is still in its infancy and there is an urgent need to monitor the implementation and evaluate the effectiveness of these diverse policies.     

Evolution of strategy and coverage rates for hepatitis B vaccination in France, a country with low endemicity

Both HBV plasma derived vaccines and HBV recombinant vaccines have proved safe and highly immunogenic. In France, exhaustive population surveys have revealed a vaccine coverage rate of over 21.7% and very low three-dose vaccine coverage among infants (19.8%), children (23.3%), and adolescents. Among hospital staff, around 80 to 90% of physicians and health care personnel in public or private hospitals were vaccinated against hepatitis B and the level of coverage was higher among personnel accidentally exposed to blood (90 to 100%). Among risk groups, the specific prevention program against mother-infant transmission was unevenly applied, and between 25 to 45% of intravenous drug abusers, prisoners, or STD patients were vaccinated. These coverage rates are inadequate to obtain a significant reduction and control of hepatitis B infections in France. The complete eradication of HBV transmission might take another 20 years to achieve unless great efforts are made to vaccinate the general population (infants especially) and high-risk groups.     

Migrant participation in Norwegian health care. A qualitative study using key informants

Abstract

Background: Little is known about how migrants adapt to first-world public health systems. In Norway, patients are assigned a registered general practitioner (RGP) to provide basic care and serve as gatekeeper for other medical services. Objectives: To explore determinants of migrant compliance with the RGP scheme and obstacles that migrants may experience. Methods: Individuals in leadership positions within migrant organizations for the 13 largest migrant populations in Norway in 2008 participated in this qualitative study. Semi-structured interviews, with migrants serving as key informants, were used to elucidate possible challenges migrant patients face in navigating the local primary health-care system. Conversations were structured using an interview guide covering the range of challenges that migrant patients meet in the health-care system. Results: According to informants, integration into the RGP scheme and adequacy of patient-physician communication varies according to duration of stay in Norway, the patient's country of origin, the reason for migration, health literacy, intention to establish permanent residence in Norway, language proficiency, and comprehension of information received about the health system. Informants noted as obstacles: doctor-patient interaction patterns, conflicting ideas about the role of the doctor, and language and cultural differences. In addressing noted obstacles, one strategy would be to combine direct intervention by migrant associations with indirect intervention via the public-health system.

Conclusion: Our results will augment the interpretation of forthcoming quantitative data on migrant integration into the public-health system and shed light on particular obstacles.     

劳务工预防乙肝相关知识知晓情况及健康教育需求的调查分析

目的 了解龙岗区劳务工对预防乙型病毒性肝炎(简称乙肝)相关知识的掌握情况,为今后开展有针对性的预防乙肝健康教育提供科学依据.方法 自行设计调查问卷,随机选取深圳市龙岗区某工厂412名工人为调查对象,进行一般情况、乙肝防治知识、乙肝预防措施、乙肝相关知识和相关知识需求方式的调查.结果 该工厂工人乙肝防治知识知晓水平较低.在乙肝传播途径方面,如“与得了乙肝的人很近地说话”能否传染,认为不能传染的只占25.2％；“与得了乙肝的人共用澡盆”能否传染,认为不能传染的只占24.5％；认为“蚊虫叮咬”不能传染乙肝的只占10.7％,认为能传染的则占80.6％.总体而言,乙肝防治知识的接受和掌握情况在性别、年龄、文化程度间存在差异.就宣传资料需求而言,92.2％的劳务工人想得到一些预防乙肝宣传资料,其中最想得到的宣传材料依次是音像制品(55.4％)、文字材料(52.4％)和以图画为主的宣传材料(32.0％).结论 劳务工乙肝防治知识水平较低,应加大劳务工人乙肝传播途径方面知识的健康教育.     

Health care access for refugees and immigrants with precarious status: public health and human right challenges

Migration flux is being transformed by globalization, and the number of people with either undocumented or with a precarious status is growing in Canada. There are no epidemiological data on the health and social consequences of this situation, but clinicians working in primary care with migrants and refugees are increasingly worried about the associated morbidity. This commentary summarizes findings from a pilot study with health professionals in the Montreal area and suggests that the uninsured population predicament is a national problem. Although ethical and legal issues associated with data collection by clinicians, institutions and governments need to be examined, estimating the public health consequences and long-term cost associated with problems in access to health care due to migratory status should be a priority. Current regulations and administrative policies appear to be at odds with the principles of equal rights set out by the Canadian Charter of Rights and Freedoms and the UN Convention on the Rights of the Child. Beyond the commitment of individual clinicians, Canadian medical associations should take an advocacy role and scrutinize the ethical and medical implications of the present system.     

Hepatitis B prevalence in the Turkish population of Arnhem: implications for national screening policy?

Despite the increased prevalence of hepatitis B and C in most migrant groups in The Netherlands, a national screening policy for these infections is not available. In order to estimate the prevalence of hepatitis B and C in the largest group of first-generation migrants (FGM) in The Netherlands, we conducted a screening project in the Turkish community of Arnhem. In a separate project we identified patients from the target population with chronic hepatitis B and C from hospital records (1990-2008). Educational meetings concerning hepatitis were organized, with all participants being offered a blood screening test. Participants were tested for hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc) and antibodies to hepatitis C virus (anti-HCV). In total 709 persons were tested, a complete dataset was available for 647 patients. We found that 3·0% and 0·4% of Turkish FGM aged >24 years in Arnhem had active hepatitis B, defined as HBsAg positive, and tested positive for anti-HCV, respectively. The hospital records revealed another 32 patients, 28 with hepatitis B and four with hepatitis C representing 0·7% for hepatitis B and 0·1% for hepatitis C in relation to the total number of Turkish FGM in Arnhem. We believe that active hepatitis screening of FGM from Turkey should be part of the national health policy as it will benefit the individual and public health.     

Features of public healthcare services provided to migrant patients in the Eastern Macedonia and Thrace Region (Greece)

BackgroundThe influx of migrants, refugees and asylum-seekers into European Union (EU) countries, especially into Greece, in the last 20 years is an issue of growing concern and requires a rational approach. The aim of this study is to chart the use of public health services by the migrants of the Eastern Macedonia and Thrace Region, which forms the northeastern border of Greece.MethodsWe collected data from five of the six public hospitals in the specified region, and we carried out a per clinic cross tabulation analysis of admission diagnosis and citizenship variables in order to establish the frequency at which the various diagnoses emerge per distinct group of migrant and non-migrant patients in each clinic. The main limitation of the study was the lack of age-standardised data. An additional analysis of frequencies per clinic focusing on migrant patients yielded hospitalisation frequencies per country of origin. We also performed a t-test to compare the average length of stay per clinic between the two groups. Finally, we utilised our available data to map the insurance status of migrant patients.ResultsThe results have indicated that the hospitalisation rate of migrant patients due to chronic medical conditions is statistically significantly lower compared to non-migrant patients, while the opposite is true when looking at accident-related diagnoses, certain infectious diseases and medical conditions pertaining to depression and alcohol abuse. The comparisons of the average length of stay showed no overall differences between migrants and non-migrants. Only 2.04% of the migrant patients were uninsured.ConclusionsOne of the key issues raised by the influx of migrants settling in host countries is concerned with health policy. The knowledge afforded by the medical parameters that characterise the provision of healthcare to them and the findings of relevant studies can lead to a more efficient identification of health risk factors and more effective prevention and treatment. This knowledge also constitutes a particularly crucial and useful tool to help authorities shape their healthcare policies and modify national health systems, which are currently based on the size and characteristics of indigenous populations, to take into account the different conditions with regard to both the number of patients treated and the epidemiological characteristics of the migrants. A greater appreciation of the particular current and potential roles of non-governmental organisations (NGOs) can help to provide appropriate healthcare services to migrants, refugees and asylum-seekers, especially when these groups are excluded from the public health system.     

2009年深圳市外来劳务工血清乙肝标志物与HBV-DNA的检测分析

目的了解深圳市外来劳务工乙肝病毒的感染情况,探讨劳务工血清乙肝标志物与乙肝DNA之间的关系。方法利用ELISA法对235份深圳市外来劳务工的血清标本进行乙肝五项检测,并应用实时荧光定量PCR法检测乙肝患者的HBV-DNA水平。结果在235例感染乙肝病毒的外来劳务工中,30岁以下劳务工患者占总的乙肝病毒感染人数的74.89%。大三阳（1,3,5阳性）和小三阳（1,4,5阳性）患者占劳务工乙肝患者总数的77.45%,其乙肝DNA的检出率分别为97.8%和68.8%,HBsAg（＋）和HBcAb（＋）患者的HBV-DNA的阳性率为76.5%。结论乙肝五项不足以真实反映乙肝患者的病毒复制水平,对于年青外来劳务工乙肝五项异常者必须进行DNA测定以正确判断患者的传染性,从而为乙肝的防控和治疗提供依据。     

Are migrants health policies aimed at improving access to quality healthcare? An analysis of Spanish policies

Although until April 2012, all Spanish citizens regardless of their origin, residence status and work situation were entitled to health care, available evidence suggested inadequate access for immigrants. Following the Aday and Andersen model, we conducted an analysis of policy elements that affect immigrants’ access to health care in Spain, based on documentary analysis of national policies and selected regional policies related to migrant health care. Selected documents were (a) laws and plans in force at the time containing migrant health policies and (b) evaluations. The analysis included policy principles, objectives, strategies and evaluations. Results show that the national and regional policies analyzed are based on the principle that health care is a right granted to immigrants by law. These policies include strategies to facilitate access to health care, reducing barriers for entry to the system, for example simplifying requirements and raising awareness, but mostly they address the necessary qualities for services to be able to attend to a more diverse population, such as the adaptation of resources and programs, or improved communication and training. However, limited planning was identified in terms of their implementation, necessary resources and evaluation. In conclusion, the policies address relevant barriers of access for migrants and signal improvements in the health system's responsiveness, but reinforcement is required in order for them to be effectively implemented.     

COVID-19 en migrantes y minorías étnicas

There are still few publications that analyse the effects on migrants or ethnic minorities of COVID-19 or of measures taken to curb this pandemic, although early studies point to a greater impact on black, asian and ethnic minority populations in the UK or on migrants in Mexico. In addition to barriers to access to information and health services, we consider it a priority to focus on their living conditions, particularly those in situations of vulnerability or social exclusion. People who are unemployed or with precarious jobs, without social benefits, in overcrowded conditions, may be more at risk of infection and not receiving adequate treatment. Confinement has predictably more negative impact on migrants in irregular administrative situations, victims of gender-based violence and those unable to comply with physical estrangement measures, such as refugees in camps or migrants under-living and settlements, without adequate hygienic conditions. Recommendations such as suspending deportations, extending or facilitating residence and work permits, closing detention centres for foreign persons, evacuating those in prisons and refugee camps or settlements have been applied unequally in different countries. Only a strong political commitment to global health equity can ensure the health of migrant populations and ethnic minorities, as well as their access to protection measures, information, medical testing and health services.Keywords: Migrants, COVID-19, Minority Groups, Vulnerable Populations, Social Determinants of Health.     

Factors associated with hepatitis B virus immunization coverage at the beginning of a population campaign in the Lazio region, Italy.

BACKGROUND: The hepatitis B virus (HBV) vaccination was introduced in Italy in 1991 as compulsory among newborns and among 11-year-old children. METHODS: We conducted a retrospective study to evaluate the HBV immunization coverage of the two target populations by the public health services in the Lazio region and to analyze factors associated with starting and completing HBV immunization in the initial period of the campaign. We used data registered in the public health services of 7/51 Health Districts. As a proxy indicator of services' performance we used the "expected immunization period," that is, the 6-month period in which each child should have been started on immunization, according to the calendar. RESULTS: HBV vaccine coverage rates were 63% in the younger cohort and 50% in the older one. The results of univariate and multivariate regression analysis showed that starting HBV immunization was associated with being newborn (crude OR = 3.30; 95%CI 2.17-2.44), with living in a small city (crude OR = 6.81; 95%CI 6.12-7.58), and with being assigned to the second (crude OR = 1.77; 95%CI 1.65-1.90) or to the third 6-month period of the expected immunization period (crude OR = 2.58; 95%CI 2.42-2.76). The probability of completing HBV immunization was higher among children who had had the first dose "age-appropriately" or with "acceptable delay" and among those living in small cities. It was lower among children in the second or the third 6-month period. Size of urban area of residence was associated with both outcomes: the city of Rome showed the lowest probabilities of starting and completing HBV immunization, while the small cities showed the highest ones. CONCLUSIONS: The performance of public health services was the most important determinant of recourse to public health services for vaccinations; it varied according to size of urban area; in towns organization difficulties contributed to the delay of starting vaccination, for at least a year. The expected immunization period was a good proxy indicator of services' performance. The timing of the first dose was the strongest predictor of completing vaccination also at the beginning of the campaign.     

社会融合对流动老人基本公共卫生服务利用的影响研究

目的 了解流动老人基本公共卫生服务利用情况,以及社会融合对基本公共卫生服务利用的影响。方法 于2021年7—12月,采用方便抽样的方法,抽取广州市、深圳市、江门市452名流动老人进行问卷调查。采用二元logistic回归模型分析流动老人社会融合对建立健康档案、接受健康教育和老年人健康管理之间的影响。结果 在452名流动老人中,60.8%建立了居民健康档案,接受过健康教育和老年人健康管理的分别有64.4%和60.0%。Logistic分析结果显示,流动老人的居民健康档案行为受到月消费水平（B = 0.368,P＜0.05）、社区文体活动参与程度（B = 0.362,P＜0.01）、居留意愿（B = 0.408,P＜0.001）、年龄（B = - 0. 513,P＜0.01）、户籍类型（B = 0.742,P＜0.01）、流动类型（B = - 0.539,P＜0.05）等变量的影响;健康教育服务利用行为受到社区文体活动参与程度（B = 0.354,P＜0.01）、年龄（B = - 0.411,P＜0.05）、户籍类型（B = 0.561,P＜0.05）的影响;老年人健康管理服务利用行为受到社区文体活动参与程度（B = 0.291,P＜0.01）、居留意愿（B = 0.239,P＜0.05）、年龄（B = - 0.474,P＜0.05）、流动类型（B = - 0.471,P＜0.05）、流动时间（B = 0.225,P＜0.05）、流动目的（B = 0.328,P＜0.01）的影响。结论 流动老人基本公共卫生服务利用率较低,社会融合会对流动老人的基本公共卫生服务利用产生积极影响。可以通过提高流动老人获得基本公共卫生服务的能力和社会融合水平来促进流动老人的基本公共卫生服务利用,从而实现基本公共服务均等化。     

Evidence of divergence with duration of residence in circulatory disease mortality in migrants to Australia

BACKGROUND: Very little is known about how acculturation affects health in different societal settings. Using duration of residence, this study investigates acculturation and circulatory disease mortality among migrants in Australia. METHODS: Data from death records, 1998-2002, and from 2001 Census data were extracted for seven migrant groups [New Zealand; United Kingdom (UK)/Ireland; Germany; Greece; Italy; China/Singapore/Malaysia/Vietnam (East Asia); and India/Sri Lanka (South Asia)] aged 45-64 years. Poisson regression models were fitted to estimate the duration of residence effect (categorized in 5-year bands and also as having arrived 2-16, 17-31 and 32 years ago or more), adjusted for sex, 5-year age group and year of death, then additionally for occupational class and marital status (SES) on relative risks (RR) of CVD mortality. RESULTS: Compared with the Australia-born population, CVD mortality was generally lower in each migrant group. Decreasing mortality with increasing duration of residence was observed for migrants from New Zealand (RR 0.95, 95% Confidence Interval 0.92-0.98, P<0.01, per 5-year increase), Greece (0.90, 0.86-0.94, P<0.01), Italy (0.94, 0.91-0.97, P<0.01) and South Asia (0.95, 0.91-0.99, P<0.01), mainly in older age groups. Trends remained after SES adjustment and also when broader categories of duration of residence were used. CVD mortality among migrants from the UK/Ireland appeared to converge towards those of the Australian-born. CONCLUSIONS: These results show divergence in CVD mortality compared with the Australian rate for New Zealanders, Greeks, Italians and South Asians. Sustained cardio-protective behavioural practices in the Australian setting is a potential explanation.     

Hepatitis B Virus Infection in US Correctional Facilities: A Review of Diagnosis,Management, and Public Health Implications

Among the blood-borne chronic viral infections, hepatitis B virus (HBV) infection is one that is not only treatable but also preventable by provision of vaccination. Despite the availability of HBV vaccine for the last 15 years, more than 1.25 million individuals in the USA have chronic HBV infection, and about 5,000 die each year from HBV-related complications. From a societal perspective, access to treatment of chronic viral infections, like HIV and viral hepatitis, is highly cost-effective and has lasting benefits by reducing risk behaviors, morbidity, mortality, as well as disease transmission in the community. Individuals in correctional facilities are specially predisposed to such chronic viral infections because of their high-risk behaviors. The explosion of incarceration in the USA over the last few decades and the disproportionate burden of morbidity and mortality from chronic infections among the incarcerated have put incredible strains on an overcrowded system that was not originally designed to provide comprehensive medical care for chronic illnesses. Recently, there has been a call to address medical care for individuals with chronic medical conditions in correctional settings, including those with infectious diseases. The economic and public health burden of chronic hepatitis B and its sequelae, including cirrhosis and hepatocellular carcinoma, is felt most prominently in managed care settings with limited budgets, like correctional facilities. Prevalence of HBV infection among the incarcerated in the USA is fivefold that of the general population. We present a review of diagnosis, prevention, and the recently streamlined treatment guidelines for management of HBV infection in correctional settings, and discuss the implications and public health impact of these measures.