Increased rates of migration to and within the European Union and European Economic Area (EU/EEA) in recent years has made the development of migration policy, including health policy, a priority for the region. A migrant is defined as any individual who lives in a country temporarily or permanently away from his or her usual place of residence for at least a year. Migrants do not generally pose a health threat to the host population. However, some subgroups of migrants, including refugees, asylum seekers, and irregular migrants are particularly vulnerable to infectious diseases and may have worse health outcomes than the host population. In a number of EU/EEA Member States, subgroups of migrant populations are disproportionately affected by infectious diseases such as tuberculosis, HIV, and hepatitis B and C. Consequently, screening and vaccination programmes may be of benefit for newly arrived migrants, i.e. those who have arrived in the EU/EEA within the past five years.  

The European health policy framework ‘Health 2020’ aims to ‘significantly improve the health and well-being of populations, reduce health inequalities, strengthen public health and ensure people-centred health systems that are universal, equitable, sustainable and of high quality’. ECDC has sought to support this aim in migrant health by developing evidence-based guidance on the prevention of infectious diseases among newly arrived migrants in the EU/EEA.

Objective, method and approach

The main objective of this guidance is to provide scientific advice, based on an evidence-based assessment of targeted public health interventions, to facilitate effective screening and vaccination for priority infectious diseases among newly arrived migrant populations to the EU/EEA. It is intended to support EU/EEA Member States to develop national strategies to strengthen infectious disease prevention and control among migrants and meet the health needs of these populations.  

The guidance has been developed using a series of systematic evidence reviews and the grading of recommendations assessment, development and evaluation (GRADE) evidence-to-decision framework, as well as drawing on the opinions of an ad hoc scientific panel through a consultation and assessment process. ECDC appointed a scientific panel consisting of 21 experts from EU/EEA Member States to review the evidence and express opinions on the evidence-based statements that relate to vulnerable migrant groups. None of the members of the panel declared any conflicts of interest with regard to the topic and their participation in the panel. In addition to the scientific panel, ECDC established an advisory group of experts in infectious disease, public health and migration to participate in meetings in order to select the key infectious diseases for which guidance is needed and to support the review process.  

The advisory group and ad hoc scientific panel selected the following key infectious diseases for consideration: active tuberculosis (TB) and latent TB infection (LTBI), HIV, hepatitis B (HBV), hepatitis C (HCV), vaccine-preventable diseases (measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B, strongyloidiasis, and schistosomiasis.

Key overarching questions were:

• Should newly arrived migrants be offered screening for active TB, LTBI, HIV, hepatitis B, hepatitis C, strongyloidiasis, and schistosomiasis? Who should be targeted and how?
• Should newly arrived migrants be offered vaccination for measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B (HiB) and hepatitis B?
• What are the implementation considerations in EU/EEA countries?

The approach involved developing key research questions (PICO: population, intervention, comparison, outcome) and an analytic framework to identify key steps and questions related to evidence of effectiveness along the screening– intervention pathway, in order to formulate search strategies and identify relevant literature.

Search terms and strategies appropriate for each infectious disease were used to search for published literature in PubMed, the Cochrane Database of Systematic Reviews, and Embase from January 2005 to May 2016; grey literature and existing guidelines were also identified. In developing the guidance, ECDC sought to build on existing systematic reviews and randomised controlled trials; in addition, newly developed additional evidence reviews were used to address gaps in the evidence base. The systematic reviews that underpin this guidance were conducted in line with PRISMA reporting guidelines. 

The GRADE evidence-to-decision approach was used to frame evidence and develop statements, and to rate the strength of the evidence-based statements. Evidence-based statements were developed and graded through an iterative consensus process with the advisory group and ad hoc scientific panel. The ad hoc scientific panel members completed a FACE survey (feasibility, acceptability, cost and equity), which was used to inform the guidance. GRADE Pro Panel Voice Software3 was used to review statements and vote on all evidence-to-decision criteria. The evidence review and guideline development process consisted of three rounds of review: of the evidence review findings, the draft evidence-based statements, and the draft guidance. Results This guidance focuses on newly arrived migrants within the EU/EEA, taking into consideration country of origin, circumstances of migration, and age and gender, where relevant.  Available evidence suggests that it likely to be effective and cost-effective to screen child, adolescent and adult migrants for active TB and LTBI, HIV, HCV, HBV, strongyloidiasis and schistosomiasis, and that there is a clear benefit to enrolling migrants in vaccination programmes and ensuring catch-up vaccination where needed. This is, however, often conditional on the burden of disease in migrants’ countries of origin.