Migrant health: the Apulian model.
BACKGROUND
Since the 1990s Puglia has been totally involved in the reception and assistance of refugees. The prevention of infectious diseases among migrants, especially those residing in communities, is an important concern for public health authorities, since infectious diseases eliminated in Europe may still be widespread in the migrants' countries of origin, and other diseases may have a higher incidence than in European countries. Thus immigrants may contribute to the burden and spread of infectious diseases.


OBJECTIVE
We describe the Apulian model of management and prevention of infectious disease among the population of Asylum Seeker Centres (CARA). It consists of a number of activities: surveillance of Poliovirus circulation, tuberculosis screening, seroprevalence studies of viral hepatitis and HIV, an immunization program for children, and syndromic surveillance. All the activities are organized and carried out by the Regional Observatory for Epidemiology among refugees hosted in the Bari Palese CARA.


RESULTS
Surveillance of Poliovirus circulation has been carried out periodically since 2008 by assessing the presence of wild poliovirus or Sabin-like poliovirus in stool samples and seroprevalence studies. Data did not show circulation of poliovirus and indicated a good level of immunization against polio among refugees. Seroprevalence studies of viral hepatitis and HIV were carried out in 2008 and involved 529 refugees; 44 individuals (8.3%) were HBsAg positive, 24 (4.5%) were anti-HCV positive, 8 (1.5%) were HIV positive. Tuberculosis screening started in 2009 after a refugee's death due to tuberculosis and has been ongoing since then. The Mantoux tuberculin skin test is used and cutipositive migrants are examined by chest X-ray. Around 50% of migrants have been found to be cutipositive and 10% showed TB sequelae. Syndromic surveillance and an immunization program began in 2011 because of the significant increase in migration flow following civil unrest in North Africa; respiratory tract infection and diarrhoea were the most frequent notified syndromes. The immunization program involved 129 children coming from 23 countries: all received the appropriate vaccinations. The program also includes an annual special session to vaccinate all refugees against flu.


CONCLUSIONS
The results confirmed some traditional concerns about migrant health and especially about the control of infectious diseases among these populations and the need, from our point of view, to strengthen screening to aid the development of trust between migrants and resident population.
Dip. Scienze biomediche e oncologia umana, Università "Aldo Moro", Bari, Italy. cinziaannatea.germinario@uniba.it.
Cinzia
C
Germinario
Dip. Scienze biomediche e oncologia umana, Università "Aldo Moro", Bari, Italy.
Maria Serena
MS
Gallone
Dip. Scienze biomediche e oncologia umana, Università "Aldo Moro", Bari, Italy.
Silvio
S
Tafuri
D000328:Adult; D000352:Africa, Northern / Q000208:ethnology; D001208:Asia / Q000208:ethnology; D002648:Child; D003967:Diarrhea / Q000453:epidemiology; D004197:Disease Reservoirs; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D006525:Hepatitis, Viral, Human / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007558:Italy; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008962:Models, Theoretical; D011051:Poliomyelitis / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D017955:Poliovirus / Q000302:isolation & purification; D011159:Population Surveillance; D012036:Refugees / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000453:epidemiology; D016036:Seroepidemiologic Studies; D013577:Syndrome; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control; D014611:Vaccination