title: Tetanus and diphtheria immunity in refugees in Europe in 2015.
abstract: BACKGROUND
  Current political crises in the Middle East and economic discrepancies led millions of people to leave their home countries and to flee to Western Europe. This development raises unexpected challenges for receiving health care systems. Although pan-European initiatives strive for updated and optimized vaccination strategies, little data on immunity against vaccine-preventable diseases in the current refugee population exist.
  
  
  METHODS
  We quantified serum IgG against tetanus and diphtheria (TD) in n = 678 refugees currently seeking shelter in six German refugee centers.
  
  
  RESULTS
  Reflecting current migration statistics in Europe, the median age within the cohort was 26 years, with only 23.9 % of female subjects. Insufficient IgG levels without long-term protection against tetanus were found in 56.3 % of all refugees. 76.1 % of refugees had no long-term protection against diphtheria. 47.7 % of subjects needed immediate vaccination against tetanus, and 47.7 % against diphtheria. For both diseases, an age-dependent decline in protective immunity occurred.
  
  
  CONCLUSIONS
  We observed a considerably low rate of tetanus-protected refugees, and the frequency of diphtheria-immune refugees was far from sufficient to provide herd immunity. These findings strongly support recent intentions to implement and enforce stringent guidelines for refugee vaccination in the current crisis.
authors.affiliation: Department of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany. jablonka.alexandra@mh-hannover.de.|German Center for Infection Research, Hannover, Germany. jablonka.alexandra@mh-hannover.de.
authors.forename: Alexandra
authors.identifier: http://orcid.org/0000-0001-7129-100X
authors.initials: A
authors.lastname: Jablonka
authors.affiliation: Department of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.|German Center for Infection Research, Hannover, Germany.
authors.forename: Georg M N
authors.initials: GM
authors.lastname: Behrens
authors.affiliation: Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Stange
authors.affiliation: Department of Pedatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.|German Center for Lung Research, BREATH, Hannover, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Dopfer
authors.affiliation: Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Grote
authors.affiliation: Department of Pedatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.|German Center for Lung Research, BREATH, Hannover, Germany.
authors.forename: Gesine
authors.initials: G
authors.lastname: Hansen
authors.affiliation: Department of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.|German Center for Infection Research, Hannover, Germany.
authors.forename: Reinhold Ernst
authors.initials: RE
authors.lastname: Schmidt
authors.affiliation: Department of Pedatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.|German Center for Lung Research, BREATH, Hannover, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Happle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D004165:Diphtheria / Q000276:immunology* / Q000517:prevention & control*; D005260:Female; D005858:Germany; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D012036:Refugees; D016036:Seroepidemiologic Studies; D013742:Tetanus / Q000276:immunology* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G
keywords: Asylum; Diphtheria; Immunity; Refugee; Tetanus; Vaccination; Vaccine-preventable diseases