Migration and infectious diseases.
BACKGROUND
Infectious diseases still represent an important cause of morbidity and mortality among foreign-born individuals. The rising migration flows towards Europe throughout the last few years are raising renewed concerns about management issues and the potential associated risk for the native population.


OBJECTIVE
To discuss the health implications and challenges related to the four phases of migration, from first arrival to stable resettlement.


METHODS
Scientific literature and relevant statistical reports.


BACKGROUND
Although infectious diseases are not a health priority at first arrival, a syndromic screening to identify the most common communicable conditions (pulmonary tuberculosis above all) should be promptly conducted. Reception centres where asylum seekers are gathered after arrival may be crowded, so favouring epidemic outbreaks, sometimes caused by incomplete vaccine coverage for preventable diseases. After resettlement, the prevalence of some chronic infections such as human immunodeficiency virus, viral hepatitis or tuberculosis largely reflects the epidemiological pattern in the country of origin, with poor living conditions being an additional driver. Once resettled, migrants usually travel back to their country of origin without seeking pre-travel advice, which results in a high incidence of malaria and other infections.


CONCLUSIONS
Although infectious diseases among migrants are known to have a negligible impact on European epidemiology, screening programmes need to be implemented and adapted to the different stages of the migratory process to better understand the trends and set priorities for action. Appropriate access to care regardless of the legal status is crucial to improve the health status and prevent the spread of contagious conditions.
University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy; UNESCO Chair 'Training and empowering human resources for health development in resource-limited countries', University of Brescia, Brescia, Italy. Electronic address: francesco.castelli@unibs.it.
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Castelli
University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy.
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Sulis
D002908:Chronic Disease; D003141:Communicable Diseases / Q000453:epidemiology*; D004196:Disease Outbreaks / Q000517:prevention & control*; D054242:Emigrants and Immigrants; D004641:Emigration and Immigration; D005060:Europe / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006304:Health Status; D006505:Hepatitis / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D006801:Humans; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D012036:Refugees; D014195:Travel; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control
Asylum seekers; Human immunodeficiency virus; Immunization coverage; Migrants; Refugees; Screening; Syndromic approach; Tuberculosis; Viral hepatitis