Migrant holding centres in Europe are institutional settings that typically host closed/semi-open communities. As in other institutional settings, also migrant holding centres face specific challenges in preventing and controlling communicable disease transmission. In order to strengthen capacity to prevent and detect communicable diseases among the hosted migrant populations within participating countries (Italy, Greece, Malta, Croatia, Slovenia) and Portugal, the CARE project implemented three activities.
Firstly, the project developed and piloted a syndromic surveillance system to strengthen the capacity to rapidly detect disease outbreaks and potential public health emergencies occurring in hotspots or migrants’/refugees’ centres. The term “syndromic surveillance” applies to surveillance using health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak as quickly as possible, to warrant further public health response. Syndromic surveillance, therefore, by definition, provides information at an earlier stage than laboratory confirmation and, for this reason, has the potential to inform timely actions that might reduce the impact of disease in a community.
Secondly, the project conducted a survey to assess the current policy in vaccination offer targeting newly arrived migrants in different European countries. Specifically, the survey assessed the national policies in vaccination offer targeting newly arrived migrants and described how national immunization policies are locally implemented in different types of migrant detention/reception centres.
Thirdly, the project produced dispatches of targeted information on communicable disease outbreaks occurring along the recognized Mediterranean migration routes for frontline healthcare professionals.
The main objective of syndromic surveillance was to identify illness clusters early, before diagnoses are confirmed, in order to allow timely and appropriate public health response. This methodology has a remarkable ability to adapt to rapidly shifting public health needs. In Italy and Greece, syndromic surveillance has been successfully applied in the context of migrant surges in 2011-2013 and 2016 respectively, with the aim of supporting health care providers of migration Centres in rapidly detecting potential health emergencies.
Within a syndromic surveillance system, information on combinations of clinical signs and symptoms (i.e. syndromes), chosen as potentially indicative of events of public health concern, are collected and systematically recorded. Data is entered aggregated by syndrome and age group each day. This means that no personal (sensitive) information on the migrant is collected.
Data are analysed timely using customized tools to detect statistical alerts. In case of alert, local health authorities and specific centres are contacted to verify the situation and, if needed, ensure a rapid response.
A dedicated web-based platform and operating procedures, based on national and international experiences in applying syndromic surveillance, have been developed to adapt to the specific context of migration within CARE participating countries.
CARE participating countries experiencing migration flows through recognized migration routes piloted these tools. CARE participating countries not experiencing migration flows at the time of the project’s implementation simulated instead the implementation of these tools in order to increase their preparedness to possible future large inflows of migrants. This flexible approach was needed for the CARE project to be effective notwithstanding the inherent volatility of the migratory phenomenon.
The implementation of a collaborative syndromic surveillance system in migrant detention/reception centres was an innovative action in the EU. CARE proved that collaborative syndromic surveillance is feasible in Southern EU countries and that this approach might be useful even in a wider scale in the EU/EEA.
The main objective of this activity is to assess the current policy in vaccination offer targeting newly arrived migrants in different European countries. Specific objectives were:
- to assess existing national policies in vaccination offer targeting newly arrived migrants,
- to describe how national immunization policies are implemented locally, and
- to collect and share relevant documents, protocols and procedures on vaccination strategies targeting newly arrived migrants.
The survey was conducted at two levels:
- national level, in order to explore the national strategies and policies in vaccination offer targeting newly arrived migrants
- local level, in order to explore practice. This level explored what is being implemented in the field: from how the migrant immunization status is checked to how vaccines are administered in the migration centre or at community level (vaccination services, GPs, paediatricians) depending on how local services were organized in the CARE participating countries. This level also included information on tracking of immunization data.
No questionnaires were submitted to individual migrants.
Information service model on endemic and currently epidemic diseases in the countries of origin and transit
Migrants arriving to the EU are generally in good health. This is due to several factors, such as good pre-travel health status and the fact that most infectious diseases have much shorter incubation periods than the time required to journey across the recognized Mediterranean migration routes.
Notwithstanding, travelling conditions might make some migrants more vulnerable to health threats, due to exposures before arriving to the EU combined with low vaccination coverage. For this reason, it is important for front line health-care workers assessing the health of newly arrived migrants in point of entry Southern European Union countries, to be aware of the epidemiology of disease and vaccination rates in countries of origin and transit of their patients.
In order to meet this information need, the implementation of an information service model (dispatch) was included among the activities of the CARE project.
This dispatch is a travel-medicine information service targeting epidemic prone diseases in countries part of recognized Mediterranean migration routes and is intended for front line health-care workers.
It was compiled weekly using digital detection technologies from a number of different internet sources (including institutional official websites as well as non-official sources, e.g. online news articles and blogs). For each information in the dispatch, the official/non official nature of the source was stated. This dispatch therefore contained non-verified information and is only to be used as an information tool to support health-care workers in performing clinical health evaluations under the general medical principle of precaution.
The dispatch was compiled by monitoring the Medical Information System (MedISys) managed by the European Commission Joint Research Centre (JRC). MedISys is a fully automatic event-based surveillance platform that monitors reporting on infectious diseases in humans and animals; chemical, biological, radiological, and nuclear (CBRN) threats; plant health; and food and feed contaminations on the internet. The system retrieves news articles from specialized official and nonofficial medical sites, general news media, and selected blogs; categorizes all incoming articles according to predefined multilingual disease categories; identifies known names, such as organizations, people, and locations; extracts events; clusters news articles; and calculates statistics to detect emerging threats. The MedISys platform has been used in the past to monitor infectious diseases of public health importance and during mass gatherings.
The dispatch was complemented by an appendix on diseases and countries of interest identified through an online survey targeting front line health-care workers assessing the health of newly arrived migrants in Italy, Greece, Malta, Croatia and Slovenia. This appendix was not be updated weekly.
The dispatch was issued from October to December 2016, following this time all recipients were asked to evaluate its usefulness.