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An outbreak of chickenpox occurred between December 2015 and May 2016 among asylum seekers in a reception centre in Latium, Italy. We describe the epidemiological and laboratory investigations, control measures and validity of reported history of chickenpox infection. Serological screening of all residents and incoming asylum seekers was performed, followed by vaccine offer to all susceptible individuals without contraindication. Forty-six cases were found and 41 were associated with the outbreak. No complications, hospitalisations or deaths occurred. Serological testing was performed in 1,278 individuals and 169 were found to be susceptible, with a seroprevalence of 86.8%. A questionnaire was administered to 336 individuals consecutively attending the CARA health post to collect their serological result. The sensitivity, specificity and the positive and negative predictive value (PPV and NPV) of the reported history of chickenpox were 45.0%, 76.1%, 88.3% and 25.6%, respectively. We observed an increasing trend for the PPV and decreasing trend for the NPV with increasing age. Our report confirms that, in the asylum seeker population, chickenpox history is not the optimal method to identify susceptible individuals. Our experience supports the need for additional prevention and control measures and highlights the importance of national and local surveillance systems for reception centres.


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  1. International Organization for Migration (IOM). Mediterranean migrant arrivals reach 345,440; deaths at sea: 4,655. Grand-Saconnex: IOM; 2016. Available from: http://www.iom.int/news/mediterranean-migrant-arrivals-reach-345440-deaths-sea-4655
  2. Presenze dei migranti nelle strutture di accoglienza in Italia. [Presence of migrants in reception centres in Italy]. Rome: Italian Ministry of Interior; 2016. Italian. Available from: http://www.interno.gov.it/it/sala-stampa/dati-e-statistiche/sbarchi-e-accoglienza-dei-migranti-tutti-i-dati
  3. European Centre for Disease Prevention and Control (ECDC). Infectious diseases of specific relevance to newly-arrived migrants in the EU/EEA. ECDC: Stockholm; 2015. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/Infectious-diseases-of-specific-relevance-to-newly-arrived-migrants-in-EU-EEA.pdf
  4. European Centre for Disease Prevention and Control (ECDC). Handbook on using the ECDC preparedness checklist tool to strengthen preparedness against communicable disease outbreaks at migrant reception/detention centres. Stockholm: ECDC; 2016. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/preparedness-checklist-migrant-centres-tool.pdf
  5. Centers for Disease Control and Prevention (CDC). Health information for international travel 2016. New York: Oxford University Press; 2016.
  6. Centers for Disease Control and Prevention (CDC). Epidemiology and prevention of vaccine-preventable diseases. The Pink Book: course textbook. 13th ed. Atlanta: CDC; 2015. Available from: https://www.cdc.gov/vaccines/pubs/pinkbook/index.html
  7. Cadieux G, Redditt V, Graziano D, Rashid M. Risk factors for varicella susceptibility among refugees to Toronto, Canada. J Immigr Minor Health. 2017;19(1):6-14.  https://doi.org/10.1007/s10903-015-0313-y 
  8. Mandal BK, Mukherjee PP, Murphy C, Mukherjee R, Naik T. Adult susceptibility to varicella in the tropics is a rural phenomenon due to the lack of previous exposure. J Infect Dis. 1998;178(s1) Suppl 1;S52-4.  https://doi.org/10.1086/514262 
  9. de Valliere S, Cani N, Grossenbacher M, Puig F, Masserey E, Bodenmann P. Comparison of two strategies to prevent varicella outbreaks in housing facilities for asylum seekers. Int J Infect Dis. 2011;15(10):e716-21.  https://doi.org/10.1016/j.ijid.2011.06.001 
  10. Lesens O, Baud O, Henquell C, Lhermet Nurse A, Beytout J. Varicella outbreak in Sudanese refugees from Calais. J Travel Med. 2016;23(5).  https://doi.org/10.1093/jtm/taw042 
  11. Gabutti G, Fedele A, Aprile V, Guido M, Lopalco P. Immigration flows and new epidemiological evidence in southern Italy. Vaccine. 2003;21(5-6):399-400.  https://doi.org/10.1016/S0264-410X(02)00402-4 
  12. Protocollo operativo per la sorveglianza sindromica e la profilassi immunitaria in relazione all’emergenza immigrati dall’Africa settentrionale. [Operational protocol for syndromic surveillance and immune prophylaxis in relation to the immigration emergency from North Africa]. Rome: Ministry of Health; 2011 Italian. Available from: http://www.salute.gov.it/imgs/C_17_newsAree_1478_listaFile_itemName_1_file.pdf
  13. Vairo F, Sane Schepisi M, Perrelli F, Di Bari V, Pisapia R, Nicastri E, et al. Preparedness and response during mass-gatherings: The ongoing experience of the regional plan for surveillance and response to infectious diseases emergencies during the extraordinary Jubilee 2015-16. Poster presentation. International Meeting on Emerging Diseases and Surveillance (IMED); Vienna, Austria; 4-7 November 2016. Available from: http://imed.isid.org/downloads/Abstracts_Posters.pdf
  14. Decreto del presidente della repubblica 16 settembre 2004, n. 303 (in G.U. n. 299 del 22 dicembre 2004) - Regolamento relativo alle procedure per il riconoscimento dello status di rifugiato. [Decree of the President of the Republic of 16 September 2004, no. 303 (in G.U. 299 of 22 December 2004) - Regulation on procedures for the recognition of refugee status]. Rome: Consiglio dei Ministri; 2004. Italian. Available from: https://www.unhcr.it/wp-content/uploads/2015/12/Decreto_16_settembre_2004_n._303.pdf
  15. Decreto Legislativo 28 gennaio 2008, n.25 “Attuazione della direttiva 2005/85/CE recante norme minime per le procedure applicate negli Stati membri ai fini del riconoscimento e della revoca dello status di rifugiato”. Gazzetta Ufficiale n. 40. 16 Feb 2008. [Legislative Decree of 28 January 2008, No.25 "Implementation of Directive 2005/85/ EC laying down minimum standards for procedures in Member States for the recognition and withdrawal of refugee status"]. 2008. Available from: http://www.camera.it/parlam/leggi/deleghe/08025dl.htm
  16. Communication from the commission to the European Parliament and the Council on the state of play of implementation of the priority actions under the European agenda on migration. Brussels: European Commission; 2016. Available from: https://ec.europa.eu/transparency/regdoc/rep/1/2016/EN/1-2016-85-EN-F1-1.PDF
  17. EUVAC.NET. Surveillance of varicella and herpes zoster in Europe. Copenhagen: Statens Serum Institut; 2011. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/varicella_zoster_report_2009_euvacnet.pdf
  18. Jonzon R, Lindkvist P, Johansson E. A state of limbo--in transition between two contexts: Health assessments upon arrival in Sweden as perceived by former Eritrean asylum seekers. Scand J Public Health. 2015;43(5):548-58.  https://doi.org/10.1177/1403494815576786 
  19. de Valliere S, Cani N, Grossenbacher M, Puig F, Masserey E, Bodenmann P. Comparison of two strategies to prevent varicella outbreaks in housing facilities for asylum seekers. Int J Infect Dis. 2011;15(10):e716-21.  https://doi.org/10.1016/j.ijid.2011.06.001 
  20. Lopez AS, Burnett-Hartman A, Nambiar R, Ritz L, Owens P, Loparev VN, et al. Transmission of a newly characterized strain of varicella-zoster virus from a patient with herpes zoster in a long-term-care facility, West Virginia, 2004. J Infect Dis. 2008;197(5):646-53.  https://doi.org/10.1086/527419 
  21. Haas EJ, Dukhan L, Goldstein L, Lyandres M, Gdalevich M. Use of vaccination in a large outbreak of primary varicella in a detention setting for African immigrants. Int Health. 2014;6(3):203-7.  https://doi.org/10.1093/inthealth/ihu017 
  22. Valdarchi C, Farchi F, Dorrucci M, De Michetti F, Paparella C, Babudieri S, et al. Epidemiological investigation of a varicella outbreak in an Italian prison. Scand J Infect Dis. 2008;40(11-12):943-5.  https://doi.org/10.1080/00365540802308449 
  23. Arvin AM. Varicella-zoster virus. Clin Microbiol Rev. 1996;9(3):361-81.
  24. Marin M, Marti M, Kambhampati A, Jeram SM, Seward JF. Global varicella vaccine effectiveness: a meta-analysis. Pediatrics. 2016;137(3):e20153741.  https://doi.org/10.1542/peds.2015-3741 
  25. Galea SA, Sweet A, Beninger P, Steinberg SP, Larussa PS, Gershon AA, et al. The safety profile of varicella vaccine: a 10-year review. J Infect Dis. 2008;197(s2) Suppl 2;S165-9.  https://doi.org/10.1086/522125 
  26. Centers for Disease Control and Prevention (CDC). Manual for the surveillance of vaccine-preventable diseases. Atlanta: CDC; 2008. Chickenpox: Chapter 17-1. Available from: https://www.cdc.gov/vaccines/pubs/surv-manual/index.html
  27. Toikkanen SE, Baillot A, Dreesman J, Mertens E. Seroprevalence of antibodies against measles, rubella and varicella among asylum seekers arriving in Lower Saxony, Germany, November 2014-October 2015. Int J Environ Res Public Health. 2016;13(7):E650.  https://doi.org/10.3390/ijerph13070650 
  28. Jablonka A, Happle C, Grote U, Schleenvoigt BT, Hampel A, Dopfer C, et al. Measles, mumps, rubella, and varicella seroprevalence in refugees in Germany in 2015. Infection. 2016;44(6):781-7.  https://doi.org/10.1007/s15010-016-0926-7 
  29. Christiansen D, Barnett ED. Comparison of varicella history with presence of varicella antibody in refugees. Vaccine. 2004;22(31-32):4233-7.  https://doi.org/10.1016/j.vaccine.2004.04.024 
  30. Burnham BR, Wells TS, Riddle JR. A cost-benefit analysis of a routine varicella vaccination program for United States Air Force Academy cadets. Mil Med. 1998;163(9):631-4.
  31. Jerant AF, DeGaetano JS, Epperly TD, Hannapel AC, Miller DR, Lloyd AJ. Varicella susceptibility and vaccination strategies in young adults. J Am Board Fam Pract. 1998;11(4):296-306.  https://doi.org/10.3122/jabfm.11.4.296 
  32. Holmes CN. Predictive value of a history of varicella infection. Can Fam Physician. 2005;51:60-5.

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