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The 2015 refugee crisis raised concerns about an import of infectious diseases affecting the German population. To evaluate public and individual health benefits of stool screening, and explore whether importation of enteric pathogens by newly arrived asylum seekers impacts on the host population. : We used data from mandatory stool screening to determine the overall, age, sex, and country-specific prevalence of enteric bacteria and helminths. We used surveillance data to assess whether the number of incoming asylum seekers influenced notifications of salmonellosis and shigellosis in Rhineland-Palatinate. : were found in 0.2% (95% confidence interval (CI) 0.2–0.3%) of 23,410 samples collected from January 2015 to May 2016. Prevalence was highest in children under 5 years (0.8%; 95% CI: 0.5–1.3%). No or invasive spp. were detected. In a subset of 14,511 samples, the prevalence of helminth infestation was 2.4% (95% CI: 2.1–2.6%), with highest proportions detected in adolescents (4.6%; 95% CI 3.8–5.4%) and among Eritreans (9.3%; 95% CI: 7.0–12.0%); in the latter particularly and spp. The increase in asylum applications did not increase notifications of salmonellosis and shigellosis. No transmission from asylum seekers to German residents was notified. : Public health risk associated with imported enteric pathogens is very low overall. Addressing individual and public health risks, we recommend replacing stool screening of all newly arrived asylum seekers by a targeted approach, with target groups and approaches being adapted if necessary. Target groups supported by our data are children, adolescents, and Eritreans.


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  1. Asyl S. 2017. [Key figures on asylum applications 2017.] Nürnberg: Bundesministerium für Migration und Flüchtlinge; 2018. German. Available from: http://www.bamf.de/SharedDocs/Anlagen/DE/Publikationen/Flyer/flyer-schluesselzahlen-asyl-2017.pdf
  2. United Nations. (UN) Statistics division. Standard Country or Area Codes for Statistical Use. New York: UN; 2018. [Accessed 01 Feb 2018]. Available from: https://unstats.un.org/unsd/methodology/m49/
  3. World Health Organization (WHO) and United Nations Children’s Fund. (UNICEF). Progress on drinking water, sanitation and hygiene: 2017 update and SDG baselines. New York: UNICEF; 2017. Available from: https://www.unicef.org/publications/index_96611.html
  4. Lederer I, Taus K, Allerberger F, Fenkart S, Spina A, Springer B, et al. Shigellosis in refugees, Austria, July to November 2015. Euro Surveill. 2015;20(48):30081.  https://doi.org/10.2807/1560-7917.ES.2015.20.48.30081  PMID: 26676065 
  5. Castelli F, Sulis G. Migration and infectious diseases. Clin Microbiol Infect. 2017;23(5):283-9.  https://doi.org/10.1016/j.cmi.2017.03.012  PMID: 28336382 
  6. Verwaltungsvorschrift 21260: Gesundheitsuntersuchung bei Asylbegehrenden. [Administrative provision 21260: Health check for asylum seekers]. Ministerialblatt. 1999. p 532. Mainz: Ministerium für Arbeit Soziales und Gesundheit. Rheinland-Pfalz; German.
  7. Bundesministerium der Justiz und für Verbraucherschutz (BMVJ). Gesetz zur Verhütung und Bekämpfung von Infektionskrankheiten beim Menschen (Infektionsschutzgesetz - IfSG). [Act for the prevention and control of human infectious diseases (Protection against infection act)]. Berlin: BMVJ; 2000. [Accessed 01 Feb 2018]. German. Available from: https://www.gesetze-im-internet.de/ifsg/IfSG.pdf
  8. Ackermann N, Marosevic D, Hörmansdorfer S, Eberle U, Rieder G, Treis B, et al. Screening for infectious diseases among newly arrived asylum seekers, Bavaria, Germany, 2015. Euro Surveill. 2018;23(10):pii=17-00176. https://doi.org/10.2807/1560-7917.ES.2018.23.10.17-00176
  9. Kato K, Miura M. Comparative examinations. Kisechugaku Zasshi. 1954;3:35.
  10. Hotez PJ, Gurwith M. Europe’s neglected infections of poverty. Int J Infect Dis. 2011;15(9):e611-9.  https://doi.org/10.1016/j.ijid.2011.05.006  PMID: 21763173 
  11. Berry A, Moné H, Iriart X, Mouahid G, Aboo O, Boissier J, et al. Schistosomiasis haematobium, Corsica, France. Emerg Infect Dis. 2014;20(9):1595-7.  https://doi.org/10.3201/eid2009.140928  PMID: 25153697 
  12. Colley DG, Bustinduy AL, Secor WE, King CH. Human schistosomiasis. Lancet. 2014;383(9936):2253-64.  https://doi.org/10.1016/S0140-6736(13)61949-2  PMID: 24698483 
  13. Gauert B. [Comparative study of the incidence and dissemination of intestinal parasites in child day care centers of the district capital Schwerin]. Gesundheitswesen. 1998;60(5):301-6. PMID: 9676012 
  14. Masucci L, Graffeo R, Bani S, Bugli F, Boccia S, Nicolotti N, et al. Intestinal parasites isolated in a large teaching hospital, Italy, 1 May 2006 to 31 December 2008. Euro Surveill. 2011;16(24):19891.  https://doi.org/10.2807/ese.16.24.19891-en  PMID: 21699767 
  15. Garcia HH, Nash TE, Del Brutto OH. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol. 2014;13(12):1202-15.  https://doi.org/10.1016/S1474-4422(14)70094-8  PMID: 25453460 
  16. Donadeu M, Lightowlers MW, Fahrion AS, Kessels J, Abela-Ridder B. Taenia solium: WHO endemicity map update. Wkly Epidemiol Rec. 2016;91(49-50):595-9. PMID: 27966846 
  17. Zammarchi L, Strohmeyer M, Bartalesi F, Bruno E, Muñoz J, Buonfrate D, et al. COHEMI Project Study Group. Epidemiology and management of cysticercosis and Taenia solium taeniasis in Europe, systematic review 1990-2011. PLoS One. 2013;8(7):e69537.  https://doi.org/10.1371/journal.pone.0069537  PMID: 23922733 
  18. Nikolay B, Brooker SJ, Pullan RL. Sensitivity of diagnostic tests for human soil-transmitted helminth infections: a meta-analysis in the absence of a true gold standard. Int J Parasitol. 2014;44(11):765-74.  https://doi.org/10.1016/j.ijpara.2014.05.009  PMID: 24992655 
  19. Rauch AM, Van R, Bartlett AV, Pickering LK. Longitudinal study of Giardia lamblia infection in a day care center population. Pediatr Infect Dis J. 1990;9(3):186-9.  https://doi.org/10.1097/00006454-199003000-00008  PMID: 2336299 
  20. Birkhead G, Vogt RL. Epidemiologic surveillance for endemic Giardia lamblia infection in Vermont. The roles of waterborne and person-to-person transmission. Am J Epidemiol. 1989;129(4):762-8.  https://doi.org/10.1093/oxfordjournals.aje.a115191  PMID: 2923123 
  21. Casey GJ, Montresor A, Cavalli-Sforza LT, Thu H, Phu LB, Tinh TT, et al. Elimination of iron deficiency anemia and soil transmitted helminth infection: evidence from a fifty-four month iron-folic acid and de-worming program. PLoS Negl Trop Dis. 2013;7(4):e2146.  https://doi.org/10.1371/journal.pntd.0002146  PMID: 23593517 
  22. Yimam Y, Degarege A, Erko B. Effect of anthelminthic treatment on helminth infection and related anaemia among school-age children in northwestern Ethiopia. BMC Infect Dis. 2016;16(1):613.  https://doi.org/10.1186/s12879-016-1956-6  PMID: 27793110 
  23. Ojha SC, Jaide C, Jinawath N, Rotjanapan P, Baral P. Geohelminths: public health significance. J Infect Dev Ctries. 2014;8(1):5-16.  https://doi.org/10.3855/jidc.3183  PMID: 24423707 

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