- Lutz Ehlkes1,2,3,4, Maja George1,4, Donald Knautz1, Florian Burckhardt1, Klaus Jahn5, Manfred Vogt1, Philipp Zanger1,6,7
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View Affiliations Hide AffiliationsAffiliations: 1 Federal State Agency for Consumer and Health Protection Rhineland-Palatinate, Koblenz, Germany 2 Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany 3 European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden 4 These authors contributed equally to this work and share first authorship 5 Federal State Ministry for Social Affairs, Employment, Health, and Demographics Rhineland-Palatinate, Mainz, Germany 6 Heidelberg Institute of Public Health, University Hospitals, Heidelberg, Germany 7 Department of Infectious Diseases, Medical Microbiology and Hygiene, University Hospitals, Heidelberg, GermanyPhilipp Zangerphilipp.zanger uni-heidelberg.de
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Citation style for this article: Ehlkes Lutz, George Maja, Knautz Donald, Burckhardt Florian, Jahn Klaus, Vogt Manfred, Zanger Philipp. Negligible import of enteric pathogens by newly arrived asylum seekers and no impact on incidence of notified Salmonella and Shigella infections and outbreaks in Rhineland-Palatinate, Germany, January 2015 to May 2016. Euro Surveill. 2018;23(20):pii=17-00463. https://doi.org/10.2807/1560-7917.ES.2018.23.20.17-00463 Received: 10 Jul 2017; Accepted: 11 Feb 2018
Negligible import of enteric pathogens by newly arrived asylum seekers and no impact on incidence of notified Salmonella and Shigella infections and outbreaks in Rhineland-Palatinate, Germany, January 2015 to May 2016
Abstract
The 2015 refugee crisis raised concerns about an import of infectious diseases affecting the German population. Aims: 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. Methods: 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. Results: Salmonella 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 Shigella or invasive Salmonella 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 Schistosoma mansoni and Taenia spp. The increase in asylum applications did not increase notifications of salmonellosis and shigellosis. No transmission from asylum seekers to German residents was notified. Conclusion: 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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