Surveillance and outbreak report Open Access
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Europe received an increased number of migrants in 2015. Housing in inadequate mass accommodations (MA) made migrants prone to infectious disease outbreaks. In order to enhance awareness for infectious diseases (ID) and to detect clusters early, we developed and evaluated a syndromic surveillance system in three MA with medical centres in Berlin, Germany. Healthcare workers transferred daily data on 14 syndromes to the German public health institute (Robert Koch-Institute). Clusters of ID syndromes and single cases of outbreak-prone diseases produced a signal according to a simple aberration-detection algorithm that computes a statistical threshold above which a case count is considered unusually high. Between May 2016–April 2017, 9,364 syndromes were reported; 2,717 (29%) were ID, of those 2,017 (74%) were respiratory infections, 262 (10%) skin parasites, 181 (7%) gastrointestinal infections. The system produced 204 signals, no major outbreak was detected. The surveillance reinforced awareness for public health aspects of ID. It provided real-time data on migrants' health and stressed the burden of non-communicable diseases. The tool is available online and was evaluated as being feasible and flexible. It complements traditional notification systems. We recommend its usage especially when laboratory testing is not available and real-time data are needed.


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  1. Bundeszentrale für politische Bildung [Internet]. Zahlen zu Asyl in Deutschland [Asylum numbers in Germany]. Bonn: Bundeszentrale für politische Bildung. [Accessed 26 May 2017].German. Available from: https://www.bpb.de/politik/innenpolitik/flucht/218788/zahlen-zu-asyl-in-deutschland
  2. Global Migration Data Analysis Centre (GMDAC). International Organization for Migration. Migration, Asylum and Refugees in Germany: Understanding the Data. Bristol: GMDAC; 2016. Available from: https://gmdac.iom.int/sites/default/files/Data_Briefing_Migration_asylum_and_refugees_in_Germany.pdf
  3. Ben Taleb Z, Bahelah R, Fouad FM, Coutts A, Wilcox M, Maziak W. Syria: health in a country undergoing tragic transition. Int J Public Health. 2015;60(S1) Suppl 1;S63-72.  https://doi.org/10.1007/s00038-014-0586-2  PMID: 25023995 
  4. Cousins S. Syrian crisis: health experts say more can be done. Lancet. 2015;385(9972):931-4.  https://doi.org/10.1016/S0140-6736(15)60515-3  PMID: 25784334 
  5. European Centre for Disease Prevention and Control (ECDC). Communicable disease risks associated with the movement of refugees in Europe during the winter season. Stockholm: ECDC; 10 Nov 2015. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/refugee-migrant-health-in-european-winter-rapid-risk-assessment.pdf
  6. Frank L, Yesil-Jürgens R, Razum O, Bozorgmehr K, Schenk L, Gilsdorf A, et al. Health and healthcare provision to asylum seekers and refugees in Germany. Journal of Health Monitoring. Mar 2017. Available from: https://edoc.rki.de/handle/176904/2601
  7. Gushulak BD, MacPherson DW. Globalization of infectious diseases: the impact of migration. Clin Infect Dis. 2004;38(12):1742-8.  https://doi.org/10.1086/421268  PMID: 15227621 
  8. MacPherson DW, Gushulak BD. Human mobility and population health. New approaches in a globalizing world. Perspect Biol Med. 2001;44(3):390-401.  https://doi.org/10.1353/pbm.2001.0053  PMID: 11482008 
  9. Rechel B, Mladovsky P, Ingleby D, Mackenbach JP, McKee M. Migration and health in an increasingly diverse Europe. Lancet. 2013;381(9873):1235-45.  https://doi.org/10.1016/S0140-6736(12)62086-8  PMID: 23541058 
  10. Sasse T, Demikhovska E, Sielaff N, Keuchel A, Ziems G, Littmann M. (Determination of VZV (IgG) status for asylum seekers in Mecklenburg-Western Pomerania). Bestimmung des VZV (IgG) Status bei Asylsuchenden in Mecklenburg-Vorpommern. Gesundheitswesen. 2015;16(04):V55.
  11. Catchpole M, Coulombier D. Refugee crisis demands European Union-wide surveillance! Euro Surveill. 2015;20(45):30063.  https://doi.org/10.2807/1560-7917.ES.2015.20.45.30063  PMID: 26606945 
  12. Federal Ministry of Justice and consumer protection. Asylum Seekers Benefits Act. Available from: https://www.gesetze-im-internet.de/asylblg/BJNR107410993.html
  13. Bozorgmehr K, Razum O. Effect of restricting access to health care on health expenditures among asylum-seekers and refugees: a quasi-experimental study in Germany, 1994–2013. PLoS One. 2015;10(7):e0131483.  https://doi.org/10.1371/journal.pone.0131483  PMID: 26201017 
  14. European Centre for Disease Prevention and Control. Expert Opinion on the public health needs of irregular migrants, refugees or asylum seekers across the EU's southern and south-eastern borders. Stockholm: ECDC; 2015.
  15. Brusin S. The Communicable Disease Surveillance System in the Kosovar refugee camps in the former Yugoslav Republic of Macedonia April-August 1999. J Epidemiol Community Health. 2000;54(1):52-7.  https://doi.org/10.1136/jech.54.1.52  PMID: 10692963 
  16. Germinario C, Gallone MS, Tafuri S. Migrant health: the Apulian model. Epidemiol Prev. 2015;39(4) Suppl 1;76-80. PMID: 26499420 
  17. Jones G, Haeghebaert S, Merlin B, Antona D, Simon N, Elmouden M, et al. Measles outbreak in a refugee settlement in Calais, France: January to February 2016. Euro Surveill. 2016;21(11):30167.  https://doi.org/10.2807/1560-7917.ES.2016.21.11.30167  PMID: 27020578 
  18. Napoli C, Riccardo F, Declich S, Dente MG, Pompa MG, Rizzo C, et al. An early warning system based on syndromic surveillance to detect potential health emergencies among migrants: results of a two-year experience in Italy. Int J Environ Res Public Health. 2014;11(8):8529-41.  https://doi.org/10.3390/ijerph110808529  PMID: 25140999 
  19. Theocharopoulos Y. Stories from the field: Mission to Greece. EAN News. June 2016. http://epietalumni.net/wp-content/uploads/2014/09/EAN_Newsletter_Spring-2016.pdf
  20. Riccardo F, Napoli C, Bella A, Rizzo C, Rota MC, Dente MG, et al. Syndromic surveillance of epidemic-prone diseases in response to an influx of migrants from North Africa to Italy, May to October 2011. Euro Surveill. 2011;16(46):20016.  https://doi.org/10.2807/ese.16.46.20016-en  PMID: 22115045 
  21. Santé Publique France. Principaux motifs de recours aux structures de soins des populations migrantes des sites de Calais et Grande-Synthe. Le point épidémiologique.[Main reasons for resorting to the care structures of migrant populations at the Calais and Grande-Synthe sites. The epidemiological point.] Euralille 2016 May 13. French. Available from: http://www.invs.sante.fr/content/download/126911/451273/version/135/file/pe_npdc_camps_migrants_calais_130516.pdf.
  22. Robert Koch Institute. Surveillance-Tool for syndromic data collection and analysis. Berlin: RKI; 2017. www.rki.de/synsurvrefugees
  23. Buehler JW, Hopkins RS, Overhage JM, Sosin DM, Tong V; CDC Working Group. Framework for evaluating public health surveillance systems for early detection of outbreaks: recommendations from the CDC Working Group. MMWR Recomm Rep. 2004;53(RR-5) RR05;1-11. PMID: 15129191 
  24. Kühne A, Gilsdorf A. (Infectious disease outbreaks in centralized homes for asylum seekers in Germany from 2004-2014). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016;59(5):570-7. PMID: 27072500 
  25. Lindner A, Sagebiel D, Bärwolff S, Schmidt B, Drauz D, Ghaeni L, et al. Varizellen in der größten Flüchtlingsnotunterkunft in Berlin – Herausforderungen einer Impfkampagne. Jahrestagung der Deutschen Gesellschaft für Tropenmedizin und Internationale Gesundheit eV [Varicella in the largest refugee emergency shelter in Berlin - Challenges of a vaccination campaign. Annual Meeting of the German Society for Tropical Medicine and International Health]. 2016 Oct 7.-8. Bonn, Germany. German. DOI:  https://doi.org/10.13140/RG.2.2.25430.34889 
  26. European Centre for Disease Prevention and Control (ECDC). Handbook on implementing syndromic surveillance in migrant reception/detention centres and other refugee settings. Stockholm: ECDC; 2016. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/syndromic-surveillance-migrant-centres-handbook.pdf
  27. Brodhun B, Altmann D, Hauer B, Fiebig L, Haas W. Bericht zur Epidemiologie der Tuberkulose in Deutschland für 2015 [Report on the epidemiology of tuberculosis in Germany for 2015]. Berlin: Robert Koch-Institut, 2016.
  28. Bozorgmehr K, Razum O, Saure D, Joggerst B, Szecsenyi J, Stock C. Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis. Euro Surveill. 2017;22(12):30491. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=28367795&dopt=Abstract https://doi.org/10.2807/1560-7917.ES.2017.22.12.30491  PMID: 28367795 
  29. Hallas P, Hansen AR, Staehr MA, Munk-Andersen E, Jorgensen HL. Length of stay in asylum centres and mental health in asylum seekers: a retrospective study from Denmark. BMC Public Health. 2007;7(1):288.  https://doi.org/10.1186/1471-2458-7-288  PMID: 17931414 
  30. Kühne A, Fiebig L, Jansen K, Koschollek C, Santos-Hövener C. (Migration and infectious disease surveillance in Germany: Analyses of Tuberculosis, HIV and Syphilis surveillance data). Migrationshintergrund in der infektionsepidemiologischen Surveillance in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2015;58(6):560-8.  https://doi.org/10.1007/s00103-015-2157-y  PMID: 25868420 

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