Comprehensive infectious disease screening in a cohort of unaccompanied refugee minors in Germany from 2016 to 2017: A cross-sectional study

Autoři: Ales Janda aff001;  Kristin Eder aff001;  Roland Fressle aff002;  Anne Geweniger aff001;  Natalie Diffloth aff001;  Maximilian Heeg aff001;  Nadine Binder aff004;  Ana-Gabriela Sitaru aff006;  Jan Rohr aff001;  Philipp Henneke aff001;  Markus Hufnagel aff001;  Roland Elling aff001
Působiště autorů: Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Freiburg, Germany aff001;  Practice for Childhood and Adolescent Medicine, Freiburg, Germany aff002;  Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany aff003;  Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany aff004;  Institute of Digitalization in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Germany aff005;  Center of Laboratory Diagnostics, MVZ Clotten, Freiburg, Germany aff006;  Berta Ottenstein Programme, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany aff007
Vyšlo v časopise: Comprehensive infectious disease screening in a cohort of unaccompanied refugee minors in Germany from 2016 to 2017: A cross-sectional study. PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003076
Kategorie: Research Article



Information regarding the prevalence of infectious diseases (IDs) in child and adolescent refugees in Europe is scarce. Here, we evaluate a standardized ID screening protocol in a cohort of unaccompanied refugee minors (URMs) in a municipal region of southwest Germany.

Methods and findings

From January 2016 to December 2017, we employed a structured questionnaire to screen a cohort of 890 URMs. Collecting sociodemographic information and medical history, we also performed a standardized diagnostics panel, including complete blood count, urine status, microbial stool testing, tuberculosis (TB) screening, and serologies for hepatitis B virus (HBV) and human immunodeficiency virus (HIV). The mean age was 16.2 years; 94.0% were male, and 93.6% originated from an African country. The most common health complaints were dental problems (66.0%). The single most frequent ID was scabies (14.2%). Of the 776 URMs originating from high-prevalence countries, 7.7% and 0.4% tested positive for HBV and HIV, respectively. Nineteen pathogens were detected in a total of 119 stool samples (16.0% positivity), with intestinal schistosomiasis being the most frequent pathogen (6.7%). Blood eosinophilia proved to be a nonspecific criterion for the detection of parasitic infections. Active pulmonary TB was identified in 1.7% of URMs screened. Of note, clinical warning symptoms (fever, cough >2 weeks, and weight loss) were insensitive parameters for the identification of patients with active TB. Study limitations include the possibility of an incomplete eosinophilia workup (as no parasite serologies or malaria diagnostics were performed), as well as the inherent selection bias in our cohort because refugee populations differ across Europe.


Our study found that standardized ID screening in a URM cohort was practicable and helped collection of relevant patient data in a thorough and time-effective manner. However, screening practices need to be ameliorated, especially in relation to testing for parasitic infections. Most importantly, we found that only a minority of infections were able to be detected clinically. This underscores the importance of active surveillance of IDs among refugees.

Klíčová slova:

Diagnostic medicine – Europe – Germany – Hepatitis B virus – HIV – Parasitic diseases – Tuberculosis – Eosinophilia


1. Pohl C, Mack I, Schmitz T, Ritz N. The spectrum of care for pediatric refugees and asylum seekers at a tertiary healthcare facility in Switzerland in 2015. Eur J Pediatr. 2017;176:1681–7. doi: 10.1007/s00431-017-3014-9 28963630

2. Ehlkes L, George M, Knautz D, Burckhardt F, Jahn K, Vogt M, et al. 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. Eurosurveillance. 2018;23:40–7. doi: 10.2807/1560-7917.ES.2018.23.20.17–00463

3. Weatherhead JE, Hotez PJ, Mejia R, The Global State of Helminth Control and Elimination in Children. Pediatr Clin North Am. 2017 Aug;64(4):867–877. doi: 10.1016/j.pcl.2017.03.005 28734515

4. WHO. Global Tuberculosis Report 2017. Geneva: World Health Organization; 2017. doi: WHO/HTM/TB/2017.23

5. WHO. Global Hepatitis Report 2017. Geneva: World Health Organization; 2017. ISBN 978-92-4-156545-5.

6. Poethko-Müller C, Zimmermann R, Hamouda O, Faber M, Stark K, Ross RS, et al. [Epidemiology of hepatitis A, B, and C among adults in Germany. Results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt—Gesundheitsforsch–Gesundheitsschutz. 2013;56:707–15. doi: 10.1007/s00103-013-1673-x

7. UNAIDS. HIV Statistics 2018. Geneva: UNAIDS; [cited 2019 Jul 29]. Available from:

8. European Commission. Eurostat: Asylum and managed migration. Brussels: European Commission; 2019 [cited 2019 Aug 10]. Available from:

9. Heudorf U, Karathana M, Krackhardt B, Huber M, Raupp P, Zinn C. Surveillance for parasites in unaccompanied minor refugees migrating to Germany in 2015. GMS Hyg Infect Control. 2016;11:1–3. doi: 10.3205/dgkh000265 26958459

10. Maassen W, Wiemer D, Frey C, Kreuzberg C, Tannich E, Hinz R, et al. Microbiological screenings for infection control in unaccompanied minor refugees: The German Armed Forces Medical Service’s experience. Mil Med Res. 2017;4:1–9. doi: 10.1186/s40779-016-0112-3

11. Marquardt L, Krämer A, Fischer F, Prüfer-Krämer L. Health status and disease burden of unaccompanied asylum-seeking adolescents in Bielefeld, Germany: cross-sectional pilot study. Trop Med Int Health. 2016;21:210–8. doi: 10.1111/tmi.12649 26610271

12. Mockenhaupt FP, Barbre KA, Jensenius M, Larsen CS, Barnett ED, Stauffer W, et al. Profile of illness in syrian refugees: A geosentinel analysis, 2013 to 2015. Eurosurveillance. 2016;21:1–5. doi: 10.2807/1560-7917.ES.2016.21.10.30160 26987893

13. Theuring S, Friedrich-Jänicke B, Pörtner K, Trebesch I, Durst A, Dieckmann S, et al. Screening for infectious diseases among unaccompanied minor refugees in Berlin, 2014–2015. Eur J Epidemiol. 2016;31:707–10. doi: 10.1007/s10654-016-0187-x 27450185

14. Kloning T, Nowotny T, Alberer M, Hoelscher M, Hoffmann A, Froeschl G. Morbidity profile and sociodemographic characteristics of unaccompanied refugee minors seen by paediatric practices between October 2014 and February 2016 in Bavaria, Germany. BMC Public Health. 2018;18. doi: 10.1111/j.1365-2133.1983.tb00542.x

15. Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, et al. Evidence-based clinical guidelines for immigrants and refugees. Can Med Assoc. J 2011;183:e824–925. doi: 10.1503/cmaj

16. Centers for Disease Control and Prevention. Guidelines for the U.S. Domestic Medical Examination for Newly Arriving Refugees 2012. Atlanta, GA: CDC; [cited 2019 Jul 20]. Available from:

17. Chaves NJ, Paxton GA, Biggs BA, Thambiran A, Gardiner J, Williams J, et al. The Australasian Society for Infectious Diseases and Refugee Health Network of Australia recommendations for health assessment for people from refugee-like backgrounds: An abridged outline. Med J Aust. 2017;206:310–5. doi: 10.5694/mja16.00826 28403765

18. Schrier L, Wyder C, del Torso S, Stiris T, von Both U, Brandenberger J, et al. Medical care for migrant children in Europe: a practical recommendation for first and follow-up appointments. Eur J Pediatr. 2019;178:1449–67. doi: 10.1007/s00431-019-03405-9 31240389

19. Pfeil J, Kobbe R, Trapp S, Kitz C, Hufnagel M. [Recommendations for the diagnosis and prevention of infectious diseases in pediatric and adolescent refugees in Germany]. Monatsschr Kinderheilkd. 2015;163:1269–86. doi: 10.1007/s00112-015-0003-9

20. Bundestag Deutscher. Gesetz zur Verhütung und Bekämpfung von Infektionskrankheiten beim Menschen (Infektionsschutzgesetz–IfSG). Infektionsschutzgesetz 2000;Stand. 18.0:1–41. doi: 10.1007/978-1-4419-7046-6_59

21. WHO. BMI-for-age (5–19 years). Geneva: World Health Organization; 2018 [cited 2019 May 20]. Available from:

22. Lampertico P, Agarwal K, Berg T, Buti M, Janssen HLA, Papatheodoridis G, et al. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67:370–98. doi: 10.1016/j.jhep.2017.03.021 28427875

23. Yun K, Urban K, Mamo B, Matheson J, Payton C, Scott KC, et al. Increasing hepatitis B vaccine prevalence among refugee children arriving in the United States, 2006–2012. Am J Public Health. 2016;106:1460–2. doi: 10.2105/AJPH.2016.303203 27310356

24. Alberer M, Malinowski S, Sanftenberg L, Schelling J. Notifiable infectious diseases in refugees and asylum seekers: experience from a major reception center in Munich, Germany. Infection. 2018;46:375–83. doi: 10.1007/s15010-018-1134-4 29616458

25. Seybolt LM, Christiansen D, Barnett ED. Diagnostic Evaluation of Newly Arrived Asymptomatic Refugees with Eosinophilia. Clin Infect Dis. 2006;42:363–7. doi: 10.1086/499238 16392081

26. Naidu P, Yanow SK, Kowalewska-Grochowska KT. Eosinophilia: A poor predictor of strongyloides infection in refugees. Can J Infect Dis Med Microbiol. 2013;24:93–6. doi: 10.1155/2013/290814 24421809

27. Dawson-Hahn EE, Greenberg SLM, Domachowske JB, Olson BG. Eosinophilia and the Seroprevalence of Schistosomiasis and Strongyloidiasis in Newly Arrived Pediatric Refugees: An Examination of Centers for Disease Control and Prevention Screening Guidelines. J Pediatr. 2010;156. doi: 10.1016/j.jpeds.2010.02.043 20400098

28. Posey DL, Blackburn BG, Weinberg M, Flagg EW, Ortega L, Wilson M, et al. High Prevalence and Presumptive Treatment of Schistosomiasis and Strongyloidiasis among African Refugees. Clin Infect Dis. 2007;45:1310–5. doi: 10.1086/522529 17968826

29. Bennet R, Eriksson M. Tuberculosis infection and disease in the 2015 cohort of unaccompanied minors seeking asylum in Northern Stockholm, Sweden. Infect Dis (Auckl). 2017;49:501–6. doi: 10.1080/23744235.2017.1292540 28276801

30. 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. Eurosurveillance. 2017;22:30491. doi: 10.2807/1560-7917.ES.2017.22.12.30491 28367795

31. Mueller-Hermelink M, Kobbe R, Methling B, Rau C, Schulze-Sturm U, Auer I, et al. Universal screening for latent and active tuberculosis (TB) in asylum seeking children, Bochum and hamburg, Germany, September 2015 to November 2016. Eurosurveillance. 2018;23. doi: 10.2807/1560-7917.ES.2018.23.12.17–00536

32. Greenaway C, Pareek M, Abou Chakra C-N, Walji M, Makarenko I, Alabdulkarim B, et al. The effectiveness and cost-effectiveness of screening for active tuberculosis among migrants in the EU/EEA: a systematic review. Eurosurveillance. 2018;23:5–18. doi: 10.2807/1560-7917.ES.2018.23.14.17–00542

33. Sloot R Schim van der Loeff MF, Kouw PM., Borgdorff MW, Risk of tuberculosis after recent exposure. A 10-year follow-up study of contacts in Amsterdam. Am J Respir Crit Care Med. 2014; 190: 1044–1052. doi: 10.1164/rccm.201406-1159OC 25265362

34. Kuehne A, Hauer B, Brodhun B, Haas W, Fiebig L. Screening and prevention of infectious diseases in newly arrived migrants. Find and treat or find and lose? Tuberculosis treatment outcomes among screened newly arrived asylum seekers in Germany 2002 to 2014. Eurosurveillance. 2018;23:pii = 17–00042. doi: 10.2807/1560-7917.ES.2018.23.11.17–00042

35. Bozorgmehr K, Wahedi K, Noest S, Szecsenyi J, Razum O. Infectious disease screening in asylum seekers: Range, coverage and economic evaluation in Germany, 2015. Eurosurveillance. 2017;22. doi: 10.2807/1560-7917.ES.2017.22.40.16–00677

36. Agbata EN, Morton RL, Bisoffi Z, Bottieau E, Greenaway C, Biggs B-A, et al. Effectiveness of Screening and Treatment Approaches for Schistosomiasis and Strongyloidiasis in Newly-Arrived Migrants from Endemic Countries in the EU/EEA: A Systematic Review. Int J Environ Res Public Health. 2019;16:11. doi: 10.3390/ijerph16010011 30577567

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