Dissertation committee:
Παυλοπούλου Ιωάννα, Αναπληρώτρια Καθηγήτρια, Νοσηλευτική, ΕΚΠΑ
Τσουμάκας Κωνσταντίνος, Καθηγητής, Νοσηλευτική, ΕΚΠΑ
Τσολιά Μαρία, Καθηγήτρια, Ιατρική, ΕΚΠΑ
Καλοκαιρινού Αθηνά, Καθηγήτρια, Νοσηλευτική, ΕΚΠΑ
Μαντάς Ιωαννής, Καθηγητής, Νοσηλευτική, ΕΚΠΑ
Μπενέτου Βασιλική, Καθηγήτρια, Ιατρική, ΕΚΠΑ
Φώτος Νικόλαος, Καθηγητής, Νοσηλευτική, ΕΚΠΑ
Summary:
Background and aims
The effort to develop a recommendation of screening tests for vaccine preventable infectious diseases in refugee and immigrant children through the investigation of their vaccination status, the presence of protective antibodies per disease and the detection of subclinical or active diseases.
Methods
Α cross-sectional prevalence study of infectious diseases was conducted in newly arrived immigrant and refugee children, aged 1-14 years, which were addressed to a pediatric hospital of Athens, in order to issue a Health Certificate, within three months of their arrival in our country. For data collection a modified questionnaire was used and blood serum was stored deep-frozen (- 80 ° C) for antibody testing. A selected group of children were vaccinated with booster vaccine doses for hepatitis B. To investigate the relationship in between the variables x2, x2 trend and t-test controls were used. In order to eliminate confounding multivariate logistic regression analyses was performed.
Results
Between 2010-2013 a total of 274 children were included (mean age: 7.1; S.D: 3.8) with a response rate of 100%. Males outnumbered females in a ratio of 1.19 and the largest percentage were refugees (54.7%) from countries with a low Human Development Index (57.7%). Main continent of origin was Asia (72.2%), followed by Eastern Europe (10.2%), Africa (8.8%) and the Middle East (8.8%). A significant percentage of children were found without valid vaccination records (79.3%), while this phenomenon was more common among refugee children (p<0.001). Fully vaccinated were found 18.2% for diphtheria-tetanus, 17.9% for polio, 1.8% for hepatitis A, 15,3% for hepatitis B, 8 % with MMR, 2.6% for varicella and 88% for BCG. The majority appeared susceptible to hepatitis A (64.6%), while in a row for negative protective antibody levels follows varicella (51.1%), hepatitis B (42.3%), diphtheria (40.5%), mumps (36.5%), rubella (35.4%), tetanus (21.2%), measles (17.5%) and polio (10.9%; Negative title for all 3 serotypes). Latent tuberculosis was detected in 7 children, while all of them had a normal chest x-ray. Multivariate logistic regression analyses showed a positive relationship between the seroprotection and increasing age for Hepatitis A (p <0.001), mumps (p=0.002), rubella (p<0.001) and varicella (p<0.001). Conversely, for diphtheria (p=0.01), tetanus (p=0.001), serotype 2 and 3 of polio virus (p = 0.004; p = 0.01 respectively) and hepatitis B (p<0.001) increasing age was a negative predictor. For diphtheria and rubella, children originating from Eastern Europe were more likely to have positive antibodies than those originating from Asia (p=0.006; p=0.001), while the opposite applied for hepatitis A (p=0.002). Likewise, children originating from Africa were more likely to be found with protective antibody levels for rubella than children originating from Asia (p=0.009), whereas children originating from countries with a low Human Development Index were more likely to have positive antibodies for mumps (p=0.038). Children lacking a protective antibody titre for hepatitis B, appeared low compliance for a scheduled booster vaccination.
Conclusions
A significant proportion of immigrant and refugee children entering our country was found susceptible for vaccine- preventable infectious diseases, while the majority did not present vaccination documentation. Due to their constant moving and poor compliance, it is imperative to vaccinate all children on their first medical evaluation with priority vaccines, especially those lacking vaccination certificates, and record the vaccines administered in official immunization cards to present at all times during travel. Finally, screening before vaccination is a costly and impractical method and may be scheduled for specific infectious diseases according to the epidemiology in their home country, the local conditions, and resources available if a long-term stay is anticipated.
Keywords:
Serologic screening, Infectious diseases, Vaccination, Refugees, Immigrants, Children
