公共卫生应对大量寻求庇护者入境：传染病筛查的实施和时间安排。

Public health response to large influx of asylum seekers: implementation and timing of infectious disease screening.

机构信息

Doctoral Programme for Population Health, University of Helsinki, Helsinki, Finland.

Department of Health Security, Infectious Disease Control and Vaccinations Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.

出版信息

BMC Public Health. 2018 Sep 24;18(1):1139. doi: 10.1186/s12889-018-6038-9.

DOI:10.1186/s12889-018-6038-9

PMID:30249224

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6154941/

Abstract

BACKGROUND

Infectious disease screening of migrants at increased risk is a feature of national infection prevention and control measures. Asylum seekers in Finland are offered screening of tuberculosis (TB), hepatitis B, human immunodeficiency virus infection (HIV) and syphilis based on individual risk assessment. We aimed to evaluate the public health response to a large influx of asylum seekers to Finland in 2015-2016 with respect to national guidelines on initial health services and infectious disease screening.

METHODS

We used immigration and healthcare procurement data for all 38,134 asylum seekers to Finland during 2015-2016 to assess the implementation, timing and yields of infectious disease screening.

RESULTS

The coverage of pulmonary TB screening was 71.6% [95% CI 71.1-72.0%] and that of hepatitis B, HIV or syphilis 60.6% [60.1-61.1%] among those eligible for screening. The estimated average delay from arrival to pulmonary TB screening was 74 days for adults and 43 days for children. Delay to hepatitis B, HIV and syphilis screening was 91 days for adults and 47 days for children. The seroprevalence of hepatitis B surface antigen positivity was 1.4% [95% CI 1.3-1.6%], HIV 0.3% [95% CI 0.1-0.4%] and Treponema pallidum specific antibodies 1.0% [95% CI 0.8-1.1%]. Data did not allow assessment of yields of pulmonary TB screening.

CONCLUSIONS

Up to one third of asylum seekers were not reached by screening and screenings were delayed from target timeframes. Children, as a vulnerable population, were screened earlier than adults. To ensure higher screening coverage, infectious disease risks should be reassessed and screening completed at contacts to healthcare during the post-asylum phase of integration. The large influx of asylum seekers to Finland in 2015-2016 tested the country's public health preparedness. After action reviews of the public health response to the large migrant influx such as screening implementation can be used for evidence-based improvement of public health preparedness and guidelines for initial health services and infectious disease screening.

摘要

背景

对高风险移民进行传染病筛查是国家感染预防和控制措施的一个特征。芬兰根据个人风险评估，为寻求庇护者提供结核病（TB）、乙型肝炎、人类免疫缺陷病毒感染（HIV）和梅毒筛查。我们旨在评估 2015-2016 年大量寻求庇护者涌入芬兰对国家初步卫生服务和传染病筛查指南的公共卫生反应。

方法

我们使用 2015-2016 年期间所有 38134 名芬兰寻求庇护者的移民和医疗保健采购数据，评估传染病筛查的实施、时间安排和效果。

结果

符合筛查条件的人群中，肺结核筛查覆盖率为 71.6%（95%CI 71.1-72.0%），乙型肝炎、HIV 或梅毒筛查覆盖率为 60.6%（60.1-61.1%）。从抵达到肺结核筛查的估计平均延迟时间为成人 74 天，儿童 43 天。乙型肝炎、HIV 和梅毒筛查的延迟时间为成人 91 天，儿童 47 天。乙型肝炎表面抗原阳性的血清流行率为 1.4%（95%CI 1.3-1.6%），HIV 为 0.3%（95%CI 0.1-0.4%），梅毒螺旋体特异性抗体为 1.0%（95%CI 0.8-1.1%）。数据无法评估肺结核筛查的效果。

结论

多达三分之一的寻求庇护者未接受筛查，筛查时间从目标时间延迟。儿童作为弱势群体，比成年人更早接受筛查。为确保更高的筛查覆盖率，应重新评估传染病风险，并在融合后的庇护后阶段通过医疗保健接触完成筛查。2015-2016 年大量寻求庇护者涌入芬兰考验了该国的公共卫生准备情况。在对大规模移民涌入等公共卫生反应进行行动审查后，可以将筛查实施等作为改进公共卫生准备和初步卫生服务及传染病筛查指南的依据。