Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada.
Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada.
J Travel Med. 2019 Feb 1;26(2). doi: 10.1093/jtm/taz007.
Human migration is increasing in magnitude and scope. The majority of migrants arriving in high-income countries originate from countries with a high prevalence of infectious diseases. The risk and burden of infectious diseases are not equally distributed among migrant groups and vary with migration stage.
A broad literature review was conducted on the drivers for infectious diseases and associated health outcomes among migrants across different stages of migration. The aim was to provide practitioners with an overview of the key infectious disease risks at each stage to guide health promotion strategies.
A complex interaction of factors leads to infectious diseases and associated poor health outcomes among migrants. The most important drivers are the epidemiology of infectious diseases in their countries of origin, the circumstances and conditions of the migration journey and barriers accessing healthcare post-arrival. During the recent large waves of forced migration into Europe, the primary health concerns on arrival were psychological, traumatic and chronic non-communicable diseases. In the early settlement period, crowded and unhygienic living conditions in reception camps facilitated outbreaks of respiratory, gastrointestinal, skin infections and vaccine preventable diseases. After re-settlement, undetected and untreated latent infections due to tuberculosis, viral hepatitis, HIV, chronic helminthiasis and Chagas' disease led to poor health outcomes. Migrants are disproportionally affected by preventable travel-related diseases such as malaria, typhoid and hepatitis due to poor uptake of pre-travel prophylaxis and vaccination. Infectious diseases among migrants can be decreased at all migration stages with health promotion strategies adapted to their specific needs and delivered in a linguistically and culturally sensitive manner.
Tailored health promotion and screening approaches and accessible and responsive health systems, regardless of legal status, will be needed at all migration stages to limit the burden and transmission of infectious diseases in the migrant population.
人类的迁移规模和范围正在不断扩大。大多数抵达高收入国家的移民都来自传染病高发的国家。传染病的风险和负担在移民群体中分布不均，且因迁移阶段而异。
我们对不同迁移阶段的移民中传染病及其相关健康结果的驱动因素进行了广泛的文献综述。目的是为从业者提供每个阶段主要传染病风险的概述，以指导健康促进策略。
各种因素的复杂相互作用导致了移民中的传染病和相关不良健康结果。最重要的驱动因素是原籍国传染病的流行病学、迁移过程的情况和条件以及抵达后获得医疗保健的障碍。在最近欧洲大规模被迫移民潮中，抵达时的主要健康问题是心理、创伤和慢性非传染性疾病。在早期定居阶段，接待营中拥挤和不卫生的生活条件促成了呼吸道、胃肠道、皮肤感染和疫苗可预防疾病的爆发。重新定居后，由于结核病、病毒性肝炎、艾滋病毒、慢性寄生虫病和恰加斯病等潜伏感染未被发现和未得到治疗，导致健康状况不佳。由于预防性旅行相关疾病（如疟疾、伤寒和肝炎）的预防措施和疫苗接种率低，移民不成比例地受到可预防的旅行相关疾病的影响。通过针对其特定需求制定并以语言和文化敏感的方式提供的健康促进策略，可以在所有迁移阶段降低移民中的传染病发病率。
无论法律地位如何，在所有迁移阶段都需要有针对性的健康促进和筛查方法以及可及和响应的卫生系统，以限制移民人群中传染病的负担和传播。
