Gogoi Mayuri, Martin Christopher A, Bird Paul W, Wiselka Martin J, Gardener Judi, Ellis Kate, Renals Valerie, Lewszuk Adam J, Hargreaves Sally, Pareek Manish
Department of Respiratory Sciences, University of Leicester, UK.
Development Centre for Population Health, University of Leicester, UK.
J Migr Health. 2024 Feb 25;9:100217. doi: 10.1016/j.jmh.2024.100217. eCollection 2024.
Vaccine preventable diseases (VPDs) such as measles and rubella cause significant morbidity and mortality globally every year. The World Health Organization (WHO), reported vaccine coverage for both measles and rubella to be 71 % in 2019, indicating an immunity gap. Migrants in the EU/EEA may be at high risk of VPDs due to under-immunisation and poor living conditions. However, there are limited data on VPD seroprotection rates amongst migrants living in the United Kingdom (UK).
We conducted an exploratory cross-sectional serosurvey amongst a sample of adult migrants living in Leicester, UK to: (a) determine seroprotection rates for measles, varicella zoster, and rubella in this group; (b) identify risk factors associated with seronegativity and, (c) understand if self-reported vaccine or diseases history is an effective measure of seroprotection. Participants gave a blood sample and completed a questionnaire asking basic demographic details and vaccine and disease history for the three VPDs. We summarised the data using median and interquartile range (IQR) for non-parametric continuous variables and count and percentage for categorical variables. We used logistic regression to establish predictors of seroprotection against these diseases. We examined the reliability of self-reported vaccination/disease history for prediction of seroprotection through a concordance analysis.
149 migrants were included in the analysis. Seroprotection rates were: varicella zoster 98 %, rubella 92.6 % and measles 89.3 %. Increasing age was associated with seroprotection (OR 1.07 95 % CI 1.01-1.13 for each year increase in age). Migrants from Africa and the Middle East (aOR 15.16 95 % CI 1.31 - 175.06) and South/East Asia and Pacific regions (aOR 15.43 95 %CI 2.38 - 100.00) are significantly more likely to be seroprotected against measles as compared to migrants from Europe and Central Asia. The proportions of migrants unsure about their vaccination and disease history combined were 53.0 % for measles; 57.7 % for rubella; 43.0 % for varicella. There was no agreement between self-reported vaccination/disease history and serostatus.
Our findings suggest lower levels of seroprotection against measles in migrants living in Leicester, UK, with younger migrants and those from Europe and Central Asia more likely to lack seroprotection. A high proportion of surveyed migrants were unaware of their vaccination/disease history and self-reported vaccine/disease was a poor predictor of seroprotection against VPDs which is important for clinical decision-making regarding catch-up vaccination in this population. Our results, although derived from a small sample, suggest that there may be gaps in seroimmunity for certain VPDs in particular migrant populations. These findings should inform future qualitative studies investigating barriers to vaccine uptake in migrants and population-level seroprevalence studies aimed at determining individualised risk profiles based on demographic and migration factors.
麻疹和风疹等疫苗可预防疾病每年在全球造成大量发病和死亡。世界卫生组织（WHO）报告称，2019年麻疹和风疹的疫苗接种覆盖率均为71%，这表明存在免疫差距。由于免疫接种不足和生活条件差，欧盟/欧洲经济区的移民可能面临较高的疫苗可预防疾病风险。然而，关于居住在英国（UK）的移民中疫苗可预防疾病血清保护率的数据有限。
我们对居住在英国莱斯特的成年移民样本进行了一项探索性横断面血清学调查，目的是：（a）确定该群体中麻疹、水痘带状疱疹和风疹的血清保护率；（b）识别与血清阴性相关的风险因素；（c）了解自我报告的疫苗接种或疾病史是否是血清保护的有效指标。参与者提供了一份血样，并填写了一份问卷，询问基本人口统计学细节以及三种疫苗可预防疾病的疫苗接种和疾病史。对于非参数连续变量，我们使用中位数和四分位间距（IQR）汇总数据；对于分类变量，我们使用计数和百分比汇总数据。我们使用逻辑回归来确定针对这些疾病的血清保护预测因素。我们通过一致性分析检查自我报告的疫苗接种/疾病史对血清保护预测的可靠性。
149名移民纳入分析。血清保护率分别为：水痘带状疱疹98%，风疹92.6%，麻疹89.3%。年龄增长与血清保护相关（年龄每增加一岁，OR为1.07，95%CI为1.01 - 1.13）。与来自欧洲和中亚的移民相比，来自非洲和中东（调整后OR为15.16，95%CI为1.31 - 175.06）以及南亚/东亚和太平洋地区（调整后OR为15.43，95%CI为2.38 - 100.00）的移民更有可能对麻疹具有血清保护。不确定自己疫苗接种和疾病史的移民比例，麻疹为53.0%；风疹为57.7%；水痘为43.0%。自我报告的疫苗接种/疾病史与血清状态之间没有一致性。
我们的研究结果表明，居住在英国莱斯特的移民中针对麻疹的血清保护水平较低，年轻移民以及来自欧洲和中亚的移民更有可能缺乏血清保护。很大一部分接受调查的移民不知道自己的疫苗接种/疾病史，自我报告的疫苗/疾病情况对疫苗可预防疾病血清保护的预测能力较差，这对于该人群补种疫苗的临床决策很重要。我们的结果虽然来自小样本，但表明特定移民群体中某些疫苗可预防疾病的血清免疫可能存在差距。这些发现应为未来调查移民疫苗接种障碍的定性研究以及旨在根据人口统计学和移民因素确定个体风险概况的人群水平血清流行率研究提供参考。
