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Infectious disease testing of UK-bound refugees: a population-based, cross-sectional study.

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posted on 17.09.2019, 15:31 by AF Crawshaw, M Pareek, J Were, S Schillinger, O Gorbacheva, KP Wickramage, S Mandal, V Delpech, N Gill, H Kirkbride, D Zenner
BACKGROUND: The UK, like a number of other countries, has a refugee resettlement programme. External factors, such as higher prevalence of infectious diseases in the country of origin and circumstances of travel, are likely to increase the infectious disease risk of refugees, but published data is scarce. The International Organization for Migration carries out and collates data on standardised pre-entry health assessments (HA), including testing for infectious diseases, on all UK refugee applicants as part of the resettlement programme. From this data, we report the yield of selected infectious diseases (tuberculosis (TB), HIV, syphilis, hepatitis B and hepatitis C) and key risk factors with the aim of informing public health policy. METHODS: We examined a large cohort of refugees (n = 18,418) who underwent a comprehensive pre-entry HA between March 2013 and August 2017. We calculated yields of infectious diseases stratified by nationality and compared these with published (mostly WHO) estimates. We assessed factors associated with case positivity in univariable and multivariable logistic regression analysis. RESULTS: The number of refugees included in the analysis varied by disease (range 8506-9759). Overall yields were notably high for hepatitis B (188 cases; 2.04%, 95% CI 1.77-2.35%), while yields were below 1% for active TB (9 cases; 92 per 100,000, 48-177), HIV (31 cases; 0.4%, 0.3-0.5%), syphilis (23 cases; 0.24%, 0.15-0.36%) and hepatitis C (38 cases; 0.41%, 0.30-0.57%), and varied widely by nationality. In multivariable analysis, sub-Saharan African nationality was a risk factor for several infections (HIV: OR 51.72, 20.67-129.39; syphilis: OR 4.24, 1.21-24.82; hepatitis B: OR 4.37, 2.91-6.41). Hepatitis B (OR 2.23, 1.05-4.76) and hepatitis C (OR 5.19, 1.70-15.88) were associated with history of blood transfusion. Syphilis (OR 3.27, 1.07-9.95) was associated with history of torture, whereas HIV (OR 1521.54, 342.76-6754.23) and hepatitis B (OR 7.65, 2.33-25.18) were associated with sexually transmitted infection. Syphilis was associated with HIV (OR 10.27, 1.30-81.40). CONCLUSIONS: Testing refugees in an overseas setting through a systematic HA identified patients with a range of infectious diseases. Our results reflect similar patterns found in other programmes and indicate that the yields for infectious diseases vary by region and nationality. This information may help in designing a more targeted approach to testing, which has already started in the UK programme. Further work is needed to refine how best to identify infections in refugees, taking these factors into account.


This study was internally funded by Public Health England. MP is supported by the National Institute for Health Research (NIHR Post-Doctoral Fellowship, Dr. Manish Pareek, PDF-2015-08-102). The views expressed in this publication are those of the authors and do not necessarily reflect those of the affiliated organisations, including Public Health England, the International Organization for Migration, the NHS, the National Institute for Health Research or the Department of Health and Social Care.



BMC Medicine, 2018, 16, Article number: 143

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/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Infection, Immunity and Inflammation


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The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Additional file 1: Supplementary material. (DOCX 69 kb) Additional file 2: Supporting tables: logistic regression analysis. Table S1. Testing yield and logistic regression analysis of the TB test cohort† (outcome = active TB). Table S2. Testing yield and logistic regression analysis of the HIV test cohort† (outcome = HIV positive). Table S3. Testing yield and logistic regression analysis of the syphilis test cohort† (outcome = syphilis positive). Table S4. Testing yield and logistic regression analysis of the hepatitis B test cohort† (outcome= hepatitis B positive). Table S5. Testing yield and logistic regression analysis of the hepatitis C test cohort† (outcome: hepatitis C positive). (DOCX 62 kb)