NIHR Leicester Biomedical Research Centre

About: NIHR Leicester Biomedical Research Centre is a facility organization based out in . It is known for research contribution in the topics: Medicine & Internal medicine. The organization has 12 authors who have published 16 publications receiving 136 citations.

Prevention and treatment of infectious diseases in migrants in Europe in the era of universal health coverage

Abstract: Some subpopulations of migrants to Europe are generally healthier than the population of the country of settlement, but are at increased risk of key infectious diseases, including tuberculosis, HIV, and viral hepatitis, as well as under- immunisation. Infection screening programmes across Europe work in disease silos with a focus on individual diseases at the time of arrival. We argue that European health-care practitioners and policy makers would benefit from developing a framework of universal health care for migrants, which proactively offers early testing and vaccinations by delivering multi-disease testing and catch-up vaccination programmes integrated within existing health systems. Such interventions should be codeveloped with migrant populations to overcome barriers faced in accessing services. Aligning policies with the European Centre for Disease Prevention and Control guidance for health care for migrants, community-based preventive health-care programmes should be delivered as part of universal health care. However, effective implementation needs appropriate funding, and to be underpinned by high-quality evidence. Some subpopulations of migrants to Europe are generally healthier than the population of the country of settlement, but are at increased risk of key infectious diseases, including tuberculosis, HIV, and viral hepatitis, as well as under- immunisation. Infection screening programmes across Europe work in disease silos with a focus on individual diseases at the time of arrival. We argue that European health-care practitioners and policy makers would benefit from developing a framework of universal health care for migrants, which proactively offers early testing and vaccinations by delivering multi-disease testing and catch-up vaccination programmes integrated within existing health systems. Such interventions should be codeveloped with migrant populations to overcome barriers faced in accessing services. Aligning policies with the European Centre for Disease Prevention and Control guidance for health care for migrants, community-based preventive health-care programmes should be delivered as part of universal health care. However, effective implementation needs appropriate funding, and to be underpinned by high-quality evidence. IntroductionThe 2030 Sustainable Development Goals of leaving no one behind call on UN member states to ensure universal health coverage so that all populations receive the health services they need.1UNTransforming our world: the 2030 agenda for Sustainable Development.https://sustainabledevelopment.un.org/post2015/transformingourworld/publicationDate: 2015Date accessed: November 7, 2021Google Scholar However, at least half of the world's population still does not have full coverage of essential health services (from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course).2WHOUniversal health coverage (UHC).https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)Date: April 1, 2021Date accessed: February 22, 2022Google Scholar Despite migrants explicitly being included under universal health coverage, with commitments for UN member states to provide access to health coverage for refugees and migrants,3UNGlobal compact on refugees.https://refugeesmigrants.un.org/refugees-compactDate: 2017Date accessed: June 14, 2022Google Scholar migrant populations have particularly low access,4Wickramage K Vearey J Zwi AB Robinson C Knipper M Migration and health: a global public health research priority.BMC Public Health. 2018; 18: 987Crossref PubMed Scopus (87) Google Scholar with vast and sudden population movements such as the recent exodus from Ukraine leaving individuals especially vulnerable. The WHO Regional Office for Europe has identified that ensuring countries neighbouring Ukraine have the infrastructure and expertise in place to meet the health needs of those arriving as a key priority.5WHOStatement–WHO: health care provision for civilians within and refugees beyond Ukraine our priority.https://www.who.int/europe/news/item/08-03-2022-statement-who-health-care-provision-for-civilians-within-and-refugees-beyond-ukraine-our-priorityDate: March 8, 2022Date accessed: March 21, 2022Google Scholar European countries vary greatly in the amount and type of health care to which migrants are legally entitled, particularly undocumented migrants.6Lebano A Hamed S Bradby H et al.Migrants' and refugees' health status and healthcare in Europe: a scoping literature review.BMC Public Health. 2020; 201039Crossref PubMed Scopus (86) Google Scholar Migrants might be charged for treatment,7Aldridge RW Miller AK Jakubowski B Pereira L Fille F Noret I Falling through the cracks: the failure of universal healthcare coverage in Europe.https://mdmeuroblog.files.wordpress.com/2014/01/observatory-report-2017-web-version.pdfDate: 2017Date accessed: January 21, 2022Google Scholar, 8Nazareth J Baggaley RF Divall P et al.What is the evidence on existing national policies and guidelines for delivering effective tuberculosis, HIV, and viral hepatitis services for refugees and migrants among member states of the WHO European region?.https://apps.who.int/iris/handle/10665/352055Date: 2022Date accessed: June 2, 2022Google Scholar, 9Onarheim KH Melberg A Meier BM Miljeteig I Towards universal health coverage: including undocumented migrants.BMJ Glob Health. 2018; 3e001031Crossref PubMed Google Scholar limiting uptake and thereby harming health and exacerbating inequalities. Furthermore, restricting services risks increasing overall health costs (early and preventive care are often cost saving, preventing infection transmission and disease incidence and progression), compromising public trust in confidential health systems, and undermining the doctor–patient relationship and the protection of human rights.7Aldridge RW Miller AK Jakubowski B Pereira L Fille F Noret I Falling through the cracks: the failure of universal healthcare coverage in Europe.https://mdmeuroblog.files.wordpress.com/2014/01/observatory-report-2017-web-version.pdfDate: 2017Date accessed: January 21, 2022Google ScholarSome migrants in Europe are disproportionately affected by infections including tuberculosis, HIV, and viral hepatitis B and C.10European Centre for Disease Prevention and ControlPublic health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA.https://www.ecdc.europa.eu/en/publications-data/public-health-guidance-screening-and-vaccination-infectious-diseases-newlyDate: Dec 5, 2018Date accessed: November 8, 2021Google Scholar, 11European Centre for Disease Prevention and ControlMigrant health: background note to the ECDC report on migration and infectious diseases in the EU.https://www.ecdc.europa.eu/en/publications-data/migrant-health-series-background-note-ecdc-report-migration-and-infectiousDate: July 21, 2009Date accessed: February 1, 2022Google Scholar, 12European Centre for Disease Prevention and ControlTuberculosis surveillance and monitoring in Europe 2021–2019 data.https://www.ecdc.europa.eu/en/publications-data/tuberculosis-surveillance-and-monitoring-europe-2021-2019-dataDate: March 22, 2021Date accessed: November 8, 2021Google Scholar, 13European Centre for Disease Prevention and ControlWHO Regional Office for EuropeHIV/AIDS surveillance in Europe 2020, 2019 data.https://www.ecdc.europa.eu/sites/default/files/documents/hiv-surveillance-report-2020.pdfDate: 2020Date accessed: November 7, 2021Google Scholar, 14European Centre for Disease Prevention and ControlEpidemiological assessment of hepatitis B and C among migrants in the EU/EEA.https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/epidemiological-assessment-hepatitis-B-and-C-among-migrants-EU-EEA.pdfDate: 2016Date accessed: February 1, 2022Google Scholar This burden is due to a combination of factors before, during, and after migration, including exposure to infections, inadequate health-care access, and poor living conditions.15WHOReport on the health of refugees and migrants in the WHO European region: no public health without refugee and migrant health.https://apps.who.int/iris/handle/10665/311347Date: 2018Date accessed: November 7, 2021Google Scholar This burden is mirrored by the effect of COVID-19 on migrant populations, with migrants at higher risk of COVID-19 infection, possibly higher mortality risk, and greater economic and educational effects of COVID-19 interventions, such as school and workplace closures, than non-migrants.16Organisation for Economic Co-operation and DevelopmentWhat is the impact of the COVID-19 pandemic on immigrants and their children?.https://www.oecd.org/coronavirus/policy-responses/what-is-the-impact-of-the-covid-19-pandemic-on-immigrants-and-their-children-e7cbb7de/Date: Oct 19, 2020Date accessed: February 21, 2022Google Scholar, 17European Centre for Disease Prevention and ControlReducing COVID-19 transmission and strengthening vaccine uptake among migrant populations in the EU/EEA.https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-reducing-transmission-and-strengthening-vaccine-uptake-in-migrants.pdfDate: June 3, 2021Date accessed: February 21, 2022Google Scholar, 18Hayward SE Deal A Cheng C et al.Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: a systematic review.J Migr Health. 2021; 3100041PubMed Google ScholarAlthough pan-European plans are in place to tackle tuberculosis, HIV, viral hepatitis, and vaccine-preventable diseases, migrant health outcomes have not necessarily been prioritised, undermining progress towards health targets for infectious disease control and vaccination uptake.19WHOTuberculosis action plan for the WHO European region 2016–2020.https://www.euro.who.int/__data/assets/pdf_file/0007/283804/65wd17e_Rev1_TBActionPlan_150588_withCover.pdfDate: 2015Date accessed: February 1, 2022Google Scholar, 20WHOAction plan for the health sector response to HIV in the WHO European region.https://www.euro.who.int/__data/assets/pdf_file/0007/357478/HIV-action-plan-en.pdfDate: 2017Date accessed: February 1, 2022Google Scholar, 21WHOAction plan for the health sector response to viral hepatitis in the WHO European region.https://www.euro.who.int/__data/assets/pdf_file/0008/357236/Hepatitis-9789289052870-eng.pdfDate: 2017Date accessed: February 1, 2022Google Scholar, 22WHOEuropean vaccine action plan 2015–2020.https://www.euro.who.int/__data/assets/pdf_file/0007/255679/WHO_EVAP_UK_v30_WEBx.pdfDate: 2014Date accessed: February 1, 2022Google Scholar There remains considerable debate on how best to adapt health systems to improve the health of migrants, so we must re-evaluate how we develop effective, evidence-based infection services for migrants.23Pareek M Noori T Hargreaves S van den Muijsenbergh M Linkage to care is important and necessary when identifying infections in migrants.Int J Environ Res Public Health. 2018; 15e1550Crossref Scopus (8) Google Scholar Such strategies must improve engagement of migrants, integrating services within national and local health-care structures, considering migrants’ fluidity of movement, wide range of relevant personal and social circumstances, disparities in access to preventive health care, complex health needs, and barriers to treatment initiation and completion.24UNGlobal compact for migration.https://refugeesmigrants.un.org/migration-compactDate: July 13, 2018Date accessed: February 21, 2022Google ScholarThe 2018 European Centre for Disease Prevention and Control (ECDC) guidance on screening and vaccination for infectious diseases in newly arrived migrants to the EU or European Economic Area (EEA) were developed in response to the burden of infectious diseases in migrants, and barriers to testing, treatment, and vaccination.10European Centre for Disease Prevention and ControlPublic health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA.https://www.ecdc.europa.eu/en/publications-data/public-health-guidance-screening-and-vaccination-infectious-diseases-newlyDate: Dec 5, 2018Date accessed: November 8, 2021Google Scholar The focus on migrants to the region rather than migrants within the EU or EEA, reflects the greater risk of infection, morbidity, and mortality for the former group.25Aldridge RW Nellums LB Bartlett S et al.Global patterns of mortality in international migrants: a systematic review and meta-analysis.Lancet. 2018; 392: 2553-2566Summary Full Text Full Text PDF PubMed Scopus (102) Google Scholar The guidance provided evidence that clinicians and public health programmes should avoid working in disease silos and aim for holistic, integrated, multiple infection testing, and vaccination programmes. However, there are many evidence gaps underlying the guidance26Noori T Hargreaves S Greenaway C et al.Strengthening screening for infectious diseases and vaccination among migrants in Europe: what is needed to close the implementation gaps?.Travel Med Infect Dis. 2021; 39101715Crossref PubMed Scopus (12) Google Scholar and further research to address these and to develop services that better align with countries’ commitments to universal health coverage are urgently required.In this Viewpoint, we explore the role of migrants (hereafter referring to migrants to the WHO European region, as this group of migrants is at highest risk of infection) in the epidemiology of key infectious diseases (eg, tuberculosis, HIV, and viral hepatitis) in Europe, current shortfalls in European migrant screening programmes, key components needed to meet migrants’ needs throughout the entire screening and treatment pathway, and continuing evidence gaps and research needs. We then define and propose a roadmap to adapt and de-silo health systems to reduce inequities in access to care and facilitate infectious disease screening and vaccination for all migrant groups at high-risk, considered within the framework of delivering high-quality universal health coverage.Migration and infection in EuropeMigration is an important driver of demographic change in the WHO European region. An estimated 30 million migrants born outside the European continental region arrived between 2000 and 2020, with 87 million migrants resident in Europe in 2020.27UN Department of Economic and Social AffairsPopulation DivisionInternational migration 2020 highlights.https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/undesa_pd_2020_international_migration_highlights.pdfDate: 2020Date accessed: November 7, 2021Google Scholar Predominant migration flows from outside Europe are from Asia, Africa, and the Middle East.27UN Department of Economic and Social AffairsPopulation DivisionInternational migration 2020 highlights.https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/undesa_pd_2020_international_migration_highlights.pdfDate: 2020Date accessed: November 7, 2021Google ScholarThe 2018 UCL–Lancet Commission on Migration and Health highlighted that migrants to high-income countries have lower mortality rates than host populations for non-infectious conditions including cardiovascular diseases, neoplasms, and diabetes, but face a two-fold increased mortality risk for infectious diseases, with risks for mortality from HIV and tuberculosis even higher.25Aldridge RW Nellums LB Bartlett S et al.Global patterns of mortality in international migrants: a systematic review and meta-analysis.Lancet. 2018; 392: 2553-2566Summary Full Text Full Text PDF PubMed Scopus (102) Google Scholar However, few studies have focused on the most vulnerable migrant groups such as asylum seekers, refugees, and undocumented migrants.28Zenner D Requena Méndez A Schillinger S Val E Wickramage K Health and illness in migrants and refugees arriving in Europe: analysis of the electronic personal health record system.J Travel Med. 2022; (published online March 22.)https://doi.org/10.1093/jtm/taac035Crossref PubMed Google Scholar In addition to an increased mortality risk for infectious diseases,18Hayward SE Deal A Cheng C et al.Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: a systematic review.J Migr Health. 2021; 3100041PubMed Google Scholar data suggest that migrants might present late29Delpech V Brown AE Croxford S et al.Quality of HIV care in the United Kingdom: key indicators for the first 12 months from HIV diagnosis.HIV Med. 2013; 14: 19-24Crossref PubMed Scopus (27) Google Scholar, 30Blanas DA Nichols K Bekele M Lugg A Kerani RP Horowitz CR HIV/AIDS among African-born residents in the United States.J Immigr Minor Health. 2013; 15: 718-724Crossref PubMed Scopus (42) Google Scholar, 31European Centre for Disease Prevention and Control and WHO Regional Office for EuropeHIV/AIDS surveillance in Europe 2017, 2016 data.https://www.ecdc.europa.eu/en/publications-data/hivaids-surveillance-europe-2017-2016-dataDate: 2017Date accessed: February 1, 2022Google Scholar, 32Health Protection AgencyMigrant health: infectious diseases in non-UK born populations in the UK. Health Protection Agency Centre for Infections, London2011Google Scholar and have worse outcomes,33Kruijshaar ME Abubakar I Increase in extrapulmonary tuberculosis in England and Wales 1999–2006.Thorax. 2009; 64: 1090-1095Crossref PubMed Scopus (132) Google Scholar which could lead to increased transmission within migrant communities.34European Centre for Disease Prevention and ControlMigrant health: sexual transmission of HIV within migrant groups in the EU/EEA and implications for effective interventions.https://www.ecdc.europa.eu/en/publications-data/migrant-health-sexual-transmission-hiv-within-migrant-groups-eueea-andDate: 2013Date accessed: February 1, 2022Google ScholarBefore the COVID-19 pandemic, migrants to the EU or EEA comprised a third of all tuberculosis cases in the region in 2019.12European Centre for Disease Prevention and ControlTuberculosis surveillance and monitoring in Europe 2021–2019 data.https://www.ecdc.europa.eu/en/publications-data/tuberculosis-surveillance-and-monitoring-europe-2021-2019-dataDate: March 22, 2021Date accessed: November 8, 2021Google Scholar Reactivation of latent tuberculosis infection among migrants is an important determinant of tuberculosis epidemiology in Europe, which has driven national policies for identifying and treating latent tuberculosis infection in migrants to achieve targets to reduce tuberculosis incidence.35Pareek M Greenaway C Noori T Munoz J Zenner D The impact of migration on tuberculosis epidemiology and control in high-income countries: a review.BMC Med. 2016; 14: 48Crossref PubMed Scopus (179) Google Scholar, 36Pareek M Watson JP Ormerod LP et al.Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis.Lancet Infect Dis. 2011; 11: 435-444Summary Full Text Full Text PDF PubMed Scopus (163) Google Scholar Similarly, 44% of people diagnosed with HIV in Europe in 2019 were migrants.13European Centre for Disease Prevention and ControlWHO Regional Office for EuropeHIV/AIDS surveillance in Europe 2020, 2019 data.https://www.ecdc.europa.eu/sites/default/files/documents/hiv-surveillance-report-2020.pdfDate: 2020Date accessed: November 7, 2021Google Scholar Data on hepatitis B and hepatitis C virus prevalence are more limited. However, the ECDC estimates that hepatitis B virus (ie, HBsAg positive) prevalence in the general population in EU or EEA countries is 0–7·5% (data from 38 studies) and 1·7% in the UK (as an example country of settlement).37European Centre for Disease Prevention and ControlHepatitis B and C epidemiology in selected population groups in the EU/EEA.https://www.ecdc.europa.eu/en/publications-data/hepatitis-b-and-c-epidemiology-selected-population-groups-eueeaDate: 2018Date accessed: February 1, 2022Google Scholar Hepatitis B virus prevalence for first-generation migrants to EU or EEA countries is 0–5·6% among migrants from the east Mediterranean region, 0–5·0% from south Asia, 0·3–20·0% from southeast Asia, 0–11·7% from eastern Europe, 0–5·6% from Latin America, and 0–22·2% among migrants from sub-Saharan Africa. Hepatitis C virus (ie, anti-hepatitis C virus antibody positive) prevalence in the general population in EU or EEA countries is 0–27·6% (data from 41 studies) and 0·4–1·2% in the UK (data from two studies).37European Centre for Disease Prevention and ControlHepatitis B and C epidemiology in selected population groups in the EU/EEA.https://www.ecdc.europa.eu/en/publications-data/hepatitis-b-and-c-epidemiology-selected-population-groups-eueeaDate: 2018Date accessed: February 1, 2022Google Scholar Hepatitis C virus prevalence for first-generation migrants is 0–3·0% among migrants from the east Mediterranean region, 0–9·6% from south Asia, 0·6–1·6% from southeast Asia, 3·1–9·3% from eastern Europe, 0–10·0% from Latin America, and 0–19·2% among migrants from sub-Saharan Africa.30Blanas DA Nichols K Bekele M Lugg A Kerani RP Horowitz CR HIV/AIDS among African-born residents in the United States.J Immigr Minor Health. 2013; 15: 718-724Crossref PubMed Scopus (42) Google Scholar, 37European Centre for Disease Prevention and ControlHepatitis B and C epidemiology in selected population groups in the EU/EEA.https://www.ecdc.europa.eu/en/publications-data/hepatitis-b-and-c-epidemiology-selected-population-groups-eueeaDate: 2018Date accessed: February 1, 2022Google ScholarMigrants are also more likely to be under-immunised and face greater disease burden, disability, and deaths from vaccine-preventable diseases than the host population in countries of settlement.38De Vito E Parente P de Waure C Poscia A Ricciardi W A review of evidence on equitable delivery, access, and utilization of immunization services for migrants and refugees in the WHO European region. World Health Organization Regional Office for Europe, Copenhagen2017Google Scholar They might present with incomplete vaccination histories and missing documentation of previous vaccinations, presenting challenges to assessing vaccination status.38De Vito E Parente P de Waure C Poscia A Ricciardi W A review of evidence on equitable delivery, access, and utilization of immunization services for migrants and refugees in the WHO European region. World Health Organization Regional Office for Europe, Copenhagen2017Google Scholar For example, unaccompanied minors (ie, children and adolescents younger than 18 years who migrate without being accompanied by a legal guardian)39United Nations Children's FundA child is a child–protecting children on the move from violence, abuse, and exploitation.https://data.unicef.org/resources/child-child-protecting-children-move-violence-abuse-exploitation/Date: 2017Date accessed: June 5, 2022Google Scholar have particularly low vaccination coverage or knowledge of coverage, which could be due to constant movement, disruption, and emergencies in their countries of origin.40Corona Maioli S Bhabha J Wickramage K et al.International migration of unaccompanied minors: trends, health risks, and legal protection.Lancet Child Adolesc Health. 2021; 5: 882-895Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 41Kloning T Nowotny T Alberer M Hoelscher M Hoffmann A Froeschl G Morbidity profile and sociodemographic characteristics of unaccompanied refugee minors seen by paediatric practices between October 2014 and February 2016 in Bavaria, Germany.BMC Public Health. 2018; 18: 983Crossref PubMed Scopus (15) Google Scholar, 42Mipatrini D Stefanelli P Severoni S Rezza G Vaccinations in migrants and refugees: a challenge for European health systems. A systematic review of current scientific evidence.Pathog Glob Health. 2017; 111: 59-68Crossref PubMed Scopus (101) Google Scholar Low immunisation rates have implications for the individual and for public health. As vaccine coverage falls below the herd immunity threshold, migrants and the wider community become at higher risk of infection.42Mipatrini D Stefanelli P Severoni S Rezza G Vaccinations in migrants and refugees: a challenge for European health systems. A systematic review of current scientific evidence.Pathog Glob Health. 2017; 111: 59-68Crossref PubMed Scopus (101) Google ScholarCOVID-19 might have increased vulnerability to other infectious diseases including tuberculosis, HIV, viral hepatitis, and vaccine-preventable diseases. As efforts for detection and treatment of other infections have been reduced, resources have been diverted towards COVID-19 containment, and health-seeking behaviours have changed.43International Union against Tuberculosis and Lung DiseaseStatement on tuberculosis in migrants during the COVID-19 pandemic.https://theunion.org/sites/default/files/2020-12/TB_Migr_COVID_Statement_November2020.pdfDate: 2020Date accessed: January 21, 2022Google Scholar Migrants might disproportionately face COVID-19-mediated vulnerabilities because of increased unemployment and loss of income limiting access to food, housing, and health-care services, increasing susceptibility to infectious disease acquisition (eg, associated with employment roles, housing, transportation, or ethnicity), and concomitant morbidity and mortality.16Organisation for Economic Co-operation and DevelopmentWhat is the impact of the COVID-19 pandemic on immigrants and their children?.https://www.oecd.org/coronavirus/policy-responses/what-is-the-impact-of-the-covid-19-pandemic-on-immigrants-and-their-children-e7cbb7de/Date: Oct 19, 2020Date accessed: February 21, 2022Google Scholar, 17European Centre for Disease Prevention and ControlReducing COVID-19 transmission and strengthening vaccine uptake among migrant populations in the EU/EEA.https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-reducing-transmission-and-strengthening-vaccine-uptake-in-migrants.pdfDate: June 3, 2021Date accessed: February 21, 2022Google ScholarEffectiveness of existing migrant screening and vaccination programmes in EuropeAlthough many European countries have guidelines on infection testing and vaccination, they have a limited focus on migrants, are highly heterogeneous, and there is a clear disconnect between their recommendations and actual clinical implementation.8Nazareth J Baggaley RF Divall P et al.What is the evidence on existing national policies and guidelines for delivering effective tuberculosis, HIV, and viral hepatitis services for refugees and migrants among member states of the WHO European region?.https://apps.who.int/iris/handle/10665/352055Date: 2022Date accessed: June 2, 2022Google Scholar, 44Alvarez-Del Arco D Monge S Caro-Murillo AM et al.HIV testing policies for migrants and ethnic minorities in EU/EFTA Member States.Eur J Public Health. 2014; 24: 139-144Crossref PubMed Scopus (26) Google Scholar, 45Hargreaves S Rustage K Nellums LB et al.What constitutes an effective and efficient package of services for the prevention, diagnosis, treatment, and care of tuberculosis among refugees and migrants in the WHO European region?. World Health Organization Regional Office for Europe, Copenhagen2018Google Scholar, 46Kärki T Napoli C Riccardo F et al.Screening for infectious diseases among newly arrived migrants in EU/EEA countries—varying practices but consensus on the utility of screening.Int J Environ Res Public Health. 2014; 11: 11004-11014Crossref PubMed Scopus (60) Google Scholar, 47Pareek M Abubakar I White PJ Garnett GP Lalvani A Tuberculosis screening of migrants to low-burden nations: insights from evaluation of UK practice.Eur Respir J. 2011; 37: 1175-1182Crossref PubMed Scopus (45) Google Scholar, 48Pareek M Baussano I Abubakar I Dye C Lalvani A Evaluation of immigrant tuberculosis screening in industrialized countries.Emerg Infect Dis. 2012; 18: 1422-1429Crossref PubMed Scopus (83) Google Scholar The vast majority of testing programmes focus on tuberculosis alone, specifically for asylum seekers and refugees.49Seedat F Hargreaves S Nellums LB Ouyang J Brown M Friedland JS How effective are approaches to migrant screening for infectious diseases in Europe? A systematic review.Lancet Infect Dis. 2018; 18: e259-e271Summary Full Text Full Text PDF PubMed Scopus (73) Google Scholar This approach misses opportunities to engage other at-risk migrant groups and might not adequately address multimorbidity or other key risk factors such as migration trajectory, reason for migration, or origins in countries with high infection prevalence or limited preventive health care.50Hargreaves S Carballo M Friedland JS Screening migrants for tuberculosis: where next?.Lancet Infect Dis. 2009; 9: 139-140Summary Full Text Full Text PDF PubMed Scopus (25) Google Scholar Furthermore, as routine services became restricted during the COVID-19 pandemic, migrants have faced additional barriers accessing new systems.17European Centre for Disease Prevention and ControlReducing COVID-19 transmission and strengthening vaccine uptake among migrant populations in the EU/EEA.https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-reducing-transmission-and-strengthening-vaccine-uptake-in-migrants.pdfDate: June 3, 2021Date accessed: February 21, 2022Google ScholarThe focus of migrant screening for infectious diseases has now moved from historical and poorly functioning port-of-arrival screening to a variety of initiatives including pre-entry screening and community-based case detection and vaccine catch-up approaches in countries of settlement.46Kärki T Napoli C Riccardo F et al.Screening for infectious diseases among newly arrived migrants in EU/EEA countries—varying practices but consensus on the utility of screening.Int J Environ Res Public Health. 2014; 11: 11004-11014Crossref PubMed Scopus (60) Google Scholar This framework shift takes a

Cluster analysis of transcriptomic datasets to identify endotypes of idiopathic pulmonary fibrosis

Abstract: Considerable clinical heterogeneity in idiopathic pulmonary fibrosis (IPF) suggests the existence of multiple disease endotypes. Identifying these endotypes would improve our understanding of the pathogenesis of IPF and could allow for a biomarker-driven personalised medicine approach. We aimed to identify clinically distinct groups of patients with IPF that could represent distinct disease endotypes.We co-normalised, pooled and clustered three publicly available blood transcriptomic datasets (total 220 IPF cases). We compared clinical traits across clusters and used gene enrichment analysis to identify biological pathways and processes that were over-represented among the genes that were differentially expressed across clusters. A gene-based classifier was developed and validated using three additional independent datasets (total 194 IPF cases).We identified three clusters of patients with IPF with statistically significant differences in lung function (p=0.009) and mortality (p=0.009) between groups. Gene enrichment analysis implicated mitochondrial homeostasis, apoptosis, cell cycle and innate and adaptive immunity in the pathogenesis underlying these groups. We developed and validated a 13-gene cluster classifier that predicted mortality in IPF (high-risk clusters vs low-risk cluster: HR 4.25, 95% CI 2.14 to 8.46, p=3.7×10-5).We have identified blood gene expression signatures capable of discerning groups of patients with IPF with significant differences in survival. These clusters could be representative of distinct pathophysiological states, which would support the theory of multiple endotypes of IPF. Although more work must be done to confirm the existence of these endotypes, our classifier could be a useful tool in patient stratification and outcome prediction in IPF.

Predictors of adverse outcome in the first and second waves of the COVID-19 pandemic: results from a UK centre

Abstract: Data concerning differences in demographics/disease severity between the first and second waves of COVID-19 are limited. We aimed to examine prognosis in patients presenting to hospital with COVID-19 amongst different ethnic groups between the first and second waves in the UK.In this retrospective cohort study, we included 1763 patients presenting to a regional hospital centre in Leicester (UK) and compared those in the first (n = 956) and second (n = 807) waves. Admission National Early Warning Scores, mechanical ventilation and mortality rate were lower in the second wave compared with the first.Thirty-day mortality risk in second wave patients was approximately half that of first wave patients [adjusted hazard ratio (aHR) 0.55, 95% confidence interval (CI) 0.40-0.75]. In the second wave, Black patients were at higher risk of 30-day mortality than White patients (4.73, 1.56-14.3).We found that disporportionately higher risks of death in patients from ethnic minority groups were not equivalent across consecutive waves of the pandemic. This suggests that risk factors for death in those from ethnic minority groups are malleable and potentially reversible. Our findings need urgent investigation in larger studies.