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Table 1 National and international guidelines with recommendations regarding infectious diseases, including respiratory infectious diseases

From: Reducing burden from respiratory infections in refugees and immigrants: a systematic review of interventions in OECD, EU, EEA and EU-applicant countries

Guideline Main recommendations regarding particular issues
Region/Country Guideline Vaccinations Screening or other diagnostic assessment Health-literacy Housing
Europe[21] European Centers for Disease Control and Prevention (ECDC) / WHO regional office for Europe
www.ecdc.europa.eu
Country specific vaccination schedule should be implemented for all refugees/asylum seekers/migrants staying for one week or more
Main priority should be MMR and Polio vaccines
Vaccination should not be implemented at border crossings unless in the presence of an outbreak
Regarding less of their legal status equitable and non-discriminatory access to essential health care services with preventive and curative interventions should be granted to all refugees and asylum seekers
All member countries should be prepared at any time to epidemiologically assess and adequately react to any outbreak situation
None Overcrowding should be avoided (not giving numbers)
Clean sanitary institutions and clothing should be available
Switzerland[20] Schweizerische Gesellschaft für Infektionskrankheiten
www.Sginf.ch
Following the same vaccination schedule as for indigenous previously unimmunised adults/children
Vaccination only valid when written documentation is available
All refugee children under 5 y.o. Should be screened for TB using tuberculin skin test regardless of BCG vaccination status and country of origin
All adults and children > 5 y.o. Should be screened for TB only in case of symptoms using IGRA or TST on
Syphilis Screening for all children < 2 y.o. And all juvenile refugees 12–15 y.o
None None
Germany[18, 19] Robertkochinstitut
www.rki.de
Documentation of vaccination status
Valid documentation leads to enrolment of national vaccination schedule for all residents
Invalid documentation leads to accomplishment of separate minimum vaccination schedule
All refugees should be vaccinated against influenza not only high risk population
Examination not focussing on personal health status but on outbreak prevention in the first line
General anamnesis focussing on infectious diseases
Full body examination including vital parameters focussing on infectious diseases and rashes
Screening for active lung TB by x-ray (exceptions for pregnant women and children under 15 y.o
None None
Australia[13] Australian Government—Departement of Health
www.health.gov.au
Vaccination status of refugees is not routinely assessed, differing by states
All refugees arriving to Australia should receive vaccination catch-up vaccinations
Pre-departure vaccinations and valid documentations of previous vaccinations should be considered and all vaccinations to children under 7 y.o. Should be reported to ACIR (Australian Childhood Immunisation Register)
In all arriving people with refugee-like background a general assessment regarding HIV, disability, strongyloides serology and other should be conducted
Some assessments like syphilis serology, vitamin- or ferritin status should be conducted by individual risk
Some assessments like Malaria status, Hepatitis C and Schistosoma serology should be conducted by respective country of origin
None None
USA[14] Centers for Disease Control and prevention
www.cdc.gov
Vaccination only valid when written documentation is available
Overseas vaccination program implemented by registered physicians before departure to US consisting of two doses of several vaccines with 1–2 months of time in between
-post-arrival after assessment of immunization status an age-adjusted vaccination schedule will be implemented. Serologic testing may be used for evaluating vaccination-status
If possible medical examination by special physicians will be implemented before departure from overseas. Except from vaccination status assessment there will be also presumptive treatment with albendazole enrolled
Broad medical examination by special physicians implemented during the first months after arrival in the US. Physical status as well as nutritional status, lead-test, laboratory testing and age adjusted TB screening will be assessed. Vaccination coverage is assessed and records from former overseas examination will be checked and completed
None None
Canada[16] National Advisory Committee on Immunization (NACI)
Committee to Advise on Tropical Medicine and Travel (CATMAT)
https://www.canada.ca/en/public-health/services/canadian-immunization-guide.html
Vaccination status is assessed prior to arrival with only documented proof of vaccination accepted as valid
Catch-up schedule is oriented to country of origin and age of individual
-MMR and Varicella vaccination should not be given in case of suspected active tuberculosis
Before arriving in Canada refugee claimants are enrolled in Immigration Medical Examinations
TB-screening using TST is implemented to migrants from high-risk countries
Laboratory examinations are implemented after arrival in Canada checking for full blood cell count, sickle cell status, HIV status (when coming from high-burden countries) and other
None None
United Kingdom[17] National Institute for Health Care Excellence
https://www.gov.uk/government/collections/migrant-health-guide-countries-a-to-z
Vaccination status of refugees residing in the UK should always be assessed by physicians. Age adjusted national catch-up-schedule is implemented Existing assessment guidelines for many different countries: every country of origin has its respective schedule for migrant health
Newly arriving migrants are evaluated by assessing their psycho-social status, sexual-behaviour, ethinicity and risk of communicable diseases, as well as personal health issues such as hearing, seeing and risk factors for chronic diseases
LTBI screening is implemented for all immigrants having spent significant time or being born in high-risk areas using TST or IGRA
-active TB screening is implemented to all immigrants migrating from high incidence countries using chest x-ray
Newly arriving migrants should be informed how the NHS works and how it differs to health systems they are used to None