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Immunisation status of UK-bound refugees between January, 2018, and October, 2019: a retrospective, population-based cross-sectional study
The Lancet Public Health ( IF 50.0 ) Pub Date : 2022-05-28 , DOI: 10.1016/s2468-2667(22)00089-5
Anna Deal 1 , Sally E Hayward 1 , Alison F Crawshaw 2 , Lucy P Goldsmith 2 , Charles Hui 3 , Warren Dalal 4 , Fatima Wurie 5 , Mary-Ann Bautista 6 , May Antonnette Lebanan 6 , Sweetmavourneen Agan 6 , Farah Amin Hassan 4 , Kolitha Wickramage 6 , Ines Campos-Matos 5 , Sally Hargreaves 2
Affiliation  

Background

WHO's new Immunization Agenda 2030 places a focus on ensuring migrants and other marginalised groups are offered catch-up vaccinations across the life-course. Yet, it is not known to what extent specific groups, such as refugees, are immunised according to host country schedules, and the implications for policy and practice. We aimed to assess the immunisation coverage of UK-bound refugees undergoing International Organization for Migration (IOM) health assessments through UK resettlement schemes, and calculate risk factors for under-immunisation.

Methods

We undertook a retrospective cross-sectional study of all refugees (children <10 years, adolescents aged 10–19 years, and adults >19 years) in the UK resettlement programme who had at least one migration health assessment conducted by IOM between Jan 1, 2018 and Oct 31, 2019, across 18 countries. Individuals' recorded vaccine coverage was calculated and compared with the UK immunisation schedule and the UK Refugee Technical Instructions. We carried out multivariate logistic regression analyses to assess factors associated with varying immunisation coverage.

Findings

Our study included 12 526 refugees of 36 nationalities (median age 17 years [IQR 7–33]; 6147 [49·1%] female; 7955 [63·5%] Syrian nationals). 26 118 vaccine doses were administered by the IOM (most commonly measles, mumps, and rubella [8741 doses]). During the study, 6870 refugees departed for the UK, of whom 5556 (80·9%) had at least one recorded dose of measles-containing vaccine and 5798 (84·4%) had at least one dose of polio vaccine, as per the UK Refugee Technical Instructions, and 1315 (19·1%) had at least one recorded dose of diphtheria-containing vaccine or tetanus-containing vaccine. 764 (11·1%) of refugees were fully aligned with the UK schedule for polio, compared with 2338 (34·0%) for measles and 380 (5·5%) for diphtheria and tetanus. Adults were significantly less likely than children to be in line with the UK immunisation schedule for polio (odds ratio 0·0013, 95% CI 0·0001–0·0052) and measles (0·29, 0·25–0·32).

Interpretation

On arrival to the UK, refugees' recorded vaccination coverage is suboptimal and varies by age, nationality, country of health assessment, and by disease, with particularly low coverage reported for diphtheria and tetanus, and among adult refugees. These findings have important implications for the delivery of refugee pre-entry health assessments and catch-up vaccination policy and delivery targeting child, adolescent, and adults migrants in the UK, and other refugee-receiving countries. This research highlights the need for improved data sharing and clearer definition of where responsibilities lie between host countries and health assessment providers.

Funding

UK National Institute for Health Research (NIHR300072) and Medical Research Council (MR/N013638/1).



中文翻译:

2018 年 1 月至 2019 年 10 月期间前往英国的难民的免疫接种状况:一项基于人群的回顾性横断面研究

背景

世卫组织新的《2030 年免疫议程》将重点放在确保移民和其他边缘化群体在整个生命过程中获得补种疫苗。然而,目前尚不清楚特定群体(如难民)根据东道国的时间表接种疫苗的程度,以及对政策和实践的影响。我们旨在通过英国重新安置计划评估接受国际移民组织 (IOM) 健康评估的英国难民的免疫覆盖率,并计算免疫不足的风险因素。

方法

我们对英国重新安置计划中的所有难民(10 岁以下的儿童、10-19 岁的青少年和 >19 岁的成年人)进行了一项回顾性横断面研究,这些难民在 1 月 1 日期间由 IOM 进行了至少一次移民健康评估, 2018 年和 2019 年 10 月 31 日,遍布 18 个国家/地区。计算个人记录的疫苗覆盖率,并与英国免疫计划和英国难民技术说明进行比较。我们进行了多变量逻辑回归分析,以评估与不同免疫覆盖率相关的因素。

发现

我们的研究包括来自 36 个国家的 12526 名难民(中位年龄 17 岁 [IQR 7-33];6147 名 [49·1%] 女性;7955 名 [63·5%] 叙利亚国民)。IOM 接种了 26118 剂疫苗(最常见的是麻疹、腮腺炎和风疹 [8741 剂])。在研究期间,有 6870 名难民前往英国,其中 5556 人(80·9%)至少接种过一剂麻疹疫苗,5798 人(84·4%)至少接种过一剂脊髓灰质炎疫苗。 UK Refugee Technical Instructions 和 1315 (19·1%) 至少有记录剂量的白喉疫苗或破伤风疫苗。764 名(11·1%)难民完全符合英国的脊髓灰质炎时间表,相比之下,麻疹为 2338 名(34·0%),白喉和破伤风为 380 名(5·5%)。

解释

抵达英国后,难民记录的疫苗接种覆盖率并不理想,并且因年龄、国籍、健康评估国家和疾病而异,其中白喉和破伤风以及成年难民的覆盖率特别低。这些发现对于在英国和其他难民接收国实施针对儿童、青少年和成人移民的难民入境前健康评估和补种疫苗接种政策和实施具有重要意义。这项研究强调需要改进数据共享和更清晰地定义东道国和健康评估提供者之间的责任。

资金

英国国家卫生研究所 (NIHR300072) 和医学研究委员会 (MR/N013638/1)。

更新日期:2022-05-28
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