Communicable Diseases Among Asylum Seekers: Actions for Health Professionals | Daily News Byte

Communicable Diseases Among Asylum Seekers: Actions for Health Professionals

 | Daily News Byte

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Over the past 2 years there have been a number of communicable disease notifications linked to asylum seeker housing across the country, including:

  • Diphtheria
  • Shigella
  • Group A Streptococcus
  • MRSA (Methicillin-resistant Staphylococcus aureus)
  • Varicella zoster virus
  • Corona Virus (Covid-19)
  • the flu
  • itching
  • Tuberculosis

Diphtheria is a rare, vaccine-preventable disease caused by toxigenic strains of Corynebacteria in the UK. Diphtheria can initially present with either cutaneous or respiratory symptoms, including a sore throat and, in severe cases, membranes that can lead to airway obstruction. However, this is not universally present.

Without immediate treatment with diphtheria antitoxin (DAT) and antibiotics, the case fatality rate for respiratory diphtheria reaches 10%.

Cases of communicable diseases among asylum seekers this year

As of 13 December 2022, 62 cases of diphtheria have been confirmed in asylum seekers with recent arrivals in the UK so far this year, with the majority of cases detected in the last 3 months. Cases are mainly in young men between the ages of 14 and 25, with about half of cases involving the skin.

A proportion of asylum seekers in the UK present with diffuse and varied skin lesions. Examination of asylum seekers presenting with skin lesions has identified a range of pathogens including Staphylococcus aureus, Group A Streptococcus and Corynebacterium diphtheriae.

Many individuals also develop scabies, with co-infections frequently occurring. Fuel burn has also become an issue.

Information for Healthcare Professionals

UK Health Security Agency (UKHSA) encourages clinicians to ensure the following actions are completed when managing infectious diseases in asylum-seeking populations.

Diphtheria

For individuals who have passed through the initial reception center, a mass offer of antibiotic prophylaxis and vaccination is recommended by the National Incident Management Team. There is supplementary guidance for diphtheria cases and outbreaks in asylum seeker accommodation settings.

Where a physician diagnoses suspected diphtheria in an asylum seeker (recent updates to case definitions are available), they are requested to immediately notify their local health protection team by phone to ensure appropriate public health action.

Clinicians are reminded that cases of suspected or confirmed classical respiratory diphtheria, or cutaneous diphtheria with large lesions, should be evaluated promptly, with support from an infectious diseases clinician to consider as needed. DAT.

Ensure that any swabs sent (including skin and throat swabs) are properly labelled, making it clear that the swab was taken from an asylum seeker. Testing for diphtheria is not universally performed in all local laboratories. Proper labeling of specimens, and discussion of severe cases, will ensure that laboratories carry out appropriate tests and make further referrals. UKHSA Reference laboratories where potentially toxic Corynebacterium species have been isolated. Because of the small number of multidrug-resistant cutaneous diphtheria isolates associated with this cohort, clinicians are asked to ensure clearance of the organism from where it was originally discovered. Information on antibiotic resistance and appropriate treatment and approval can be found in supplemental guidelines.

Skin lesions other than diphtheria

Skin lesions in asylum seekers may be infected or colonized with multiple bacteria; It is not uncommon to see Staphylococcus aureus (+/-). MRSA / PVL) and group A streptococcus co-infection in this group, with occasional skin diphtheria. Group A streptococcus remains universally susceptible to penicillin; However, resistance to macrolides, clindamycin and tetracycline antibiotics more than doubled between 2016 and 2021.

Effective management of skin lesions may require a complex antibiotic regimen, prescribed following the advice of a local microbiology or infectious diseases specialist and guided by susceptibility data. Due to migration routes and countries of origin, diagnostic variations may also include rare pathologies such as leishmaniasis. Failure to respond to initial clinical management strategies should prompt consideration of further referral to local infectious diseases or dermatology teams.

UKHSA Recently published guidance on the management of scabies cases and outbreaks in long-term care facilities and other closed settings.

More information about health requirements for asylum seekers

Guidance on the public health management of diphtheria in England is available on GOV.UK.

Comprehensive advice for healthcare practitioners about the health needs of migrants is in the Migrant Health Guide.

Immunization catch-up guidelines are available for individuals with uncertain or incomplete immunization status.

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