Screening Practices for infectious diseases in Migrants Rome 28th May Tanya Melillo Malta
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1 Screening Practices for infectious diseases in Migrants Rome 28th May 2015 Tanya Melillo Malta
2 Infectious disease prevention and control unit May 2015
3 Demographics Total country population for 2015: 424,838 Non Maltese: around 22,000 Total number of documented migrants (seeking work in Malta): around Majority from Philippines, Serbia, China, India, Turkey, Russia and Pakistan. Average age of migrants arriving by boat is 24 years and male Largest number came from Somali. Infectious disease prevention and control unit May 2015
4 Infectious disease prevention and control unit May 2015
5 Overview Since 2001 up till today, irregular migrants reached our shores. 14,784 were males 1,774 were males minors 2,405 were females 427 were female minors The largest intake was in 2013 with 2008 in 6 weeks. Infectious disease prevention and control unit May 2015
6 Nationalities Country Total number Somali 7119 Eritrea 3029 Egypt 1542 Nigeria 1105 Sudan 921 Ivory Coast 683 Ethiopia 652 Mali 584 Ghana 524 Syria 316
7 Infectious disease prevention and control unit May 2015
8 Total number of adults
9 Total number of minors
10 Overall total number of migrants arriving in Malta since 2001
11 Infectious disease prevention and control unit May 2015
12 Asylum Seekers coming from Libya and other countries Total Maytill 15/05/2015 April March Feb Jan Total Dec. Nov Oct Sept. Aug July June May since 12/05/ Infectious disease prevention and control unit May 2015
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14 Migrant status form the office of the Refugee Commissioner from January 2002-April 2015
15 Infectious disease prevention and control unit May 2015
16 Type of immigration centres Detention centre in South of Country ( Hal Far/Safi) Open centre in South of the country (Hal Far) for families, single women and Marsa for men only Unaccompanied minors are kept in two homes Once they leave open centre they rent flats all over the country Infectious disease prevention and control unit May 2015
17 Infectious disease prevention and control unit May 2015
18 Relevant national laws Immigration Act chapter 217 (Ministry of Hone affairs, 1970) Refugees Act (Ministry if Hone Affairs, 2000) Both these laws were amended several times and subsidiary legislations pertaining to asylum reception process. A policy document released by Government in 2005 serves as the basis for indicating various entitlements and services provided to migrants (MJHA and MFSS, 2005). Infectious disease prevention and control unit May 2015
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20 Migrants Come from countries with high risk to certain infectious diseases especially tuberculosis Factors affecting their health: Poor socioeconomic conditions Inadequate housing/overcrowding Social isolation Poor sanitation Poor diet Difficulty to access health services Language and cultural barriers Vulnerable to certain infectious diseases
21 Infectious diseases in illegal immigrants Common diseases Respiratory, urinary or skin infections Communicable diseases TB, Viral hepatitis, STD s, HIV infection Tropical diseases Malaria, filariasis, intestinal parasites
22 Infectious disease prevention and control unit May 2015
23 Tuberculosis Epidemiology Between ,195 migrants landed in Malta many originating from Africa. Tb notification rate of African migrants was 34.7/100,000 persons-years compared to 2.7/100,000 Maltese borne rate. The proportion of migrant Tb casers increased from 32% in 2002 to 72% in 2010 ( p=0.004) Infectious disease prevention and control unit May 2015
24 Tuberculosis screening Consists of : Check for symptoms Chest x ray Mantoux test If any abnormalities are found, they are referred to the Tb consultant who will under take further tests and give necessary treatment if required. Infectious disease prevention and control unit May 2015
25 Tuberculosis screening continued Those found to have active Tb are admitted to hospital to ensure treatment compliance and are only released after establishing that they are not infectious to others. They then continue their treatment for a further 6-9 months using DOTS ( directly observed treatment). Infectious disease prevention and control unit May 2015
26 Screening tests for new entrants from countries with high incidence rates of tuberculosis Age Chest x-ray Mantoux Test* < 3 months months 10 years ± years years + ± Infectious disease prevention and control unit May 2015
27 Algorithm for screening and follow-up of adult ( 18 years) new entrants Infectious disease prevention and control unit May 2015
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30 Challenges Language barriers Culture barriers Taking medication (DOTS) and keeping up appointments with specialists in hospital Understanding instructions given by Health care professionals No concept of time to keep appointments Impossible to find where they are living once they leave open centres when they do not turn up for follow up or stop their treatment. Infectious disease prevention and control unit May 2015
31 Cases Number of pulmonary cases of tuberculoses are diagnosed on arrival and not on arrival per year Pulmonary TB among migrants ( ) Diagnosed on arrival Diagnosed not on arrival Year Infectious disease prevention and control unit May 2015
32 Cases Number of extra pulmonary cases of tuberculoses are diagnosed on arrival and not on arrival per year 12 Extra-pulmonary TB among migrants ( ) Diagnosed on arrival Diagnosed not on arrival Year Infectious disease prevention and control unit May 2013
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43 Infectious disease prevention and control unit May 2013
44 Infectious disease prevention and control unit May 2013
45 Achievements 1. Offer universal free health care to migrants for primary and secondary care. 2. Health screening of migrants for Tuberculosis done within first 3 days of arrival 3. Physical examination on arrival to identify any obvious infectious diseases. 4. Vaccinations given within first 5 days of arrival. 5. A motivated and dedicated team of professionals are responsible for dealing with migrants. Infectious disease prevention and control unit May 2015
46 Lessons Learnt Intersectoral coordination amongst all entities/stakeholders who work directly with migrants makes problem solving easier. Organised clinics for migrants in detention and open centres helps early diagnosis of infectious diseases and medical conditions. Infectious disease prevention and control unit May 2015
47 THANK YOU
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