A quarter of migrants to Europe are infected with drug-resistant bacteria acquired on migration route or in refugee camps in host countries-Lancet study

5/21/18, "A quarter of migrants to Europe infected with drug-resistant bacteria," Homeland Security Newswire

"A new review of research on migrant populations in Europe has found that more than a quarter are infected or colonized with antibiotic-resistant bacteria, with evidence suggesting that the pathogens are being acquired along the migration route or in host countries. The findings come amid a recent wave of immigration that has brought more than two million migrants to Europe since 2015, an influx that’s been driven in part by conflicts and instability in the Middle East and Africa.

The findings are from a review and meta-analysis of observational studies on antimicrobial resistance (AMR) in migrants conducted by researchers from Imperial College London and published yesterday in the The Lancet Infectious Diseases. The researchers also found that the prevalence of AMR carriage or infection was even higher among refugees and asylum seekers and in high-migrant community settings. But they did not find high rates of AMR transmission from migrants to host populations....

The authors of the study suggest that the poor conditions that many migrants are exposed to in transit and in host countries-including crowded refugee camps and detention centers with poor sanitation and little access to healthcare—may promote the spread of antibiotic-resistant bacteria. The role of these settings in the spread of infectious diseases has been highlighted in previous studies....

In their review of papers published from January 2000 through January 2017, the researchers identified 23 studies reporting on antibiotic resistance in 2,319 migrants. Countries of origin included Syria, Afghanistan, Eritrea and other countries in the Middle East, Africa, and Asia. Of these migrants, 77 percent were refugees or asylum seekers.

Nineteen of the studies reported on methicillin-resistant Staphylococcus aureus (MRSA), and 12 of the studies reported on AMR in gram-negative bacteria. When they were reported, the clinical manifestations were mainly skin and other soft-tissue infections and diarrhea.

Overall, the pooled prevalence of any detected AMR infection or carriage among migrants was 25.4 percent, with MRSA accounting for 7.8 percent and drug-resistant gram-negative bacteria accounting for 27.2 percent. The pooled prevalence of infection was 3 percent, and the pooled prevalence of carriage was 23 percent.

Among refugees and asylum seekers, pooled prevalence of AMR infection or carriage was 33 percent, compared with 6 pwrcent in other migrants. In high-migrant community settings, the prevalence was 33.1 percent....
 
While many of the countries and regions that the migrants came from are known to have high rates of AMR, the authors say they found evidence in the included studies that suggests the antibiotic-resistant organisms were acquired either during migration or in the host countries, which included Spain, Italy, Greece, Germany, Austria, the Netherlands, Sweden, and Switzerland....

Three of the countries where the studies were conducted—Greece, Italy, and Spain—are the main points of entry for migrants to Europe. They have also been found to have a high prevalence of MRSA (39.2 percent, 34.1 percent, and 25.3 percent, respectively), which raises the possibility that migrants could have acquired the pathogen from people in those countries.

But it’s the poor conditions in the places where refugees are housed while they await resettlement that may be the most important factor in spreading AMR bacteria among migrants, the authors argue....

“Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries,” the authors write. “These improvements will enable timely detection and treatment of infections when they do occur, thus reducing transmission and poorer and more costly health outcomes.”"

--Read more in Laura B. Nellums et al., “Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis,” The Lancet (17 May 2018) (DOI: https://doi.org/10.1016/S1473-3099(18)30219-6)


..................