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Special Collection - Free access to reviews
Health of refugees and asylum seekers in Europe
Worldwide, the total number of forcibly displaced people is currently 59.5 million, according to UNHCR, the UN Refugee Agency. Europe is facing one of the biggest displacement crises, since the increase in displaced people travelling to the European Union from Western and South Asia, Africa, and the Western Balkans in 2015. While some migrants manage to overcome geographic limitations, they often face significant difficulties to get appropriate social and health services, and their needs tend to differ from those of local populations.
The aim of this Special Collection is to provide guidance to people attending refugees and asylum seekers, and to help the development of community programmes and policies. The collection focuses on the conditions most relevant to the context of transit or the patient population involved: common mental health disorders (post-traumatic stress disorder (PTSD) and depression), skin infections (including scabies, cellulitis, and impetigo), sexual and physical violence, vaccines-preventable diseases, and tuberculosis.
This Special Collection was developed in collaboration with Evidence Aid, Leo Ho (MSF), Kevin Pottie (University of Ottawa, Canada), and Cochrane.
Displaced people are at increased risk of many vaccine-preventable diseases. This especially the case for young children, who may not have been vaccinated in their country of origin due to cessation of vaccination programmes or poor access to vaccination centres.
Mumps, measles, and rubella (MMR) are serious diseases that can lead to potentially fatal illness, disability, and death. However, public debate over the safety of the trivalent MMR vaccine and the resultant drop in vaccination coverage in several countries persists, despite its almost universal use and accepted effectiveness. This review assesses the effectiveness and adverse effects associated with the MMR vaccine in children up to 15 years of age.
Acellular pertussis (aP) vaccines, containing purified or recombinant Bordetella pertussis antigens, were developed in the hope that they would be as effective but less reactogenic than the whole-cell vaccines. The review evaluates the efficacy and safety of acellular pertussis vaccines in children and compares them with the whole-cell vaccines.
Antibodies against hepatitis B surface antigen wane over time after vaccination for hepatitis B; hence, the duration of protection provided by the vaccine is still unknown but may be evaluated indirectly by measuring the anamnestic immune response to booster doses of vaccine. This review assesses the benefits and harms of booster dose hepatitis B vaccination for preventing hepatitis B infection.
Prevention of tetanus in neonates may be possible by the vaccination of pregnant or non-pregnant women, or both, with tetanus toxoid, and the provision of clean delivery services. This review assesses the effectiveness of tetanus toxoid, administered to women of reproductive age or pregnant women, to prevent cases of, and deaths from, neonatal tetanus.
Passive immunisation is generally considered to prevent measles in someone who is not immune and has been exposed to infection. This review assesses the effectiveness and safety of intramuscular injection or intravenous infusion of immunoglobulins for preventing measles when administered to exposed susceptible people before the onset of symptoms.
Many countries do not routinely immunise children against varicella and exposures continue to occur. Although the disease is often mild, complications such as secondary bacterial infection, pneumonitis and encephalitis occur in about 1% of cases, usually leading to hospitalisation. This review evaluates the efficacy and safety of vaccines for use as post-exposure prophylaxis for the prevention of varicella in children and adults.
Infection with rubella in early pregnancy can result in miscarriage, foetal death or congenital abnormality. This review assesses the effectiveness of intramuscular injection or intravenous infusion of polyclonal immunoglobulins of human sera or plasma origin for preventing rubella and congenital rubella syndrome when administered to exposed susceptible people before the onset of disease.
Refugees and asylum seekers, particularly women, are at high risk for domestic physical and sexual violence but also at risk for non-domestic violence due to the large conglomeration of those forcibly displaced in transit routes where men greatly outnumber women. However, due to their situation they may face a more difficult time escaping abuse.
Advocacy may contribute to reducing intimate partner abuse, empowering women to improve their situation by providing informal counselling and support for safety planning and increasing access to different services. This review assesses the effects of advocacy interventions within or outside healthcare settings in women who have experienced intimate partner abuse.
Some governments and professional organisations recommend screening all women for intimate partner violence rather than asking only women with symptoms. This review evaluates the effectiveness and safety of screening for intimate partner violence conducted within healthcare settings on identification, referral, and re-exposure to violence, and health outcomes for women.
Biological treatments of sex offenders include antilibidinal medication, comprising hormonal drugs that have a testosterone-suppressing effect, and non-hormonal drugs that affect libido through other mechanisms. This review evaluates the effects of pharmacological interventions on target sexual behaviour for people who have been convicted or are at risk of sexual offending.
Psychoanalytic/psychodynamic psychotherapy has a long-established tradition of being used for children and adolescents who have been sexually abused. This review assesses the effectiveness of this intervention for children and adolescents who have been sexually abused.
Cognitive-behavioural approaches are used to help children and their non-offending or 'safe' parent to manage the sequelae of childhood sexual abuse. This review assesses the efficacy of cognitive-behavioural approaches in addressing the immediate and longer-term sequelae of sexual abuse on children and young people up to 18 years of age.
Skin infections are common among those forcibly displaced, as they have to endure inadequate shelter and sanitation while travelling or waiting for asylum.
Impetigo is a common, superficial bacterial skin infection, most frequently encountered in children. There is no generally agreed standard therapy, and guidelines for treatment differ widely. This review evaluates the effects of treatments for impetigo, including non-pharmacological interventions and 'waiting for natural resolution'.
Cellulitis and erysipelas are now usually considered manifestations of the same condition, a skin infection associated with severe pain and systemic symptoms. This review evaluates the efficacy and safety of interventions for non-surgically-acquired cellulitis.
Scabies is an intensely itchy parasitic infection of the skin caused by the Sarcoptes scabiei mite. It is a common public health problem with an estimated global prevalence of 300 million cases. This review evaluates topical and systemic drugs for treating scabies.
Scabies is a common parasitic infection. While anyone can become infected, it causes significant morbidity in immunocompromised hosts and it spreads easily between human hosts where there is overcrowding or poor sanitation. This review assesses the effects of prophylactic interventions for contacts of people with scabies to prevent infestation in the contacts.
Post-traumatic stress disorder and depression
Those forcibly displaced have often been exposed to traumatic events as part of the reason to seek refuge or as part of their journey. These events, which include armed conflict, violence, persecution, and extreme poverty, can contribute to the onset of depression and post-traumatic stress disorder (PTSD).
Newer generation antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are often used to treat depressive disorders in young people. This review was carried out to determine the efficacy and adverse outcomes, including definitive suicidal behaviour and suicidal ideation, of newer generation antidepressants compared with placebo in the treatment of depressive disorders in children and adolescents.
Amitriptyline is a tricyclic antidepressant that was synthesised in 1960, introduced as early as 1961 in the USA, and still regularly used. This review assesses the effects of amitriptyline compared to placebo or no treatment for major depressive disorder in adults.
PTSD is a debilitating disorder which, after a sufficient delay, may be diagnosed among individuals who respond with intense fear, helplessness, or horror to traumatic events. There is some evidence that the use of pharmacological interventions immediately after exposure to trauma may reduce the risk of developing PTSD. This review assesses the effects of pharmacological interventions for the prevention of PTSD in adults, following exposure to a traumatic event.
PTSD is a distressing condition that is often treated with psychological therapies. Analyses have found these therapies to be effective, with trauma-focused treatments being more effective than non-trauma-focused treatments. This review aims to assess the effects of psychological therapies for the treatment of adults with chronic PTSD.
PTSD is highly prevalent in children and adolescents who have experienced trauma and has high personal and health costs. A wide range of psychological therapies have been used in the treatment of PTSD, and this review examines their effectiveness in treating children and adolescents who have been diagnosed with PTSD.
Mirtazapine has a unique mechanism of antidepressive action and is one of the commonly used antidepressants in clinical practice. This review aims to assess the evidence on the efficacy and acceptability of mirtazapine compared with other antidepressive agents in the acute-phase treatment of major depression in adults.
Paroxetine is the most potent inhibitor of the reuptake of serotonin of all the SSRIs and has been studied in many randomised controlled trials. However, these comparative studies provided contrasting findings and systematic reviews of trials have always considered the SSRIs as a group. This review aims to assess the efficacy, acceptability and any adverse effects of paroxetine in comparison with tricyclics, SSRIs and newer or non-conventional antidepressive agents.
Depression is common in primary care and is associated with marked personal, social and economic morbidity, thus creating significant demands on service providers. RCTs for the antidepressant fluoxetine have produced conflicting findings. This review aims to assess the effects of fluoxetine in comparison with all other antidepressive agents for depression in adult individuals with unipolar major depressive disorder.
Citalopram, one of the first selective serotonin reuptake inhibitors (SSRI) introduced in the market, is a second-generation antidepressant drug that clinicians use for routine depression care. This review assesses the evidence for the efficacy, acceptability and tolerability of citalopram in comparison with tricyclics, heterocyclics, other SSRIs and other conventional and non-conventional antidepressants in the acute-phase treatment of major depression.
Selective serotonin reuptake inhibitors are recommended as the first-line option when drug therapy is indicated for a depressive episode. Preliminary evidence suggested that sertraline might be slightly superior in terms of effectiveness. This review aims to assess the evidence for the efficacy, acceptability and tolerability of sertraline in comparison with tricyclics (TCAs), heterocyclics, other SSRIs and newer agents in the acute-phase treatment of major depression.
There is a need to identify effective and safe treatments for depression in children and adolescents. Prescribing of tricyclic drugs for depression in children and adolescents is now uncommon, but an accurate estimate of their efficacy is helpful as a comparator for other drug treatments for depression in this age group. This review aims to assess the effects of tricyclic drugs compared with placebo for depression in children and adolescents, and to determine whether there are differential responses to tricyclic drugs between child and adolescent patient populations.
Fluvoxamine, one of the oldest selective serotonin reuptake inhibitors (SSRIs), is prescribed to patients with major depression in many countries. This review aims to evaluate the effectiveness, tolerability and side effect profile of fluvoxamine for major depression in comparison with other anti-depressive agents, including tricyclics, heterocyclics, other SSRIs, SNRIs, other newer agents and other conventional psychotropic drugs.
Refugees and asylum seekers are at higher risk of getting infected or developing tuberculosis, depending on the tuberculosis incidence in their country of origin, possible contacts with an infectious case, and poor access to health services. Early diagnosis and effective treatment should be provided by the countries receiving these people.
Individuals with HIV infection are at an increased risk of developing active tuberculosis. Treatment of latent tuberculosis infection helps to prevent progression to active disease in HIV-negative populations, but the extent and magnitude of protection associated with preventive therapy in those infected with HIV needs quantifying. This review aims to determine the effectiveness of tuberculosis preventive therapy in reducing the risk of active tuberculosis and death in HIV-infected people.
The World Health Organization recommends fluoroquinolones for people with presumed drug-sensitive tuberculosis who cannot take standard first-line drugs. Their use could shorten the length of treatment and improve other outcomes in these people. This review summarises the effects of fluoroquinolones in first-line regimens in people with presumed drug-sensitive tuberculosis; and also assesses fluoroquinolones as substitute or additional components in antituberculous drug regimens for drug-sensitive tuberculosis.
While tuberculosis is curable with standardized treatment, outcomes for some forms are improved with adjunctive corticosteroid therapy. It is unclear whether corticosteroid therapy would be beneficial in treating people with pulmonary tuberculosis. This review evaluates whether adjunctive corticosteroid therapy reduces mortality, accelerates clinical recovery or accelerates microbiological recovery in people with pulmonary tuberculosis.
Incomplete tuberculosis treatment may result in patients not being cured, and development to drug resistance. Directly Observed Therapy (DOT) is a specific strategy, endorsed by the World Health Organization, to improve adherence by requiring health workers, community volunteers or family members to observe and record patients taking each dose. This review evaluates DOT compared to self-administered therapy in people on treatment for active tuberculosis or on prophylaxis to prevent active disease; while also comparing the effects of different forms of DOT.
Contacts of tuberculosis patients are a high-risk group for developing the disease. Actively screening contacts of people with confirmed tuberculosis may improve case detection rates and control of the disease. This review aims to compare whether active case finding among contacts of people with confirmed tuberculosis increases case detection compared to usual practice.
This Special Collection is a collaborative work by Leo Ho (MSF), Kevin Pottie (University of Ottawa), Evidence Aid, and Cochrane.
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First published 15 April 2016; updated 28 April 2016.