Migration and outbreaks of vaccine-preventable disease in the UK and Europe

最近移民到欧洲和欧洲内部的大幅增加与欧洲国家再次出现的传染病的死灰复燃和传播有关，包括麻疹和风疹等疫苗可预防的疾病。2015年批准的欧洲疫苗行动计划呼吁该区域所有成员国特别关注移民、国际旅行者和边缘化社区，确保他们在抵达东道国后获得有效和文化上合适的补种疫苗服务，以达到群体免疫阈值(HIT)目标，目的是消除该区域的麻疹等疾病。然而，在移民、免疫覆盖率和这些人群中的疫苗接种意向和接种率以及VPD发病率和暴发之间的联系方面，仍然存在重大数据差距。如果我们要加强针对高危移民群体的疫苗接种追赶战略，开发创新的新工具和方法，从而降低VPD暴发风险和疾病发生率，这些数据现在是至关重要的。本项目使用混合方法来解决以下目标：1.为了综合现有的关于移民在英国和欧洲VPD暴发中的作用的证据，我将按照PRISMA指南进行系统的审查，在三个主要的书目数据库中搜索与所有欧盟国家涉及移民的疫苗可预防疾病暴发有关的已发表文献。2.将提取关于疫情规模、移民人口的参与和人口结构以及任何其他相关信息的数据，并进行叙述性综合。为了评估英国和欧洲移民人口的免疫覆盖率和疫苗接种率，我将对两个关于移民免疫覆盖率的大型数据集进行回顾性定量分析。第一个数据库是国际移民组织-PHE合作的一部分，描述了12，xxx名前往英国的难民入境前的健康评估和免疫覆盖范围，将使我能够探索这些人群的免疫接种水平以及与不同覆盖范围相关的因素。第二个数据集由丹麦登记数据组成，它将使我能够比较丹麦宿主和移民人口的免疫覆盖率和接种率，这是英国没有的数据。为了探索新冠肺炎对英国危险移民获得医疗保健的影响，包括对新冠肺炎疫苗的信心和获得机会在新冠肺炎大流行的背景下，英国的许多移民群体受到了不成比例的影响，不仅在发病率和死亡率方面，而且在获得医疗保健的机会以及社会或经济方面。我将对英国的危险移民(无证移民、寻求庇护者、难民)进行定性研究，以探索大流行对生计和获得医疗保健的影响，以及对疫苗推出的看法。为了调查人们对常规疫苗的看法，并确定新冠肺炎疫情后改善服务提供的机会基于量化分析(AIMS和2)对英国和欧洲关键高危移民群体的调查结果，我将确定我们将寻求与哪些社区合作，以了解对英国常规疫苗接种的看法以及改善服务提供的潜在机会。这将通过一项大型定性研究来完成，以了解医疗保健方面的障碍和促进者，对英国NHS和疫苗接种机会的看法和担忧，以及自离开本国以来获得医疗保健或补种疫苗的历史。

The substantial recent rise in migration to and within Europe has been linked to the resurgence and spread of re-emerging infectious diseases in European countries, including vaccine-preventable diseases (VPDs) such as measles and rubella. The European Vaccine Action Plan, approved in 2015, calls on all Member States in the region to pay particular attention to migrants, international travellers and marginalised communities, to ensure their access to effective and culturally appropriate catch-up vaccination services on arrival to host countries, in order to reach Herd Immunity Threshold (HIT) targets with the aim of eliminating diseases such as measles from the Region. However, there remain major data gaps in relation to the links between migration, immunisation coverage and vaccination intent and uptake in these populations as well as VPD incidence and outbreaks. These data are now critical to acquire if we are going to strengthen vaccination catch-up strategies for at-risk migrant groups, develop innovative new tools and approaches, and thereby reduce the risk of VPD outbreaks and incidence of disease. This project uses a mixed methods approach to address the below aims:1. To synthesise existing evidence on the role of migration in the UK and Europe in outbreaks of VPDs I will carry out a systematic review following PRISMA guidelines, searching three major bibliographic databases for for published literature relating to vaccine-preventable disease outbreaks involving migrants in all EU countries. Data on scale of outbreaks, involvement and demographics of migrant populations and any other relevant information will be extracted and narratively synthesised.2. To assess immunisation coverage and vaccination uptake in migrant populations in the UK and Europe I will do retrospective quantitative analyses on two large datasets on immunisation coverage among migrants. The first database, available as part of an IOM-PHE collaboration, describes pre-entry health assessments and immunisation coverages of 12,xxx UK-bound refugees, and will allow me to explore levels of immunisation in this population as well as factors associated with varying coverage. The second dataset, which consists of Danish registry data, will allow me to compare immunisation coverage and uptake in host and migrant populations in Denmark, data which is not available in the UK.3. To explore the effect of COVID-19 on access to healthcare for precarious migrants in the UK, including confidence in and access to COVID-19 vaccinesIn the context of the COVID-19 pandemic, many migrant groups in the UK have been disproportianetely affected by the pandemic, both directly in terms of morbidity and mortality, but also in reduced access to healthcare and in social or economic terms. I will carry out a qualitative study with precarious migrants in the UK (undocumented, asylum seekers, refugees) to explore effects of the pandemic on livelihoods and access to healthcare as well as views on the vaccine roll-out.4. To investigate views on routine vaccines and and identify opportunities for improving service delivery post-COVID-19 pandemicBased on findings around key at-risk migrant groups in the UK and Europe from the quantitative analyses (Aims and 2), I will identify specific communities who we will seek to work with to understand views on routine vaccination in the UK and potential opportunities for improving service delivery. This will be done through a large qualitative study to understand barriers and facilitators to healthcare, views and concerns about the NHS and vaccination access in the UK and history of accessing medical care or catch-up vaccination since leaving their home country.