Health in migrant populations

Tackling infectious diseases in non-UK born patients.

Cases of TB in non-UK born patients have increased in the UK
Cases of TB in non-UK born patients have increased in the UK

Migrants comprise approximately 12% of the population, the majority of whom are young people with similar health problems to the UK-born population.

However, 73% of TB cases, 60% of newly diagnosed HIV cases and 80% of hepatitis B virus (HBV) infected blood donors were born abroad.

The top five countries for migrants in the UK in 2010 were India, Poland, Pakistan, Republic of Ireland and Germany. In 2010 births to non-UK born mothers accounted for 25% of all live births in England and Wales.


This update is based on a publication from the Health Protection Agency and gives an overview of some of the diseases that are more common in non-UK born populations in the UK.1

The diseases covered are TB, HIV, malaria, STIs and hepatitis B and C.

Tuberculosis

TB cases in the UK have increased from 6,864 in 2001 to 8,483 in 2010, mainly due to increased numbers of cases reported in the non-UK born. TB is most common in migrants from south-east Asia and sub-Saharan Africa and 77% presented more than two years after arrival in the UK.

Whereas typical symptoms of pulmonary TB include cough for more than three weeks, haemoptysis, weight loss, anorexia, fever, night sweats and fatigue, extra-pulmonary TB is more common in migrants. Drug resistance is also higher in migrants.

Delay in diagnosis is associated with greater deprivation in patients of black African and South Asian ethnicity and recently arrived migrants. This may be due to language barriers, lack of knowledge of or access to health services or issues relating to immigration status.

Learning points
Do you just give advice about vaccinations?
  • What advice do you give about malaria prophylaxis?
  • What advice do you give about safe sex?
  • What advice do you give about hygiene abroad?
  • Consider auditing the advice given.
Consider a diagnosis of HIV infection or TB as a significant event
  • Could it have been diagnosed earlier?
  • What can be learnt from the case?
  • The RCGP also recently launched an e-learning module on TB   
  • www.elearning.rcgp.org.uk/tb
Are there any barriers to non-UK born patients accessing healthcare in your practice?
  • Consider these at a practice meeting and discuss how they can be overcome.
  • Involve your patient participation group in this activity.

HIV

In new diagnoses of HIV between 2001 and 2010, 65% of patients were born abroad, with 85% of heterosexual non-UK born cases coming from Africa. Migrants are more likely to present late and have CD4 counts of less than 350 cells/mm2.
It has been identified that 76% of patients with HIV who presented late had been seen within the past year in primary care. As late diagnosis is associated with greater morbidity and mortality as well as greater risk of onward transmission, awareness in general practice is essential.

STIs

The proportion of STIs in non-UK born populations varies by infection, from 11% of genital warts to 30% of syphilis infections.

Europe then sub-Saharan Africa were the most commonly reported regions of birth for non-UK cases of STIs in 2010. Sexual health promotion is important for all sexually active people and should be incorporated into pre-travel health consultations.

Hepatitis B

In 2010 approximately two thirds of UK blood donors testing positive for HBV markers were of non-white ethnicity. This is against a background where only 3% of blood donors were of non-white ethnicity.

Infection in young children (often from perinatal transmission from infected mothers) is more likely to lead to chronic infection (70-90%) than infection in immunocompetent adults and older children (2-10%). We should encourage HBV testing in pregnant women possibly at risk.

Hepatitis C

Half of UK blood donors testing positive for markers of hepatitis C virus (HCV) infection were born in the UK, 29% in Europe and 17% in Asia.

However, whereas IV drug use is the main source of HCV infection in the UK, south-east Asia, Africa and South America, where the disease is prevalent, exposure is most often through contaminated blood and poorly sterilised instruments.

Ethnic minorities are more likely than white populations to be admitted to hospital or die from severe liver disease secondary to HCV.

This may be due to a higher prevalence of HCV in these communities and/or barriers to accessing healthcare.

Malaria

77% of malaria cases occurred in people who were born abroad. It is most common in those who were born in Nigeria, UK, Ghana and India. Of all reported malaria cases, 61% occurred in individuals who were visiting their country of origin.
In 2010, 85% of those affected had not taken chemoprophylaxis. As well as advice on this in travel clinics, patients should be advised about using mosquito nets and insect repellent.

  • Dr Noble is a GP trainer in Wolverhampton and a CSA assessor

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