Calls for better care for asylum seekers after rise in diphtheria cases in Europe

Health experts are calling for better care for asylum seekers as research reveals small boat crossings have been linked to a sharp increase in diphtheria cases in the UK and across Europe.

Reception centres in the UK have hit by a series of scandals in recent months, including outbreaks of disease and reports that offers of assistance from public health leaders have been declined by the Home Office.

Now experts at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) say improved health screening of people arriving in small boats is vital in order to see off the threat of future outbreaks.

Research led by Dr Helena Seth-Smith, of the University of Zurich, and Dr Sylvain Brisse, of the Pasteur Institute in Paris, found that diphtheria outbreaks across the continent over the past year had been “mostly linked to incoming migrants”.

Diphtheria is a highly contagious bacterial infection that can be fatal. It is usually rare in the UK because babies and children have been routinely vaccinated against it since the 1940s.

The researchers said there had been “evident transmission among migrant people”, which they believed had occurred “during travel within migrant facilities”. They said “a lack of proper vaccination among the migrant people” was the reason for the outbreaks.

To avoid future outbreaks of diphtheria and other diseases in the UK and elsewhere, the researchers are calling for increased awareness of disease symptoms among border officials and physicians caring for migrants and asylum seekers, “thorough vaccination protocols” and “timely screening of at-risk individuals”.

The ESCMID report for England uses figures from the UK Health Security Agency (UKHSA) and is based on genomic testing of cases across 10 countries in Europe, including 59 in England.

It says 73 cases of the disease were recorded in England in 2022, up from 12 cases the previous year, and one further case has been recorded in 2023. The data was published at the European Congress of Clinical Microbiology and Infectious Diseases.

Most of the patients (97%) were Afghan males aged under 18 with “unknown vaccination history” – although the UKHSA notes this group may be over-represented owing to “greater clinical awareness and case ascertainment” among the demographic.

About half of those infected (51%) presented with skin problems caused by the disease, which can include blisters on the legs, feet and hands, and large ulcers. Another 12% had no symptoms and the disease in these cases was picked up through screening or contact tracing.

The authors said: “Linked to an increase in migrant arrivals via small boat in the summer of 2022, the UK experienced a sharp increase in diphtheria cases caused by toxigenic Corynebacterium diphtheriae last year."

“Further monitoring of this situation using molecular typing and genomic approaches will be key to define the source and routes of this resurgence.”

They stressed that no forward transmission in the European population was seen.