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Migrant Health: Infectious diseases in non-UK born populations in the UK

Migrant Health: Infectious diseases in non-UK born populations in the UK  cover

Authors:

Health Protection Agency

Publication date: December 2011

 

Synopsis

This is the Health Protection Agency’s second report on Migrant Health, and the first UK-wide report (the baseline report focused on England, Wales and Northern Ireland). Its key messages are as follows:

  • Migrants comprise an increasing proportion of the UK population. In 2001, it was estimated that 8% of the total UK population were born abroad; in 2010 the figure was closer to 12%. This population comprises individuals from all over the world.
  • The majority of long-term migrants to the UK are young people with plans to study or work, and they will have a similar range of health concerns to UK born people in the same age bracket.
  • A small proportion of the non-UK born bear the greatest burden of infectious disease reported in the UK. In 2010, 73% of TB cases reported in the UK, almost 60% of newly diagnosed cases of HIV, and 80% of hepatitis B infected UK blood donors were born abroad (of those with country of birth information available).
  • Some migrants may have more complex health needs than the UK born population, influenced by the burden of disease and living conditions in their country of origin, experiences during migration, their circumstances in the UK, as well as factors relating to ethnicity and cultural practices.
  • Meeting the health needs of non-UK born people living in the UK is important both for individual and for public health reasons.
  • Health risks to the non-UK born can continue for many years after arrival in the UK. For example, 77% of non-UK born TB cases in 2010 were diagnosed two or more years after arrival in the UK. Half of non-UK born men who have sex with men with a newly diagnosed HIV infection between 2001 and 2010 had probably acquired their infection within the UK
  • UK residents travelling to visit friends and relatives in their country of origin are the major risk group for UK reports of several important travel associated diseases. Where information was available, 61% of malaria cases reported in the UK in 2010 and 87% of enteric fever cases in England, Wales and Northern Ireland who had travelled abroad between 2007 and 2010, were visiting friends and relatives. Both of these diseases are preventable through pre-travel advice and appropriate prophylactic measures.
  • Primary care practitioners play a vital role in early identification of infectious diseases. For example, data from sentinel surveillance of hepatitis shows that 65% of hepatitis B infections and 68% of hepatitis C infections reported between 2007 and 2010 through this scheme were diagnosed in primary care (by general practitioners, genitourinary medicine [GUM] clinics and other primary care services).
  • Early identification of risk and diagnosis of infection can improve health outcome. For example, people diagnosed late with HIV have a ten-fold increased risk of death within one year of diagnosis compared to those diagnosed promptly, yet in 2010, heterosexuals born outside the UK were more likely to be diagnosed late compared to those born in the UK.
  • Practitioners are encouraged to consider their patients’ country of birth when evaluating their risk exposures and to guide their differential diagnosis of presenting symptoms. For example, a higher proportion of non-UK born TB cases present with extra-pulmonary disease (54% compared to 31% in the UK born in 2010), which can have a variety of clinical presentations.
  • Many UK practitioners may be unfamiliar with the clinical presentation of some infectious diseases that are rarely diagnosed in the UK. For example, Chagas disease has currently only been reported within the UK in a small number of migrants from South America and is likely to be under-diagnosed.

Several of the public health recommendations made in the baseline report are carried forward in this update, and need continued attention. These include the need for non-UK born communities to have access to culturally competent and language supported services, and the importance of considering health needs relevant to an individual’s country of birth. In response to its duty to protect the health of all sections of the community, the Health Protection Agency launched the online Migrant Health Guide (Appendix A) in 2011. This aims to assist primary care practitioners caring for people who have come to live in the UK from abroad. By supporting UK practitioners in this way, to recognise and appropriately manage the health needs of non-UK born people, the HPA aims to contribute to the reduction of the burden of infectious disease in the populations that are at highest risk.


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Additional information

Migrant Health

Migrant Health Guide

Migrant Health Report 2011 Slideset (PowerPoint Presentation, 3 MB)

Last reviewed: 26 June 2012