Infection (2018) 46:375–383
Notiable infectious diseases in refugees and asylum seekers:
experience from a major reception center in Munich, Germany
· Svea Malinowski
· Linda Sanftenberg
· Jörg Schelling
Received: 11 October 2017 / Accepted: 16 March 2018 / Published online: 3 April 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose In 2016, the number of refugees worldwide reached 65.6 million. So far, only limited data are available on the health
status of refugees and asylum seekers (RAs). Especially, notiﬁable infectious diseases (NIDs) carry the risk of outbreaks in
communal accommodations hosting RAs.
Methods We conducted a monocentric retrolective cross-sectional study including 15,137 RAs treated in a special health
care unit for RAs located in the major reception center in Munich from November 2014 to October 2016. Altogether 811
RAs with NIDs according to sections 6 and 7 of the German Infection Protection Act or with other infections relevant in the
setting of a communal accommodation (RIDs) could be identiﬁed.
Results The gender and age distribution was generally comparable to that of refugees in Germany. However, patients from
East Africa and Nigeria were signiﬁcantly overrepresented. NIDs/RIDs were dominated by cases of tuberculosis, hepa-
titis B, and vaccine-preventable and parasitic diseases. Signiﬁcant risk factors included country of origin (COI) and age
for hepatitis B, age for hepatitis C, gender and age for HIV, and COI, gender and age for tuberculosis and ectoparasitosis.
Calculated prevalences of hepatitis B, hepatitis C, and HIV were mostly below those of the COI. Incidences of tuberculosis
were mostly strongly elevated.
Conclusions COI, gender, and age have an impact on the occurrence of NIDs/RIDs. Early vaccinations and improved hygiene
could be eﬀective in preventing NIDs/RIDs in communal accommodations. Screening, prompt therapy, and infection protec-
tion measures are necessary to prevent the transmission of diseases.
Keywords Refugee · Asylum seeker · Infectious diseases · Tuberculosis · Hepatitis B · Human immunodeﬁciency virus
The Global Trends Report of the United Nations High Com-
missioner for Refugees shows a number of 65.6 million for-
cibly displaced persons worldwide by the end of 2016 .
In 2015, the number of newly registered asylum seekers in
Germany amounted to a total of 890,000 people . Rep-
resentative data on the health status of refugees and asylum
seekers (RAs) are not available up to now [3, 4]. In this
study, the occurrence of notiﬁable infectious diseases (NIDs)
in accordance with section 6 as well as infections with a
pathogen according to section 7 of the German Infection
Protection Act (IfSG) or any other infectious disease rel-
evant in the setting of a communal accommodation (RIDs)
is examined using the example of the “Bayernkaserne”, the
major reception center located in Munich, Germany.
In 2015, 476,649 asylum applications were submitted
to the Federal Oﬃce for Migration and Refugees (BAMF),
followed by further 745,545 applications in 2016 [5, 6].
Syria, Afghanistan, and Iraq were among the most relevant
nationalities of RAs in 2016. In general, 65.7% of the RAs
are male and 73.8% are under the age of 30 . Due to the
sharp rise in involuntary migration, considerable challenges
for the health systems of the hosting countries arise . Pre-
vious studies showed that refugees are often suﬀering from
the same diseases as the resident population and thus do
M.A. and S.M. contributed equally to this work.
* Martin Alberer
Division of Infectious Diseases and Tropical Medicine,
Medical Center of the Ludwig-Maximilians-University
(LMU), Munich, Germany
Institute of General Practice and Family Medicine, University
Hospital, LMU Munich, Munich, Germany