Paediatric refugees from Ukraine: guidance for health care providers
BACKGROUND: With the invasion of Ukraine by the Russian Army in February 2022, refugees, the majority of whom are women and children, started fleeing the war to neighbouring countries. Even before the current escalation, the conflict in the eastern part of Ukraine has led to the internal displacement of more than 200,000 children, and many others have experienced attacks, e.g. on schools. This inevitably leads to limitations in health care delivery. During transit, overcrowding, poor shelter and vulnerability may further put refugees at increased risk for infectious diseases. This consensus document aims to provide information and guidance regarding health issues that paediatricians and general practitioners may face when caring for Ukrainian children.
METHODS: Members of the Migrant Health Reference Group of Paediatrics Switzerland and the Paediatric Infectious Disease Group in Switzerland developed this recommendation between March and April 2022 in a modified Delphi process.
RESULTS: A total of 50 recommendations were agreed on with a ≥80% consensus. These include the following topics: i) general aspects, including interpreter services, urgent health needs, personal history and general check-ups; ii) mental health, including how to search for signs of psychological distress without going into traumatic details; iii) vaccinations, including recommendations for evaluation and catch-up; iv) screening for tuberculosis, human immunodeficiency virus, and hepatitis B and C; and v) providing age-appropriate preventive and health service information.
CONCLUSION: This document provides current evidence and guidance when caring for paediatric refugees from Ukraine. The recommendations focus on Switzerland but may well be used in other countries. These are based on current evidence and may need to be adapted to individual situations and once further evidence becomes available.
- Loboda A, Smiyan O, Popov S, Petrashenko V, Zaitsev I, Redko O, et al. Child health care system in Ukraine. Turk Pediatri Ars. 2020 Sep;55 Suppl 1:98–104.
- Brandenberger J, Tylleskär T, Sontag K, Peterhans B, Ritz N. A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries - the 3C model. BMC Public Health. 2019 Jun;19(1):755. https://doi.org/10.1186/s12889-019-7049-x
- Brandenberger J, Baauw A, Kruse A, Ritz N. The global COVID-19 response must include refugees and migrants. Swiss Med Wkly. 2020 Apr;150:w20263. https://doi.org/10.4414/smw.2020.20263
- World Health Organization and UNICEF. WHO and UNICEF estimates of immunisation coverage. 2019 [cited 2022 22 March]; Available from: https://www.who.int/immunisation/monitoring_surveillance/data/ukr.pdf
- Polio Global Erradication Initative. Ukraine. 2022 [cited 2022 March 20]; Available from: https://polioeradication.org/ukraine/
- Legislation U. About the organization of outpatient obstetric and gynecological care in Ukraine. 2022 [cited 2022 April 24]; Available from: https://zakon.rada.gov.ua/rada/show/v0417282-11?lang=en#Text
- Moisseeva AV, Marichev IL, Biloschitchkay NA, Pavlenko KI, Novik LV, Kovinko LV, et al. Hepatitis A seroprevalence in children and adults in Kiev City, Ukraine. J Viral Hepat. 2008 Oct;15 Suppl 2:43–6. https://doi.org/10.1111/j.1365-2893.2008.01028.x
- FMH. Fachinformationen für Ärztinnen und Ärzte zur Betreuung von Schutzsuchenden aus der Ukraine. 2022 March, 27]; Available from: https://www.fmh.ch/files/pdf27/fachinformationen-schutzsuchende-ukraine.pdf
- Swiss Society of Paediatrics. Checklisten Vorsorgeuntersuchungen. Available from: https://cdn.paediatrieschweiz.ch/production/uploads/2021/11/Checklist_Vorsorgeunt_Formular_2017_DE.pdf
- Ministriy of Health of Ukraine. National Vaccination Schedule. 2018 [cited 2022 March 20]; Available from: https://en.moz.gov.ua/vaccinations
- Federal Office of Public Health. Schweizer Impfplan. 2022 [cited 2022 March 20]; Available from: https://www.bag.admin.ch/bag/de/home/gesund-leben/gesundheitsfoerderung-und-praevention/impfungen-prophylaxe/schweizerischer-impfplan.html
- Selina E, et al. Infektionskrankheiten und Impfungen bei Asylsuchenden. 2019 [cited 2022 April 24]; Available from: https://medicalforum.ch/de/detail/doi/smf.2019.08081
- Bernhard, Sara & Buettcher, Michael & Heiniger, Ulrich & Ratnam, Sharon & Relly, Christa & Trück, Johannes & Wagner, Noémie & Zukol, Franziska & Berger, Christoph & Ritz, Nicole & Switzerland, Paediatric. (2016). Guidance for testing and preventing infections and updating immunisations in asymptomatic refugee children and adolescents in Switzerland. PAEDIATRICA. 27.
- Fretz R, Negro F, Bruggmann P, Lavanchy D, De Gottardi A, Pache I, et al. Hepatitis B and C in Switzerland - healthcare provider initiated testing for chronic hepatitis B and C infection. Swiss Med Wkly. 2013 May;143:w13793. https://doi.org/10.4414/smw.2013.13793
- Khetsuriani N, Zaika O, Chitadze N, Slobodianyk L, Allahverdiyeva V, O’Connor P, et al. Seroprevalence of hepatitis B virus infection markers among children in Ukraine, 2017. Vaccine. 2021 Mar;39(10):1485–92. https://doi.org/10.1016/j.vaccine.2021.02.004
- World Health Organization. WHO Coronavirus Dashboard. 2022 [cited 2022 22 April]; Available from: https://covid19.who.int/table
- World Health Organization. Global Tuberculosis Report 2021. 2022 [cited 2022 April 2024]; Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2021
- Oesch Nemeth G, Nemeth J, Altpeter E, Ritz N. Epidemiology of childhood tuberculosis in Switzerland between 1996 and 2011. Eur J Pediatr. 2014 Apr;173(4):457–62. https://doi.org/10.1007/s00431-013-2196-z
- Fritschi N, Schmidt AJ, Hammer J, Ritz N ; Swiss pediatric surveillance unit. Pediatric Tuberculosis Disease during Years of High Refugee Arrivals: A 6-Year National Prospective Surveillance Study. Respiration. 2021;100(11):1050–9. https://doi.org/10.1159/000517029
- Baauw A, Kist-van Holthe J, Slattery B, Heymans M, Chinapaw M, van Goudoever H. Health needs of refugee children identified on arrival in reception countries: a systematic review and meta-analysis. BMJ Paediatr Open. 2019 Sep;3(1):e000516. https://doi.org/10.1136/bmjpo-2019-000516
- Boukamel M, Fougère Y, Gehri M, Suris JC, Rochat I, Miletto D, et al. Prevalence of tuberculosis in migrant children in Switzerland and relevance of current screening guidelines. Swiss Med Wkly. 2020 Jun;150:w20253. https://doi.org/10.4414/smw.2020.20253
- Usemann J, Ledergerber M, Fink G, Ritz N. Cost-effectiveness of tuberculosis screening for migrant children in a low-incidence country. Int J Tuberc Lung Dis. 2019 May;23(5):579–86. https://doi.org/10.5588/ijtld.18.0356
- Shedrawy J, Deogan C, Öhd JN, Hergens MP, Bruchfeld J, Jonsson J, et al. Cost-effectiveness of the latent tuberculosis screening program for migrants in Stockholm Region. Eur J Health Econ. 2021 Apr;22(3):445–54. https://doi.org/10.1007/s10198-021-01265-5
- Fritschi N, Wind A, Hammer J, Ritz N. Subclinical Tuberculosis in Children: Diagnostic Strategies for Identification Reported in a 6-year National Prospective Surveillance Study. Clin Infect Dis. 2022 Mar;74(4):678–84. https://doi.org/10.1093/cid/ciab708
- Schneeberger Geisler S, Helbling P, Zellweger JP, Altpeter ES. Screening for tuberculosis in asylum seekers: comparison of chest radiography with an interview-based system. Int J Tuberc Lung Dis. 2010 Nov;14(11):1388–94.
- European Center for Disease Prevention and Control (ECDC) and World Health Organization Regional Office for Europe. HIV/AIDS surveillance in Europe. 2021 [cited 2022 March 20]; Available from: https://www.ecdc.europa.eu/sites/default/files/documents/2021-Annual_HIV_Report_0.pdf
- Malyuta R, Newell ML, Ostergren M, Thorne C, Zhilka N. Prevention of mother-to-child transmission of HIV infection: ukraine experience to date. Eur J Public Health. 2006 Apr;16(2):123–7. https://doi.org/10.1093/eurpub/cki150
- World Health Organization. Report on 2018–2019 pre-validation assessment of elimination of mother-to-child transmission of HIV and syphilis in Ukraine. 2020 [cited 2022 April 24]; Available from: https://apps.who.int/iris/bitstream/handle/10665/336180/WHO-EURO-2020-1265-41015-55677-eng.pdf?sequence=1&isAllowed=y
- Kohns Vasconcelos M, Laws HJ, Borkhardt A, Neubert J. Medical history and clinical examinations are insufficient to exclude vertical human immunodeficiency virus transmission in healthy, at-risk adolescents. Acta Paediatr. 2019 Jun;108(6):994–7. https://doi.org/10.1111/apa.14793
- UNAIDS. AIDS and conflict: a growing problem worldwide. 2004 [cited 2022 April 24]; Available from: https://www.unhcr.org/412ef6452.pdf
- Protection Cluster Ukraine and Health Cluster Ukraine. Exploring access to health care services in Ukraine: a protection and health perspective. 2019 [cited 2022 24 April]; Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/2019-07-Exploring-access-to-health-care-services-in-Ukraine_ENG_Final.pdf
- Violari A, Cotton MF, Gibb DM, Babiker AG, Steyn J, Madhi SA, et al.; CHER Study Team. Early antiretroviral therapy and mortality among HIV-infected infants. N Engl J Med. 2008 Nov;359(21):2233–44. https://doi.org/10.1056/NEJMoa0800971
- Bregenzer A, Bruggmann P, Castro E, Moriggia A, Rothen M, Thurnheer MC, et al. Hepatitis C virus elimination in Swiss opioid agonist therapy programmes - the SAMMSU cohort. Swiss Med Wkly. 2021 Mar;151:w20460. https://doi.org/10.4414/smw.2021.20460
- Health Cluster Ukraine. Ukraine Public Health Situation Analysis. 2022 [cited 2022 March 20]; Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/ukraine-phsa-shortform-030322.pdf
- Lava SA, de Luca D, Milani GP, Leroy P, Ritz N, de Winter P. Please stop the Russian-Ukrainian war - children will be more than grateful. Eur J Pediatr. 2022 Jun;181(6):2183–5. https://doi.org/10.1007/s00431-022-04444-5
- Overbeck Ottino von. S., Entre jeu et réalité: psychothérapie d'enfants exposés à des violences collectives, in Clinique de l'exil: chroniques d'une pratique engagée., G.R.B.S. O., Editor. 2009, Chêne-Bourg, Georg. p. pp 73-86.
- Overbeck Ottino von. S., Psychological approaches in perinatal health for refugees : an ethno-psychoanalytic perspective, in Parenthood and Immigration in Psychoanalysis: Shaping the Therapeutic Setting., M.a. Welsh, Editor. 2022, Routledge p. 60-78.