High prevalence of methicillin-resistant Staphylococcus aureus, Giardia, and Blastocystis in asymptomatic Syrian asylum seekers in Denmark during 2016 through 2018

Andreas Halgreen Eiset; Christen Rune Stensvold; Kurt Fuursted; Henrik Vedel Nielsen; Christian Wejse

doi:10.1016/j.jmh.2020.100016

High prevalence of methicillin-resistant Staphylococcus aureus, Giardia, and Blastocystis in asymptomatic Syrian asylum seekers in Denmark during 2016 through 2018

J Migr Health. 2020 Dec 5:1-2:100016. doi: 10.1016/j.jmh.2020.100016. eCollection 2020.

Authors

Andreas Halgreen Eiset¹, Christen Rune Stensvold², Kurt Fuursted², Henrik Vedel Nielsen², Christian Wejse¹

Affiliations

¹ Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
² Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.

Abstract

Introduction: Concerns have been raised regarding the emergence of antimicrobial-resistance and parasitic infections in the European refugee population. Here, we estimated the prevalence of intestinal parasites and selected antimicrobial-resistant bacteria in newly arrived asylum seekers in Denmark.

Materials and methods: Using a cross-sectional one-stage cluster sample design, adult Syrian asylum seekers were included upon arrival in Denmark. Faecal samples were collected and tested for ova and parasites, extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and carbapenemase-producing organisms (CPO). Throat swabs were collected and analysed for methicillin-resistant Staphylococcus aureus (MRSA) and Corynebacterium diphtheriae.

Results: We invited 121 eligible individuals (20% of the source population) from six different asylum centres to participate, of whom 113 agreed. Throat swabs and faecal samples were received from 104 and 48 participants, respectively. Seven individuals did not provide enough material for the entire panel of faecal analyses. Three individuals (7.3%, 95%CI: 2.5-19.4%) were colonised with Giardia intestinalis and 28 (68.3%, 95%CI: 53.0-80.4%) with Blastocystis sp. (subtypes 1 [n = 5], 2 [n = 9] and 3 [n = 14]). Seven individuals (6.7%, 95%CI: 3.3-13.3%) were colonised with MRSA and one with ESBL-E. None had CPO or Corynebacterium diphtheriae and none reported any gastro-intestinal symptoms.

Discussion: Even with the most conservative estimates, the prevalence of Giardia intestinalis, Blastocystis sp. and MRSA was high in this asymptomatic refugee population.

Conclusions: We highlight the importance of raised awareness of antimicrobial-resistant bacteria when attending to newly arrived Syrian refugees. Meanwhile, our data suggest that routine screening for intestinal parasites in this population is of limited clinical relevance.

Keywords: ANOVA, Analysis-Of-Variance; C. diph, Corynebacterium diphtheriae; CI, confidence interval; CPO, Carbapenemase-producing organisms; Carbapenemase-producing organisms; ESBL-E, extended-spectrum beta-lactamase-producing Enterobacterales; Extended-spectrum beta-lactamase-producing Enterobacterales; IQR, inter-quartile range; MALDI-TOF, Matrix-assisted laser desorption-ionization time-of-flight; MRSA, Methicillin-resistant Staphylococcus aureus; Methicillin-resistant Staphylococcus aureus; Parasite colonisation; Prevalence; Syrian refugee.