Guidance

Bulgaria: migrant health guide

Advice and guidance on the health needs of migrant patients from Bulgaria for healthcare practitioners.

From:
Office for Health Improvement and Disparities
Published
31 July 2014
Last updated
25 April 2023 — See all updates

Main messages

If the patient is new to the UK:

Due to an intermediate prevalence, consider screening for hepatitis B, particularly among those who have recently arrived.

There is a risk of typhoid infection.

Consider nutritional and metabolic concerns.

Infectious diseases

Immunisation

Ensure that all patients, especially children, are up-to-date with the UK immunisation schedule.

Tuberculosis (TB)

There is a low incidence of TB (less than 40 cases per 100,000), so:

  • routine screening for TB is not required
  • consider testing in patients (including children) who show signs and symptoms
  • be aware that TB is a notifiable disease

Sexually transmitted infections and HIV

Take a sexual history, and:

  • screen for STIs and HIV according to risk as specified in the UK national standards and guidelines
  • test all sexually active patients under the age of 25 for chlamydia

There is a low rate of HIV (less than or equal to 1%), so offer and recommend an HIV test if the patient:

  • falls into a high risk group
  • is newly registering in a high prevalence area

Hepatitis B

There is an intermediate prevalence of hepatitis B, so:

  • consider screening for hepatitis B, particularly those who have recently arrived
  • offer screening for hepatitis B to all pregnant women during each pregnancy
  • immunise appropriately babies born to mothers who are hepatitis B positive, and follow up accordingly
  • be aware that the UK has a a universal infant immunisation programme for hepatitis B and a selective immunisation programme for higher risk groups

Hepatitis C

The prevalence of hepatitis C is higher than the UK, so consider screening for hepatitis C if other risk factors apply.

Travel plans and advice

Ask opportunistically about any travel plans the patient may have to visit friends and relatives in their country of origin. People who travel to visit friends and relatives (VFR travellers) should visit the Foreign, Commonwealth and Development Office for overseas travel advice and National Travel Health Network and Centre (NaTHNaC) for country specific travel advice prior to leaving the UK.

Typhoid

There is a risk of typhoid infection, so:

  • ensure that travellers are offered typhoid immunisation and advice on prevention of enteric fever
  • remember enteric fever in the differential diagnosis of illness in patients with a recent history of travel to or from this country

Women’s health

Reproductive health indicators

Reproductive health indicator UK Bulgaria
Number of children per woman (lifetime average) 1.6 1.6
Use of contraception (by woman of reproductive age or partner) 71.7% 69.2%

Find out more about women’s health.

Nutritional and metabolic concerns

Anaemia

There is a moderate risk of anaemia in adults (estimated prevalence is 5 to 20%), and pre-school children (prevalence is 20 to 40%), in Bulgaria, so:

  • consider this possibility in recently arrived migrants, particularly for women and pre-school children
  • test as clinically indicated

Vitamin D

Consider the possibility of vitamin D deficiency in people who may be at risk due to:

  • darker skin
  • those who are not often outdoors
  • those who cover up most of their skin when outdoors

Vitamin A

There may be a risk of vitamin A deficiency.

Country profile

Health indicators and health care

WHO Global Health Observatory has a summary of key health indicators and health care in Bulgaria.

Culture, politics and history

BBC News and The World Factbook provide background information on the culture, politics and history of Bulgaria.

Languages

Language Population (%) (2011 estimates)
Bulgarian (official) 76.8
Turkish 8.2
Roma 3.8
Other 0.7
Unspecified 10.5

Source: The World Factbook

Find out about language interpretation.

Religions

Religion Population (%) (2011 estimates)
Eastern Orthodox 59.4
Muslim 7.8
Other (Catholic, Protestant, Armenian Apostolic Orthodox, and Jewish) 1.7
None 3.7
Unspecified 27.4

Source: The World Factbook

Migration to the UK

There were almost 46,000 people from Bulgaria living in England and Wales at the time of the 2011 Census.

Published 31 July 2014
Last updated 25 April 2023 + show all updates

  1. The vitamin D deficiency risk groups have been updated

  2. Updated advice on testing for anaemia, based on current prevalence in Bulgaria.

  3. First published.

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