Migrant health: country-of-origin health protection advice
An overview of health protection recommendations, when caring for people who are migrants.
Main messages
This page gives an overview of health protection recommendations, when caring for people who are migrants.
More detailed information, including guidance on testing and management, can be accessed in the communicable diseases pages. Other considerations such as access to healthcare, language interpreting and translation, and migrants in vulnerable circumstances can also be accessed through the migrant health guide.
Guidance is available on assessing new patients from overseas. The summary health protection recommendations below can be used in conjunction with this page.
Health protection recommendations
Healthcare practitioners should undertake the following health protection actions:
Immunisation
Immunisation to ensure patients are up to date with the UK immunisation schedule irrespective of country of origin or travel.
Guidance is available for clinicians administering vaccinations to people who have uncertain or incomplete immunisation status.
Those who have an incomplete or uncertain immunisation history should be brought up to date as quickly as possible, planning a schedule that minimises visits to health services.
See the Immunisation migrant health guide.
Tuberculosis (TB)
Key points:
- for migrants who arrive from high TB incidence countries (more than 40 cases per 100,000 population), who have not been screened through the pre-entry screening programme, offer screening for active TB disease as soon as possible after arrival
- screening for active disease should include:
- children over 11 and (non-pregnant) adults: a symptom check, chest X-ray and where appropriate (person is coughing and able to produce sputum) a sputum assessment
- children aged 11 and under: a symptom check at the first point of contact with health care. A sputum assessment should be considered if the child is coughing and able to provide a sample
- pregnant women: a symptom check and a sputum examination where appropriate
- if the person has symptoms or an abnormal X-ray they should be referred for appropriate specialist assessment and investigation within one working day in line with National Institute for Health and Care Excellence (NICE) guidelines on TB
- neither TST (Mantoux test) nor Interferon Gamma Release Assay (IGRA) tests should be used to exclude active TB in adults or children
- offer Latent TB infection (LTBI) screening to all 16 to 35 year-olds who have arrived in England in the last 5 years and who were born or lived for more than 6 months in sub-Saharan Africa or countries where the TB incidence is more than 150 per 100,000 population
See the TB migrant health guide.
Sexually transmitted infections (STIs) and HIV
Key points:
- offer HIV testing for people from a country with a HIV rate of more than 1% including recently-arrived children
- offer testing for people who report sexual contact abroad or in the UK with individuals from countries of a HIV rate of more than 1%
- offer sexually active people who are from countries with an HIV rate of 1% or less sexual health screening as appropriate for their sexual history
- test all sexually active women under the age of 25 for chlamydia annually and/or whenever they change sexual partners, irrespective of country of origin
- consider HTLV testing for people from countries where HTLV-1/-2 is endemic
See the STI and HIV migrant health guides.
Hepatitis B and hepatitis C
Key points:
- offer hepatitis B screening, in line with NICE guidance, to people born or raised in countries where the prevalence of chronic hepatitis B is intermediate or high (2% or greater)
- offer hepatitis C screening, in line with NICE guidance, to people born or raised in countries where the prevalence of chronic hepatitis C is intermediate or high (2% or greater)
See the hepatitis B and hepatitis C migrant health guides.
Health protection recommendations: other infections
Polio
Have an awareness of polio (including circulating vaccine derived polio viruses) and possible exposure depending on country of origin or migrant travel.
See the polio migrant health guide.
Malaria
Malaria should be considered in anyone with a fever, or history of a fever, who has recently returned from, or previously visited a malaria endemic area in the last year, regardless of whether they have taken prophylaxis. Individuals who are febrile or unwell with any compatible symptoms should be offered same day malaria testing, with microscopic examination of thick and thin blood films (rapid tests must not be used alone).
See the malaria migrant health guide.
Enteric fevers (typhoid and paratyphoid A, B or C)
Enteric fevers (typhoid and paratyphoid A, B or C) can affect any susceptible person regardless of country of birth. Travellers visiting friends and relatives in a country that is endemic for enteric fever are at particularly high risk. Areas with the highest rates of typhoid fever are the Indian subcontinent, Africa, South and Southeast Asia and South America.
See the enteric fevers migrant health guide.
Helminth infections
Helminth infections should be considered in patients who have:
- unexplained symptoms, especially gastrointestinal
- eosinophilia, as there is around a 60% chance that it will be due to helminth infection in those coming or returning from the tropics
Up to 20% of migrants from endemic countries may have helminth infections at the time of their arrival in the UK. Strongyloides is common especially in South and Southeast Asia, and the Caribbean. Schistosomiasis is acquired by exposure to snail-contaminated fresh water in many tropical regions, particularly sub-Saharan Africa. There is a high risk of contracting soil-transmitted helminths in the Indian subcontinent, Indonesia and parts of sub-Saharan Africa.
See the helminth infections migrant health guide.
Chagas disease
Chagas disease is endemic throughout Central and South America with high prevalence in Bolivia (up to 30% in some regions). Chagas is usually asymptomatic for the first few decades of infection but can be diagnosed by serology. Treatment before symptom onset reduces the risk of developing end organ disease and mother to baby transmission.
Offer serological testing to any migrant from Central or South America. Screening of the following groups is particularly important:
- women of childbearing age and those who are pregnant
- people with cardiac or gastrointestinal disease
- those who are immunosuppressed, particularly those with HIV infection, undergoing transplantation or cancer chemotherapy
- those who wish to be organ donors
See the chagas disease migrant health guide.
Travel to country of origin
Ask opportunistically about travel plans and provide relevant advice for travel to visit friends and relatives in their country of origin.
For information about a specific country, refer to the NaTHNaC country information pages.