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Table 3 Sources by year published and outcomes by theme

From: Infectious disease surveillance for refugees at borders and in destination countries: a scoping review

Lead author, year

Target population

Type (topic)

Surveillance system

Surveillance methods



Valenciano et al., 1999

Kosovar refugees in Albania

Descriptive (surveillance activities)

Emergency surveillance system

Refugee camps were assigned a medical agency, with weekly reporting forms sent by car or fax, including null forms for specific high risk diseases. IPH prepared weekly updates for dissemination.

IPH Albania provided reporting sites with lists of diseases and case definitions for easier identification and reporting.

Very sensitive system led to some false alarms, but was acceptable for medical staff as it was simple and led to close collaboration between partners.

Brusin, 2000

Kosovar refugees in Macedonia

Descriptive (surveillance activities)

Surveillance system targeting refugee camps

The surveillance system was divided into: (i) 14 immediate and weekly reportable diseases in a shared reporting form, via telephone or FM radio to both Republic Institute for Health Protection (RIHP) and WHO; (ii) other diseases. WHO compiled reports and published a weekly bulletin.

Protocols were formulated and sent to all health facilities working in the refugee camps. These protocols included case definitions, forms, important contacts, as well as instructions on how, who, and when the form is to be filled


WHO, 2004

Displaced and refugee populations in Sudan and Chad


WHO early warning surveillance

WHO monitored 12 infectious diseases and other health events.


Effective as a real-time reporting system with outbreaks easily detectable.

Kouadio et al., 2009

Liberian Refugees in Cote d’Ivoire transit camps


Diseases Surveillance Team (DST) for surveillance and outbreak investigation

Under DST, active surveillance by medical staff, e.g. door-to-door searches, and passively by camp health units, and results disseminated through routine meetings.

Advisory team to support camp-level decision-making. Mandatory dissemination meetings.

Described as “active and comprehensive,” helped reduce transmission in camps due to involvement of community members.

Waterman et al., 2009

Travelers crossing US-Mexico border


Collaborative surveillance including migrants

In 1997, due to frequent infectious diseases at US-Mexico border, binational surveillance was established using common case definitions. To maintain communication, US-CDC conducts annual binational meetings on border infectious disease surveillance.

Guidelines drafted, as per WHO IHR requirements, for communicating epidemiological data across borders.

Surveillance coordination was successful and led to an agreement between Canada, US, and Mexico to strengthen collaboration.

Riccardo et al., 2011

North African migrant centres in Italy


Syndromic surveillance

Surveillance defined and implemented 13 syndromes for migration centres, with cases reported daily via fax that fit case definitions. CNESPS-ISS analysed data, monitored alarms, and published weekly surveillance updates online.

An official guidance document for migration centres was sent to respective regions.

This surveillance was the main source of migrant data and enabled detection of potential outbreaks, though challenges included some centres not following protocols.

McCarthy et al., 2013

Migrants attending clinics in 24 countries


GeoSentinel surveillance of clinic sites targeting migrants

GeoSentinel surveillance in 24 countries across 6 continents to detect infectious diseases among migrants, mainly in travel and tropical medicine clinics. Cases are reported if they have crossed international borders.

A data collection protocol was developed and reviewed by US-CDC’s institutional review board.

Gives insight on main infectious diagnoses and demographics of migrants.

Turner et al., 2013

Myanmar refugees in Maela camp in Thailand on Myanmar border


Enhanced respiratory virus surveillance in camp hospital

Hospital-based surveillance, 2009–2011, to identify Pneumonia virus burden among Myanmar refugees in Northwest Thailand. Laboratory-enhanced respiratory surveillance involved trained personnel actively searching for pneumonia diagnoses in in-patient department admission logs. Those who met case definitions and had agreed were further investigated including RT-PCR testing.


Information generated from enhanced surveillance enabled identification of pneumonia aetiology in the camp population.

Napoli et al., 2014

Migrants arriving in Italy


Ad hoc early warning system-syndromic surveillance

Paper-based forms sent to MOH and CNES by email or fax. Once received, data were entered on an electronic database and an aggregated report published online and disseminated to reporting sites and MOH officials.

Centres received a detailed protocol listing syndromes to report and case definitions. They want to allow reporting centres to apply legally existing surveillance systems

System limitations meant it cannot be sustained, which needs to be addressed.

WHO-Euro, 2014

Sicily, Italy

Assessment (information component of health system capacity to handle migrant influx)

Previous emergency syndromic surveillance

Established in 2011, the number of reporting sites has dropped and sites do not collect information in a systematic way


System not systematic. Health-workers in migrant centres mentioned some parts of the syndromic surveillance system needed to be made clearer.

Germinario et al., 2015

Refugees in Apulian Asylum-Seeker Centres (CARA)

Descriptive. Was voluntary, hence participants chose to participate.

Multiple types of surveillance

Many activities, e.g. polio circulation surveillance, TB screening, Seroprevalence of viral hepatitis and HIV, and immunization programme. Syndromic surveillance is described as the first to apply this surveillance. Methods used are the same as described in other Italy publications, including notification of 13 syndromes to authorities via fax.

An available protocol was mentioned, informing centres how to report.

Presence of syndromic surveillance showed communicable disease in crowded places as was the case in centres. Highlighted the need for EU regulations on communicable diseases screening among migrants.

Riccardo et al., 2015

Refugee in EU

Journal letter to editor

Limitations and lack of a common surveillance approach


Information in the European surveillance database include place of birth and nationality, but a review showed limited information on: legal status of migrants, country of origin or route taken, and time of arrival. This makes it hard to stratify migrant groups.

WHO-Euro, 2015


Assessment (information component of health system capacity to handle migrant influx)

No systematic syndromic surveillance system

Migrant data collected by organizations offering health services at refugee reception centres. Data collection was non-systematic with no central system linking it together


No central surveillance system, different databases maintained by different partners. WHO recommended that these be linked for a unified system

Riccardo, 2017

Refugees and migrants in EU


Common Approach for Refugees syndromic surveillance simulation

A preparedness exercise in phases:

1. Preparatory: Italy assisted partner countries to set up surveillance.

2. Pilot/simulation: tested plans developed in preparatory phase.

3. Monitoring and evaluation of these surveillance systems focused on completeness, timeliness, simplicity, and acceptability attributes.

Protocols, procedures and tools were developed in the preparatory phase, leading to “procedures for syndromic surveillance in migrant reception/detention facilities” which provides case definitions, statistical testing, and an online platform with a section on trainings and simulation.


HCDCP, 2017

Refugees/migrants arriving in Greece

Epidemiological report

Point-of-care syndromic surveillance

Reported 14 predefined syndromes or health conditions found at arrival centres, daily reporting to KEELPNO to analyse data nationally and for each centre separately.


Some diseases caught through mandatory notification system “that operates in parallel with the surveillance system in Points of Care for refugees/migrant”

Bozorgmehr et al., 2018

Refugees and asylum-seekers in EU

Scoping study

Surveillance activities targeting refugees and asylum-seekers

Collecting data and notification of diseases were the responsibility of national institutions in 18 of 27 representatives interviewed, who were also responsible for data collection for refugees and asylum-seekers. Established notification system required data to be transferred from regional to national levels.

Interviewees described data collection guidance and methods for data recording as insufficient.

Due to the burden of the ‘refugee crisis’, ad hoc measures needed to be taken.

Sarma et al., 2018

Migrants in mass accommodation in Germany

Descriptive (tool for syndromic surveillance)

Syndromic surveillance

Reporting 13 syndromes within 24 h to the national public health institute, i.e. Robert Koch-institute (RKI) surveillance team. Aggregate numbers were sent online, via telephone, or fax. RKI analysed data and conducted regular meetings between reporting sites and the surveillance team.

Surveillance team developed a toolkit, hosted on the RKI website, with information on data collection including sheets, Excel worksheet for analysis, and other supporting documents

The system was flexible with timely reporting and an obvious improvement in public health interventions, though data transfer by fax or online was considered inefficient.


Rohingya refugees in Cox’s Bazar


WHO early warning surveillance

Reporting from 155 health facilities in camps for follow-up and analysis by WHO epidemiologists.


Effective as a real-time reporting system, with outbreaks easily detectable.

WHO-Euro, 2018


Assessment (information component of health system capacity to handle migrant influx)

Syndromic surveillance

Syndromic surveillance conducted through health-worker reporting of migrant medical check-ups to a national disease registry.

No specific protocol for early warning and response.

“While syndromic surveillance is carried out by health staff during individual medical assessments of migrants, communication with the public health authorities needs to be ensured.”

Amabo et al., 2019

Minawao refugee camp, Cameroon

Description and evaluation of diarrheal surveillance system

Diarrheal disease surveillance system

Surveillance supervised by Mokolo Health District Office in camps directed by non-governmental organizations, International Medical Corps (IMC), and Médecins Sans Frontières (MSF). The diseases surveyed all diarrheal in nature. Notifications were from both passive and active reporting, on a weekly basis. Surveillance officers aggregated data from sites into a reporting sheet. Using a hierarchical reporting system, the data ends up at the Ministry of health (MoH) where reports are shared with stakeholders.

For the assessment of the surveillance system, they used the protocols set by the US Centers for Disease Control and Prevention (CDC).

For surveillance activities, the camp surveillance system used the case definitions set by the National IDSR guidelines from MoH Cameroon

They found that the surveillance system was successful in identifying interventions for outbreaks such as developing a committee and vaccination coverages. They also found that the tools used were standardized.