As the end of this century approaches, the pressure of migration is increasing. It is difficult to limit with restrictive measures the number of refugees and persons seeking asylum in Europe In each country, medical screening programs are organised for arriving refugees and asylum seekers. In Switzerland, they are screened for tuberculosis and hepatitis B. They are offered standard vaccinations and immunized for hepatitis B according to screening results. The prevalence of tuberculosis in asylum seekers is 414 per 100 000, 227 per 100 000 of bacteriologically active tuberculosis. Anti-HBc antibody is present in 22 % of women and 39 % of men. The frequency increases with age and varies greatly according to origin. Initially, refugees were screened for intestinal parasites. Over a quarter were carriers, a large majority asymptomatic. Increasing numbers of asylum seekers come from countries affected by war and insecurity. Systematic screening carried out in Geneva for orevious exposure to violence revealed that 61 % reported major trauma, 18 % reported torture and 37 % complained of symptoms such as nightmares, insomnia, flashbacks, etc. The authors discuss issues related to medical screening programs, and their relative usefulness in an increasingly mobile world where the distinction between travellers and migrants is not always clear.

Migration Medical screening Post-traumatic stress Asylumseeker Tuberculous violence

World Health refugee mass screening demography Europe human Refugees health status Residence Characteristics health Humans male female Review communicable disease control prevalence organization and management infection control migration posttraumatic stress disorder Stress Disorders, Post-Traumatic age distribution Emigration and Immigration vaccination Switzerland