key: cord-0833343-7g9o6iyl authors: Gogoi, M.; Martin, C. A.; Wiselka, M. J.; Gardener, J.; Ellis, K.; Renals, V.; Lewszuk, A. J.; Hargreaves, S.; Pareek, M. title: Risk of vaccine preventable diseases in UK migrants: a serosurvey and concordance analysis, 2020 date: 2021-05-07 journal: nan DOI: 10.1101/2021.05.04.21253031 sha: 03654bf82748bf81dda11ef5a4e882ae533424a2 doc_id: 833343 cord_uid: 7g9o6iyl We conducted a serosurvey in 2020, amongst 149 adult migrants living in the United Kingdom, to determine seroprotection rates for measles, varicella zoster, and rubella. Findings suggest a gap in seroprotection against measles (89.3%). Younger migrants and those from Europe and Central Asia may be more susceptible; self-reported vaccine/disease status is a poor predictor of seroprotection. Understanding factors associated with seroprotection among migrants is critical for informing the delivery of SARS-CoV-2 vaccine. In 2018, the United Kingdom (UK) lost its measles elimination status owing to a steep rise in cases (1) . Unvaccinated individuals are considered to be particularly vulnerable to these outbreaks. Migrants may represent an under-immunised group and therefore at increased risk of acquiring Vaccine Preventable Diseases (VPDs) (2, 3) . However, there is a paucity of data relating to VPD seroprotection rates and demographic predictors of seroprotection against VPDs in migrants living in the United Kingdom (UK). Determining factors associated with a lack of seroprotection (which are likely to be similar to factors associated with a lack of vaccination) in migrants is critical to inform SARS-CoV-2 vaccine delivery in this population. We, therefore, conducted a rapid cross-sectional serosurvey, to establish seroprotection rates and predictors of seroprotection against measles, rubella and varicella in an adult migrant population in the UK and investigated the concordance of self-reported vaccination and disease history with serostatus. The study was conducted in Leicester, UK where approximately 34% of the population are foreign-born (4) . We included adult migrants (≥16 years) residing in Leicester (those staying <6months were excluded). Recruitment was at four different sites (see supplementary information). Participation was voluntary and written informed consent was obtained from all participants. Ethical approval was received from HRA and Health and Care Research Wales (reference number 19/LO/1846). Participants completed a questionnaire in English and provided a blood sample which was analysed for the presence of IgG against measles, varicella and rubella at University . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 7, 2021. ; https://doi.org/10.1101/2021.05.04.21253031 doi: medRxiv preprint Hospitals of Leicester NHS Trust (see supplementary information). Demographic information (age, sex, ethnicity, year of UK arrival and immigration status on arrival) as well as selfreported history of infection and vaccination against measles, varicella and rubella were collected in the questionnaire. If year of UK arrival was missing we accessed the electronic health record and used the first contact with health services as a proxy measure. We summarised the data using median and interquartile range (IQR) for non-parametric continuous variables and count and percentage for categorical variables. We used univariable and multivariable logistic regression to determine predictors of (i) seroprotection against all studied VPDs and (ii) seroprotection against measles. Agreement between self-reported vaccination and disease history and IgG result were assessed using Cohen's kappa coefficients (K) and positive and negative predictive values (PPV and NPV respectively). Analyses were conducted using Stata (StataCorp LP, Texas, USA, Version 15.1), p values < 0.05 were considered significant. 150 participants were recruited. One blood sample was discarded due to a labelling error and excluded from analysis resulting in a final cohort of 149 participants. Table 1 shows a description of the cohort, median age was 38 years and the majority (67.8%) were female. Amongst migrants from Europe and Central Asia, 32/38 (84.2%) were from Eastern Europe. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) T a b l e 1 . D e s c r i p t i o n o f c o h o r t s t r a t i f i e d b y s e r o l o g y r e s u l t T o t a . It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 7, 2021. (Table 2) . . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 7, 2021. T a b l e 2 . U n a d j u s t e d a n d a d j u s t e d a n a l y s i s o f f a c t o r s a s s o c i a t e d w i t h s e r o p r o t e c t i o n a g a i n s t m e a s l e CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 7, 2021. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 7, 2021. 1 0 Over two-thirds of the population (rubella 70.5%, measles 69.1%, varicella 67.1%) were unsure of their vaccination status. Similar proportions were unsure whether they had any history of these diseases (rubella 66.4%, measles 61.7% and varicella 47.7%) ( Table 3) . Concordance between self-reported vaccination and disease history and serostatus is shown in A sensitivity analysis excluding those unsure of both their disease and vaccination status shows little change in significant findings (Supplementary Table 3 ). . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 7, 2021. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint The present study was therefore conducted to rapidly establish preliminary data on seroprotection against measles, rubella and varicella amongst adult migrants living in the UK. We found that seroprotection rate for measles was below the HIT and that migrants from Europe and Central Asia (the majority of whom were from Eastern Europe) were least likely to have seroprotection against measles is in-line with previous European serosurveys (11, 12) . Explanations for this observation may be found in the disturbance of health services by civil wars and low uptake of immunisation due to vaccine hesitancy (11, 13) . Our findings would support targeted catch-up vaccination to adult migrants, for example those coming from endemic regions/countries within Europe. Additionally, our results highlight the concerns around vaccine hesitancy that may affect uptake of the SARS-CoV-2 vaccine. Widespread distribution of this vaccine, including in hard-to-reach groups such as migrants will be critical to slowing the spread of COVID-19. Targeted public health messaging aimed at particular . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 7, 2021. ; 1 4 migrant groups may provide an effective method of improving both routine and SARS-CoV-2 vaccine coverage. We found increasing age was associated with increased likelihood of seroprotection against VPDs. An explanation for this could be decreased persistence of vaccine induced seroprotection compared to that induced by natural infection (14) . We assessed the value of self-reported vaccination history in predicting VPD serostatus. PPV was over 80% for all studied VPDs, largely due to the low number of participants that reported a history of vaccination or disease but did not have serological evidence of either event which, in turn, is due to the high seroprotection rate for all diseases. Additionally, NPVs were low and kappa coefficients showed no agreement between self-reported histories and serostatus, indicating the unreliability of self-reporting for ascertaining serostatus. Future studies should focus on comparing the cost effectiveness of checking serostatus and vaccinating the unprotected with offering catch-up vaccination to all migrants with an unclear vaccination record (9, 10). Further, larger studies examining methods of enhancing vaccine coverage (e.g. incentivising catch-up vaccination in primary care) along with qualitative studies addressing issues such as vaccine hesitancy are urgently required. Attending to these problems is critical in light of the COVID-19 pandemic, where mass vaccination programmes (inclusive of hard-to-reach migrant groups), will be paramount in slowing transmission of infection. Our study has limitations, including our small sample size. For the purposes of regression and concordance analyses we amalgamated those answering "no" and those answering "don't . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 7, 2021. ; https://doi.org/10.1101/2021.05.04.21253031 doi: medRxiv preprint know" to questions concerning vaccine/disease history. Given that a large proportion of migrants were unsure of their vaccine/disease status, excluding these individuals would have significantly reduced the number of observations in each analysis. To ensure this did not have a substantial impact on our findings we conducted a sensitivity analysis excluding those who were unsure of their status. In conclusion, seroprotection rate for measles was below the HIT in UK migrants and younger migrants from Europe and Central Asia may be at high risk of contracting VPDs. There was no agreement between self-reported vaccination and disease history and serostatus. These findings should be used to inform targeted approaches to offering catch-up vaccination, taking into account demographic risk profile. Such an approach may provide an effective method of improving vaccine coverage in high risk migrant populations and warrants urgent investigation. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 7, 2021. ; https://doi.org/10.1101/2021.05.04.21253031 doi: medRxiv preprint Public Health England (PHE) World Health Organization. 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