Infectious disease prevalence among unaccompanied minor refugees: Associations with migration journey characteristics

BACKGROUND: We examined infectious disease screening in unaccompanied minors because migration-related exposures may increase the risk of communicable diseases and because early detection enables timely treatment and prevention. However, the relationship between migration journey characteristics and infectious disease prevalence in this population remains poorly understood. We therefore examined infectious disease prevalence among unaccompanied minors upon arrival in Germany and explored its association with migration journey characteristics. METHODS: We conducted a retrospective cross-sectional study using standardized, case-specific health assessments conducted by the Public Health Service in one Bavarian district. Routine data were collected over thirteen consecutive years (2010-2022). We first described the prevalence of detected infections in the full cohort of 237 unaccompanied minors undergoing legally mandated screening, including tuberculosis, hepatitis A, hepatitis B, hepatitis C, scabies, and intestinal parasitic infections. We then analyzed the subgroup of 129 minors with documented migration journey information to describe socio-epidemiological profiles and explore patterns according to number of transit countries, journey duration, and modes of migration. RESULTS: In the full cohort, at least one infectious disease was detected in 61.2% of minors. Prevalence patterns were broadly similar in the migration-history subgroup, where 65.1% had at least one detected infectious disease. In the subgroup, most unaccompanied minors were male (79.8%) and aged 13.5 to 16.5 years (55.0%). Tuberculosis prevalence was highest among Sub-Saharan African participants (20.0%, 95% CI 11.2-32.7), while hepatitis B predominated in North African and Southeast European minors. Over half (52.9%) passed through three to four countries, and 72.1% used two different modes of travel. Although confidence intervals were wide, infectious disease positivity was numerically higher among minors with longer documented migration journeys. CONCLUSIONS: Infectious disease positivity was common among unaccompanied minors in this cohort and showed similar overall prevalence patterns in the full cohort and the migration-history subgroup. Migration journey characteristics provided useful descriptive context, but observed differences by journey duration were not supported by clear statistical evidence and should be interpreted cautiously given the limited sample size, wide confidence intervals, and potential confounding. These findings support structured health screening after arrival and careful documentation of migration history during clinical assessment.