No 24 - 2022

Prevention of infectious diseases in connection with the reception of refugees from the Ukraine

Prevention of infectious diseases in connection with the reception of refugees from the Ukraine


Due to the war in the Ukraine, a large number of refugees have fled from the Ukraine to Denmark. Refugees who have not initially applied for asylum have been given a 90-day residence permit in Denmark. However, in pursuance of the special act , they may apply for a 2-year residence permit. Many already have (28,393 have applied and 22,269 have been granted such a permit as per 12 June 2022). The majority have been received by Danish municipalities across the country, but a large number of Ukrainians have applied for asylum and are being cared for by the asylum system under the auspices of Danish Red Cross. It remains uncertain how many displaced Ukrainians will end up applying for asylum in Denmark, but, unfortunately, a real risk exists that the near future will bring a continued influx of people fleeing the war.

On 19 May 2022, the Danish Health Authority (DHA) published healthcare recommendations covering the provision of necessary healthcare services to displaced Ukrainians arriving to Denmark (in Danish). The recommendations are relevant to all of Danish healthcare, including offers that are not referred to from general practice but have a special focus on general practice, depending on the individual refugee’s permit and the provisions in place covering the group of refugees in question. In relation to free vaccination of persons who have applied for but not yet been granted a residence permit in accordance with the special act, the Danish Ministry of Health on 28 April published an executive order (in Danish); and on 6 May, the DHA published an accompanying guideline (in Danish) describing the legal basis for the offer of free vaccination depending on the permit held by the refugee and his or her age (children/adults).

The Ukraine has a high occurrence of infectious diseases, e.g., tuberculosis and HIV, and a moderate to high occurrence of chronic diseases like chronic hepatitis B and C, cardiovascular diseases, diabetes and chronic pulmonary diseases.

With respect to childhood vaccines, the coverage of the Ukrainian childhood vaccination programme varies considerably, which should be a point of attention. Furthermore, the coverage of COVID-19 vaccination has been low in the Ukraine. Measles, influenza and COVID-19, in particular, may constitute an outbreak risk among Ukrainian refugees. Additionally, a risk may exist of cases of diphtheria and polio (vaccine derived).

With respect to antimicrobial resistance (AMR), a generally high prevalence was reported for the Ukraine. In relation to war-related affections, traumatic wounds is a focus point as such wounds may give rise to infections with multiple-resistant bacteria such as, e.g., Acinetobacter baumannii and Klebsiella pneumoniae.

Ukrainian refugees who arrive to Denmark as citizens or patients and here come into contact with Danish healthcare should be received and processed in accordance with National Infectious Hygiene Guidelines (NIHG) - general NIHG (in Danish) and supplementary NIHG (in Danish) precautions in case of infections and carrier state in Danish healthcare.

For Ukrainian refugees who arrive to Denmark as citizens at asylum centres and similar, the Danish Health Authority’s guideline on Hygiene in connection with prolonged, temporary accommodation for large groups of persons (in Danish) are followed.
Where Ukrainian refugees are housed privately, we encourage enhanced attentiveness to vaccine status and any signs and symptoms of infectious disease.

In connection with medical assessment of Ukrainian refugees in Danish healthcare, special attention should be given to the following in relation to infectious diseases:

  • A medical history identifying any previous and current infectious diseases and use of antibiotics within the past six months.
  • Ukraine has a tuberculosis incidence of 73 per 100,000, which means approx. one tuberculosis patient per 1,000 persons - approx. 1/4 hereof have multi-resistant tuberculosis (MDR-TB). Read more about selective TB screening at the SSI website (in Danish).
  • In relation to pregnant refugees, attention should generally be given to infectious diseases like hepatitis B, HIV and syphilis. For more information about screening for these infections, please see the SSI website. Furthermore, the medical history should provide information to ascertain if the pregnant woman has stayed in rural communities close to cattle, sheep and goat herds, where a risk of Q fever may exist. Read more about Q fever here (in Danish).
  • When living conditions are poor, a risk of infection with lice and scabies may be present. Read more here (pdf) (in Danish).
  • In relation to resistant microorganisms, attention should be given to establish if refugees have come into contact with their own or other countries’ healthcare services before or while fleeing from the Ukraine. When admitted to Danish hospitals, refugees must be swabbed for MRSA and for multi-resistant organisms (MDRO) and, if necessary, be isolated in accordance with DHA guidelines. Read more here (in Danish).
  • Vaccination status and vaccination offers:

    o This applies to children and adults alike. The conditions assessed as having the largest epidemic potential - in the Ukraine and among groups of refugees from the Ukraine - are measles, diphtheria, polio and airway infections like COVID-19 and influenza.

    o Locally, it may be decided to prioritise vaccine offers depending on where refugees from the Ukraine are being housed. Read more on the SSI website about vaccination of children and adults (in Danish).

    o For more information about the registration in the DVR of vaccines given to displaced Ukrainians, please see the SSI website (in Danish).
  • How to order vaccines:
  • For adult (booster) vaccination, the following vaccines may be particularly relevant. See the SSI website (in Danish):
    Repevax (DTaP-IPV), single-dose, item number 104538.
    Imovax polio, single-dose, item number 94008.
    The remaining vaccines for vaccination of children and adults fleeing from the Ukraine may be ordered as normally.
  • Among refugees with newly emerged upper or lower airway symptoms, COVID-19 and influenza testing should be considered, possibly along with other differential diagnostics.

    o Refugees who test positive to COVID-19 follow the DHA’s recommendations - Read more here.

(L. Hallundbæk, L.K. Knudsen, A. Kunøe, J. Holt, P.H. Andersen, Department of Infectious Disease Epidemiology and Prevention)

14 June 2022