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PTH 7: Health Policy and Health Services 2, B308 (FCSH), September 5, 2025, 11:30 - 12:24 Aim We aimed to adapt screening recommendations for infectious diseases(ID)?and female genital mutilation(FGM) for migrants in?primary?care settings of two Spanish regions, Catalonia and Almería. Methods We followed a modified version of the ADAPTE framework. A literature review of clinical guidelines on ID and FGM screening at national and international levels was conducted. Two multidisciplinary teams of experts participated in independent consensus workshops, one at each site, where they agreed on the conditions and the criteria for the adapted screening recommendations. A questionnaire sent to the experts evaluated their level of agreement. Results Participants at both sites defined a target migrant population, including Africans, Latin Americans, Asians, and Eastern Europeans. They agreed to include human immunodeficiency virus(HIV), hepatitis B(HBV) and C virus(HCV), active tuberculosis(TB), schistosomiasis, strongyloidiasis, Chagas disease(CD) and FGM in the recommendations. In Almería, participants also included syphilis, latent TB, and intestinal parasites. Participants in both regions agreed to test for HBV in migrants from countries with an HBV-prevalence >2%, active TB in newly-arrived migrants (<5years) from countries with a TB-incidence >50 cases/100,000population, and schistosomiasis, strongyloidiasis and FGM in migrants from endemic areas. In Catalonia, participants agreed to test for HIV and HCV if the prevalence was >1% and >2%, respectively, and for CD in migrants from endemic countries. In contrast, participants in Almería agreed to test all migrants for HIV, HCV, and syphilis, and women of child-bearing age from endemic countries for CD. The recommendation for latent TB targeted migrants aged 16-35 years from countries with a TB-incidence >50 cases/100,000population, and the intestinal parasites’ recommendation targeted migrants from sub-tropical and tropical countries. Conclusions We developed screening recommendations adapted to the targeted migrant populations’ profiles and the local context of each health system, considering the available resources at the primary care level, which will lead to better healthcare provision for migrants.

Abstract Background Growing international migration has increased the complexity of tuberculosis transmission patterns. Italy’s decision to close its borders in 2018 made of Spain the new European porte entrée for migration from the Horn of Africa (HA). In one of the first rescues of migrants from this region at the end of 2018, tuberculosis was diagnosed in eight subjects, mainly unaccompanied minors. Methods Mycobacterium tuberculosis isolates from these recently arrived migrants were analysed by Mycobacterial Interspersed Repetitive-Unit/Variable-Number of Tandem Repeat (MIRU-VNTR) and subsequent whole genome sequencing (WGS) analysis. Data were compared with those from collections from other European countries receiving migrants from the HA and a strain-specific PCR was applied for a fast searching of common strains. Infections in a cellular model were performed to assess strain virulence. Results MIRU-VNTR analysis allowed identifying an epidemiological cluster involving three of the eight cases from Somalia (0 single-nucleotide polymorphisms between isolates, HA cluster). Following detailed interviews revealed that two of these cases had shared the same migratory route in most of the trip and had spent a long time at a detention camp in Libya. To confirm potential en route transmission for the three cases, we searched the same strain in collections from other European countries receiving migrants from the HA. MIRU-VNTR, WGS and a strain-specific PCR for the HA strain were applied. The same strain was identified in 12 cases from Eritrea diagnosed soon after their arrival in 2018 to the Netherlands, Belgium and Italy. Intracellular replication rate of the strain did not reveal abnormal virulence. Conclusions Our study suggests a potential en route transmission of a pan-susceptible strain, which caused at least 15 tuberculosis cases in Somalian and Eritrean migrants diagnosed in four different European countries.

Whole-genome sequencing (WGS) enhances precision in predicting antimicrobial resistance and tracking (MTB) transmission. Due to MTB's slow-growing nature, genomic results are delayed; however, few efforts have sought to accelerate them by performing WGS directly on respiratory specimens. Most culture-free efforts have focused on accelerating resistance prediction. The present study provides further evidence to the only preceding study aiming to accelerate precise delineation of transmission, coupling culture-free WGS to a surveillance programme. Our study is distinguished from its predecessor by being the first to apply flexible nanopore sequencing to further accelerate the process. A total of 71 sputa were selected, in which we applied only a procedure to deplete human DNA, thus avoiding costly and cumbersome capture-bait alternatives. Optimal results (>90% genome covered, mean coverage >45× and >70% genome covered >20×) were obtained from 33.8% of cases, allowing the assignment to transmission clusters close to diagnosis of every new case. A further 12.6% of samples yielded suboptimal results (15.5%-90.92% at >10×), which were exploited through a rescue pipeline. This approach was based on identifying informative SNPs acting as markers for relevant transmission clusters in our population. The pipeline enabled pre-allocation of new cases to pre-existing clusters and, in some cases, precise genomic relationships with the preceding cases in the cluster. In summary, this study demonstrates that epidemiologically valuable information can be obtained directly from sputum in approximately half the samples analysed. It represents a new advancement in the pursuit of faster comparative genomics, with epidemiological purposes, at diagnosis.