Systematic review and meta-analysis of infectious diseases in practically skilled EU migrant workers

Background

Migration background and low socioeconomic status are recognized determinants of burden of infectious diseases (IDB). IDB in migrant workers in practically skilled jobs (PSMW) in Europe and its determinants remain largely unknown. We aim to synthesise the existing evidence.

Methods

We performed a systematic review of quantitative, primary studies published between Jan 1, 2000, and July 15, 2025, identified through MEDLINE, Embase, Cochrane Library, and Web of Science. Eligible studies reported IDB among PSMW in EU+ countries (EU, EEA, Schengen, UK), defined as foreign-born adults in jobs requiring at most basic vocational education. Outcomes were IDB (morbidity, mortality, hospitalisation, outbreaks, association measures) and determinants. Pooled prevalence was estimated using random-effects meta-analysis in sufficiently homogeneous populations.

Results

We included 41 studies, mainly addressing sexually transmitted and bloodborne infections (STI-BB, n = 28) and COVID-19 (n = 5). We extracted data of 157,216 PS-MW from Africa (39,7%), Europe (28,5%), and Latin America (23,0%) (proportional mapping), working mainly in healthcare (72,0%), sex work (SW) (8,3%), and logistics (5,4%) across 11 EU+ countries. PSMW had higher IDB than native-born controls for COVID-19 and HIV, Syphilis, Hepatitis B/C. Meta-analysis of 19 studies (12,942 migrant SW) showed pooled prevalence of HIV 4,2% (95% CI 1,73–7,49), Syphilis 8,0% (95% CI 3,76–13,58), Chlamydia 9,9% (95% CI 7,03–13,12), Gonorrhoea 5,1% (95% CI 2,11–9,20), HBV (infectious) 2,3% (95% CI 1,28–3,59), HBV (past exposure) 24,4% (95% CI 12,78–38,38), and HCV 1,9% (95% CI 0,33–4,40). Heterogeneity was substantial (I² 85–98,8%). IDB was shaped by diverse determinants, e.g. risk behaviour, job type and country of origin.

Conclusions

There is a high burden of STI-BB for migrant SW and COVID-19 for PSMW in EU+, surpassing native-born controls. Diverse personal, migration-, and labour-related factors were associated with IDB.

Key messages

• Practically skilled migrant workers in EU have higher burden than native-born controls for COVID-19, HIV, Syphilis, Hepatitis B/C, associated with personal, migration-, and labour-related determinants.

• Research on infectious diseases among EU migrant workers beyond sex workers and COVID‑19 is largely missing, highlighting a major evidence gap and underrepresentation that urgently needs addressing.