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Despite 1.5 million migrants (MM) and refugees using the Balkan Route from Syria/Iraq via Turkey, Greece, Serbia, Croatia, Slovenia or Hungary to Austria and Germany and smoldering exodus of 250,000 MM via Mediterranean Route, who entered Italy, Spain and Malta from the African continent, every year for 10 years at least, no major epidemics were noted. Reasons for this may vary, but there is public concern of transmitting resistant micro-organisms to Europe. The aim of the study was to estimate whether there is such a risk; where are migrants colonized by bacteria; what type of bacteria are they carrying. Migrants are colonized by bacteria during prolonged stay in refugee camps in inappropriate conditions; migrating migrants are not hosts for resistant bacteria. Conditions in camps should be addressed to prevent spreading resistant micro-organisms. Conflict of interest: The authors whose names are listed in the title of the article certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, or other equity interest), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. 17 Original Articles Clinical Social Work and Health Intervention Vol. 8 No. 1 2017 • Good health and overall education of MM on prevention and early therapy of infectious diseases, • Screening for some infectious diseases during transit. However, Points 3 and 4 are present only among those migrating via Balkan and not via Mediterranean Route. On the negative side of the coin are the substantial ship tragedies off Malta, Lampedusa and Sicily, resulting to 6,000 to 10,000 non-infectious deaths. Patients and methods Samples from oropharynx of 40 migrating migrants between Hegyeshalom (HU) and Nickelsdorf (AT) were obtained between Sept. – Nov. 2016. Stationary migrants/asylum seekers were located in Veria/Alexandria from refugee camps (1,016 samples). Swabs were taken from symptomatic patients and transported to the National Reference Laboratory. Resistance to antimicrobial patterns in both groups were compared and assessed. Results and discussion Comparing the etiology in respiratory isolates of both groups, there was a significant difference in S. aureus and Candida spp. among both groups. S. aureus was significantly more frequent among migrants residing for 3-6 months in a refugee camp (12.2 % vs 2% p <0.01) and Candida spp. (C.albicans 7, and non-Albicans Candida spp. 3) as well. Also, the overall member of pathogens colonizing the respiratory systems of migrants was significantly higher among migrants in camp in comparison to migrating migrants in the Nickelsdorf or Hegyeshalom Table 1 Stationary migrants in Greek migrant camp Alexandria versus migrating migrants in the Balkan Route: discrepancies in colonization of the RTI with respiratory infections diseases pathogens. Stationary Migrants SM Migrating Migrants MM P 48 101 A) Grampositive Bacteria S. aureus 5* 2 P˂0,01 MSSA 4 2 MRSA 1 0 St. pyogenes (ERY-R) 1 1 St. pneumoniae (PEN-) 0 2 Total 6 7 B) Gramnegative HOCA 1 HAIN 1 Enterobacteriaceae 2 6 Pseudomonacae 1 1 Total 5 7 Candida spp. (total) 10 2 P˂0,01 C. albicans 7 2 NAC 3 0 18 Clinical Social Work and Health Intervention Clinical Social Work and Health Intervention Vol. 8 No. 1 2017 Health Posts (22 of 45, 48.5% vs. 15 of 101, 15%, P<0.05). Some rare (marine) organism such as Ps. stutzei, Neisseria fermentans and others were isolated from the migrating migrants subgroups, indicating having crossed the sea during traveling. (1-5) Surprising findings were of a significantly higher population of bacterial and fungal pathogens when comparing the respiratory isolates in stationary migrants compared to migrating migrants which indicates that SM are much more frequently colonized with bacteria pathogens and pathogens transferred during long-term stays in the facility. (6-10)

Migrants Are Colonized by Resistant Bacteria During Their Prolonged Stays in Refugee Camps