Infectious diseases and migrant worker health in Singapore: a receiving country's perspective.

Background: Approximately 1.4 million migrant workers reside in Singapore, presenting unique infectious disease challenges to both migrants and Singapore.

Methods: A Pubmed, MEDLINE (Ovid), EBSCO Host (Global Health) and Google Scholar search was performed for both peer, non-peer reviewed articles and reports relevant to migrant health in Singapore, published between 1 January 1989 and 1 September 2016. Additional studies were identified from citations within searched articles. We also reviewed published data and policy documents from the Ministries of Health and Manpower, Singapore.

Results: A significant proportion of malaria, enteric fevers, hepatitis A and E and tuberculosis diagnosed in Singapore involve migrant workers. From the 1990-2000 through 2009-11, while malaria and hepatitis A cases have decreased and remain sporadic, enteric fevers and tuberculosis cases have increased, possibly due to greater influx of migrant workers. Hepatitis E numbers remain low but migrant workers account for half of diagnosed cases. In an interplay of immune naivete, work and living conditions, migrants in the construction industry are at higher risk of arboviral infections such as dengue, Zika and chikungunya. Infections such as chikungunya were likely introduced into Singapore by travellers including migrant workers from the Indian subcontinent but autochthonous transmission continued due to the presence of competent mosquito vectors. There is less data regarding sexual health, networks and infections amongst migrant workers, an area which merits further attention.

Conclusions: Migrant workers appear to be at higher risk than Singaporeans for specific infectious diseases, probably due to a complex interplay of several factors, including higher disease prevalence in their countries of origin, socio-economic factors, their living conditions in Singapore and financial, language and cultural barriers to healthcare access. Receiving countries need improved surveillance, expansion of preventive measures and decreased barriers to healthcare access for migrant workers.