Spreading of SARS-CoV-2 among adult asylum seekers in refugee community shelters in Lübeck, Germany between 2020 and 2022: a mixed-cohort observational and repeated cross-sectional study

Daniel Alvarez-Fischer; Max Borsche; Alexander Balck; Bandik Föh; Arnim Hoischen; Fawad Hotak; Jan Reinhardt; Susanne A Elsner; Elke Peters; Andrea Rieck; Emily L Martin; Inga Künsting; Marc Ehlers; Alexander Mischnik; Stefan Taube; Nadja Käding; Jan Rupp; Alexander Katalinic; Christine Klein

doi:10.1186/s12889-025-22120-9

Spreading of SARS-CoV-2 among adult asylum seekers in refugee community shelters in Lübeck, Germany between 2020 and 2022: a mixed-cohort observational and repeated cross-sectional study

Daniel Alvarez-Fischer, Max Borsche, Alexander Balck, Bandik Föh, Arnim Hoischen, Fawad Hotak, Jan Reinhardt, Susanne A Elsner, Elke Peters, Andrea Rieck, Emily L Martin, Inga Künsting, Marc Ehlers, Alexander Mischnik, Stefan Taube, Nadja Käding, Jan Rupp, Alexander Katalinic, Christine Klein

Abstract

INTRODUCTION: Housing and access to healthcare pose particular challenges to asylum seekers and refugees. The main study aim was to assess their frequency of SARS-CoV-2 infection during the COVID-19 pandemic.

METHODS: We provide a prospective study on SARS-CoV-2 cases among adult asylum seekers/refugees in Europe over 18 months. Acute SARS-CoV-2 infection and antibody titers were determined in adult refugees living in shared accommodation in Lübeck, Germany, in fall 2020 (TP1) and spring 2021 (TP2) and compared to the results from a local population-based cohort. In spring 2022 (TP3), we determined antibody titers two years into the pandemic and one year of access to vaccination. At TP3, we additionally included a third cohort of recently arrived refugees from Ukraine.

RESULTS: At all three time points, we detected a marked increase in the infection frequency in refugee community shelters compared to the control group. Age, sex, or facility equipment did not impact the results. Refugees living with their own children in the shelter were significantly more often infected than those without. None of the PCR-positive refugees at TP1 and TP2 were aware of their infection. One year later, awareness of having had an infection was still much lower among the refugees compared to the control cohort. Only 32.9% of the asylum seekers were willing to be vaccinated compared to 85.5% in the control population at the beginning of the vaccination period. However, over 90% of the same population was vaccinated one year later. Among newly arrived refugees from Ukraine, uncertainty towards vaccination was significantly increased compared to the control cohort and the group of residing refugees.

CONCLUSION: Refugees residing in shared accommodations represent a vulnerable group for SARS-CoV-2 infection and transmission. This increased vulnerability does not diminish over time. Initial doubts regarding vaccination are higher among refugees. While this reservation can be overcome, awareness work is paramount and has to start anew with any new refugee wave.

Original language	English
Article number	1301
Journal	BMC Public Health
Volume	25
Issue number	1
Pages (from-to)	1301
ISSN	1471-2458
DOIs	https://doi.org/10.1186/s12889-025-22120-9
Publication status	Published - 07.04.2025

Funding

Funders	Funder number
Bundesministerium für Bildung und Forschung	FKZ 01KX2021

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Areas and Centers

Academic Focus: Center for Infection and Inflammation Research (ZIEL)
Research Area: Center for Population Medicine and Public Health (ZBV)
Research Area: Medical Genetics

DFG Research Classification Scheme

2.22-02 Public Health, Healthcare Research, Social and Occupational Medicine
2.21-03 Medical Microbiology and Mycology, Hygiene, Molecular Infection Biology
2.21-05 Immunology

Coronavirus related work

Research on SARS-CoV-2 / COVID-19

Access to Document

10.1186/s12889-025-22120-9

Cite this

Alvarez-Fischer, D., Borsche, M., Balck, A., Föh, B., Hoischen, A., Hotak, F., Reinhardt, J., Elsner, S. A., Peters, E., Rieck, A., Martin, E. L., Künsting, I., Ehlers, M., Mischnik, A., Taube, S., Käding, N., Rupp, J., Katalinic, A., & Klein, C. (2025). Spreading of SARS-CoV-2 among adult asylum seekers in refugee community shelters in Lübeck, Germany between 2020 and 2022: a mixed-cohort observational and repeated cross-sectional study. BMC Public Health, 25(1), 1301. Article 1301. https://doi.org/10.1186/s12889-025-22120-9

@article{9d684aab8eb141dc938bc28118920a28,

title = "Spreading of SARS-CoV-2 among adult asylum seekers in refugee community shelters in L{\"u}beck, Germany between 2020 and 2022: a mixed-cohort observational and repeated cross-sectional study",

abstract = "INTRODUCTION: Housing and access to healthcare pose particular challenges to asylum seekers and refugees. The main study aim was to assess their frequency of SARS-CoV-2 infection during the COVID-19 pandemic.METHODS: We provide a prospective study on SARS-CoV-2 cases among adult asylum seekers/refugees in Europe over 18 months. Acute SARS-CoV-2 infection and antibody titers were determined in adult refugees living in shared accommodation in L{\"u}beck, Germany, in fall 2020 (TP1) and spring 2021 (TP2) and compared to the results from a local population-based cohort. In spring 2022 (TP3), we determined antibody titers two years into the pandemic and one year of access to vaccination. At TP3, we additionally included a third cohort of recently arrived refugees from Ukraine.RESULTS: At all three time points, we detected a marked increase in the infection frequency in refugee community shelters compared to the control group. Age, sex, or facility equipment did not impact the results. Refugees living with their own children in the shelter were significantly more often infected than those without. None of the PCR-positive refugees at TP1 and TP2 were aware of their infection. One year later, awareness of having had an infection was still much lower among the refugees compared to the control cohort. Only 32.9\% of the asylum seekers were willing to be vaccinated compared to 85.5\% in the control population at the beginning of the vaccination period. However, over 90\% of the same population was vaccinated one year later. Among newly arrived refugees from Ukraine, uncertainty towards vaccination was significantly increased compared to the control cohort and the group of residing refugees.CONCLUSION: Refugees residing in shared accommodations represent a vulnerable group for SARS-CoV-2 infection and transmission. This increased vulnerability does not diminish over time. Initial doubts regarding vaccination are higher among refugees. While this reservation can be overcome, awareness work is paramount and has to start anew with any new refugee wave.",

author = "Daniel Alvarez-Fischer and Max Borsche and Alexander Balck and Bandik F{\"o}h and Arnim Hoischen and Fawad Hotak and Jan Reinhardt and Elsner, \{Susanne A\} and Elke Peters and Andrea Rieck and Martin, \{Emily L\} and Inga K{\"u}nsting and Marc Ehlers and Alexander Mischnik and Stefan Taube and Nadja K{\"a}ding and Jan Rupp and Alexander Katalinic and Christine Klein",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

month = apr,

day = "7",

doi = "10.1186/s12889-025-22120-9",

language = "English",

volume = "25",

pages = "1301",

journal = "BMC Public Health",

issn = "1471-2458",

number = "1",

}

Alvarez-Fischer, D , Borsche, M , Balck, A, Föh, B, Hoischen, A, Hotak, F, Reinhardt, J, Elsner, SA , Peters, E, Rieck, A, Martin, EL, Künsting, I, Ehlers, M, Mischnik, A, Taube, S , Käding, N , Rupp, J , Katalinic, A & Klein, C 2025, 'Spreading of SARS-CoV-2 among adult asylum seekers in refugee community shelters in Lübeck, Germany between 2020 and 2022: a mixed-cohort observational and repeated cross-sectional study', BMC Public Health, vol. 25, no. 1, 1301, pp. 1301. https://doi.org/10.1186/s12889-025-22120-9

Spreading of SARS-CoV-2 among adult asylum seekers in refugee community shelters in Lübeck, Germany between 2020 and 2022: a mixed-cohort observational and repeated cross-sectional study. / Alvarez-Fischer, Daniel ; Borsche, Max ; Balck, Alexander et al.
In: BMC Public Health, Vol. 25, No. 1, 1301, 07.04.2025, p. 1301.

Research output: Journal Articles › Journal articles › Research › peer-review

TY - JOUR

T1 - Spreading of SARS-CoV-2 among adult asylum seekers in refugee community shelters in Lübeck, Germany between 2020 and 2022

T2 - a mixed-cohort observational and repeated cross-sectional study

AU - Alvarez-Fischer, Daniel

AU - Borsche, Max

AU - Balck, Alexander

AU - Föh, Bandik

AU - Hoischen, Arnim

AU - Hotak, Fawad

AU - Reinhardt, Jan

AU - Elsner, Susanne A

AU - Peters, Elke

AU - Rieck, Andrea

AU - Martin, Emily L

AU - Künsting, Inga

AU - Ehlers, Marc

AU - Mischnik, Alexander

AU - Taube, Stefan

AU - Käding, Nadja

AU - Rupp, Jan

AU - Katalinic, Alexander

AU - Klein, Christine

PY - 2025/4/7

Y1 - 2025/4/7

N2 - INTRODUCTION: Housing and access to healthcare pose particular challenges to asylum seekers and refugees. The main study aim was to assess their frequency of SARS-CoV-2 infection during the COVID-19 pandemic.METHODS: We provide a prospective study on SARS-CoV-2 cases among adult asylum seekers/refugees in Europe over 18 months. Acute SARS-CoV-2 infection and antibody titers were determined in adult refugees living in shared accommodation in Lübeck, Germany, in fall 2020 (TP1) and spring 2021 (TP2) and compared to the results from a local population-based cohort. In spring 2022 (TP3), we determined antibody titers two years into the pandemic and one year of access to vaccination. At TP3, we additionally included a third cohort of recently arrived refugees from Ukraine.RESULTS: At all three time points, we detected a marked increase in the infection frequency in refugee community shelters compared to the control group. Age, sex, or facility equipment did not impact the results. Refugees living with their own children in the shelter were significantly more often infected than those without. None of the PCR-positive refugees at TP1 and TP2 were aware of their infection. One year later, awareness of having had an infection was still much lower among the refugees compared to the control cohort. Only 32.9% of the asylum seekers were willing to be vaccinated compared to 85.5% in the control population at the beginning of the vaccination period. However, over 90% of the same population was vaccinated one year later. Among newly arrived refugees from Ukraine, uncertainty towards vaccination was significantly increased compared to the control cohort and the group of residing refugees.CONCLUSION: Refugees residing in shared accommodations represent a vulnerable group for SARS-CoV-2 infection and transmission. This increased vulnerability does not diminish over time. Initial doubts regarding vaccination are higher among refugees. While this reservation can be overcome, awareness work is paramount and has to start anew with any new refugee wave.

AB - INTRODUCTION: Housing and access to healthcare pose particular challenges to asylum seekers and refugees. The main study aim was to assess their frequency of SARS-CoV-2 infection during the COVID-19 pandemic.METHODS: We provide a prospective study on SARS-CoV-2 cases among adult asylum seekers/refugees in Europe over 18 months. Acute SARS-CoV-2 infection and antibody titers were determined in adult refugees living in shared accommodation in Lübeck, Germany, in fall 2020 (TP1) and spring 2021 (TP2) and compared to the results from a local population-based cohort. In spring 2022 (TP3), we determined antibody titers two years into the pandemic and one year of access to vaccination. At TP3, we additionally included a third cohort of recently arrived refugees from Ukraine.RESULTS: At all three time points, we detected a marked increase in the infection frequency in refugee community shelters compared to the control group. Age, sex, or facility equipment did not impact the results. Refugees living with their own children in the shelter were significantly more often infected than those without. None of the PCR-positive refugees at TP1 and TP2 were aware of their infection. One year later, awareness of having had an infection was still much lower among the refugees compared to the control cohort. Only 32.9% of the asylum seekers were willing to be vaccinated compared to 85.5% in the control population at the beginning of the vaccination period. However, over 90% of the same population was vaccinated one year later. Among newly arrived refugees from Ukraine, uncertainty towards vaccination was significantly increased compared to the control cohort and the group of residing refugees.CONCLUSION: Refugees residing in shared accommodations represent a vulnerable group for SARS-CoV-2 infection and transmission. This increased vulnerability does not diminish over time. Initial doubts regarding vaccination are higher among refugees. While this reservation can be overcome, awareness work is paramount and has to start anew with any new refugee wave.

UR - https://www.scopus.com/pages/publications/105002971964

UR - https://www.mendeley.com/catalogue/9cf10af1-a34f-3757-92da-eb80ab14d7cb/

U2 - 10.1186/s12889-025-22120-9

DO - 10.1186/s12889-025-22120-9

M3 - Journal articles

C2 - 40197236

SN - 1471-2458

VL - 25

SP - 1301

JO - BMC Public Health

JF - BMC Public Health

IS - 1

M1 - 1301

ER -

Spreading of SARS-CoV-2 among adult asylum seekers in refugee community shelters in Lübeck, Germany between 2020 and 2022: a mixed-cohort observational and repeated cross-sectional study

Abstract

Funding

UN SDGs

Research Areas and Centers

DFG Research Classification Scheme

Coronavirus related work

Access to Document

Other files and links

Fingerprint

CRC/Transregio TRR 134: Ingestive Behaviour: Homeostasis and Reward

Cite this

Spreading of SARS-CoV-2 among adult asylum seekers in refugee community shelters in Lübeck, Germany between 2020 and 2022: a mixed-cohort observational and repeated cross-sectional study

Abstract

Funding

UN SDGs

Research Areas and Centers

DFG Research Classification Scheme

Coronavirus related work

Access to Document

Other files and links

Fingerprint

Projects

CRC/Transregio TRR 134: Ingestive Behaviour: Homeostasis and Reward

Cite this