International migration and control of communicable diseases

Panic and neglect—2000–2018

Since 2000, multiple infectious threats to North America have been identified. The response to these threats has generally been one of initial panic. When major problems fail to develop, then the threat is rapidly forgotten. These threats include diseases arising within North America such as Lyme Disease, Rocky Mountain Spotted Fever, Legionnaire’s Disease, and Norwalk virus, the cause of lethal diarrhea. Other diseases occurring in Latin America are moving northward. These include Dengue and Dengue Hemorrhagic Fever. The speed and efficiency of modern air travel have resulted in infections arriving from overseas. These include West Nile Fever, Chikungunya, and Zika Fevers, Ebola and Severe Acute Respiratory Syndrome (SARS) caused by a bat coronavirus. All of these affected relatively few people, and most were rapidly controlled.

The adverse health effects of punitive immigrant policies in the United States: A systematic review

BACKGROUND

Immigrants in the United States (US) today are facing a dynamic policy landscape. The Trump administration has threatened or curtailed access to basic services for 10.5 million undocumented immigrants currently in the US. We sought to examine the historical effects that punitive laws have had on health outcomes in US immigrant communities.

METHODS

In this systematic review, we searched the following databases from inception-May 2020 for original research articles with no language restrictions: Ovid MEDLINE, Ovid EMBASE, Cochrane Library (Wiley), Web of Science Core Collection (Clarivate), CINAHL (EBSCO), and Social Work Abstracts (Ovid). This study is registered with PROSPERO, CRD42019138817. Articles with cohort sizes >10 that directly evaluated the health-related effects of a punitive immigrant law or policy within the US were included.

FINDINGS

6,357 studies were screened for eligibility. Of these, 32 studies were selected for inclusion and qualitatively synthesized based upon four themes that appeared throughout our analysis: (1) impact on healthcare utilization, (2) impact on women's and children's health, (3) impact on mental health services, and (4) impact on public health. The impact of each law, policy, mandate, and directive since 1990 is briefly discussed, as are the limitations and risk of bias of each study.

INTERPRETATION

Many punitive immigrant policies have decreased immigrant access to and utilization of basic healthcare services, while instilling fear, confusion, and anxiety in these communities. The federal government should preserve and expand access for undocumented individuals without threat of deportation to improve health outcomes for US citizens and noncitizens.

COVID-19 pandemic in India: A Comparison of pandemic pattern in Selected States

The COVID-19 pandemic currently expanded its roots to the 206 countries in the world. The morbidity and mortality are not only threat to humans but also its impact on economy is indirectly affecting us. The current review was done to find trend in various states of India. Data was collected from Ministry of Health and Family Welfare and descriptive analysis of the distribution of COVID-19 cases in different states of India. First case of COVID-19 was diagnosed in southernmost state Kerala and after that it has spread to all other states, but situations are more worsen in states with high international migration. Maharashtra is now the most affected state followed by Delhi. Among epidemic curve of all these states, Maharashtra has rapidly growing epidemic curve with highest slope, whereas Kerala has the lowest. When we compared the day wise cumulative case fatality rate, it was found that the case fatality rate of the states like Maharashtra, Madhya Pradesh & Rajasthan showed decrease in the case fatality rate over the period. Population density is also one of the key determinants of social interaction and thus the spread of disease specifically in communicable diseases. Government of India had taken many strong initiatives e.g. 40 days nation-wide lockdown, thermal screening at airport, announcement of relief packages for poor and quarantine of outsiders but still there are many missed opportunities like, early stoppage of international traffic, compulsory quarantine for all international travellers, better contact tracing, strong law and order and better preparedness plan.

Seasonal influenza vaccination among Mexican migrants traveling through the Mexico-US border region

OBJECTIVE

Mobile populations are at high risk for communicable diseases and can serve as a bridge between sending and receiving communities. The objective of this study is to determine the rates of, and factors associated with, seasonal influenza vaccination among Mexican migrants traveling through the US-Mexico border.

METHODS

We used a 2013 cross-sectional population-based survey of adult mobile Mexican migrants traveling through the Mexico-US border region (N=2313; weighted N=652,500). We performed a multivariable logistic regression analysis to model the odds of receiving an influenza vaccination in the past year by sociodemographics, migration history, health status, and access to health care.

RESULTS

The seasonal influenza vaccination rate in this population was 18.6%. Gender, health status, and health insurance were associated with the likelihood to receive an influenza vaccination.

CONCLUSION

Overall, the rates of seasonal influenza vaccination in circular Mexican migrants are low compared to adults in Mexico and the US Efforts are needed to increase influenza vaccination among this highly mobile population, particularly in adults with chronic conditions.

Immigration reform and the health of Latino immigrants in California

This paper examines Latino immigrant health within the context of the current debate over immigration reform and the resulting cultural construction of public health in California. A review of epidemiologic and ethnographic data indicates that the subordinate socioeconomic status of Latino immigrants plays a major role in both disease etiology and access to health services. However, this status does not explain why certain patterns of health services utilization and disease morbidity and mortality persist although political and economic circumstances have changed. These patterns include the reluctance to utilize certain health services despite access to health insurance and the presence of an epidemiologic paradox in which Latinos have health status indicators comparable to or better than that of other ethnic groups despite high poverty, low education, and lack of access to care. An "economy of culture" model is used to explain these inconsistencies in the political economy model of Latino immigrant health.

Ethical challenges in preparing for bioterrorism: barriers within the health care system

Preparedness for bioterrorism poses significant ethical challenges. Although public health ethics and preparedness have received attention recently, health care ethics must also be considered. In epidemics, the health care system assists public health in 3 tasks: detection, containment, and treatment. Detection might fail if all patients do not have access to care, or if physicians do not understand their obligation to report infectious diseases to public health authorities. Containment might fail if physicians view themselves only as advocates for individual patients, ignoring their social obligations as health professionals. Treatment might fail if physicians do not accept their professional duty to treat patients during epidemics. Each of these potential ethical barriers to preparedness must be addressed by physicians and society.

Estudio comparativo de la patología infecciosa en niños inmigrantes de distintas procedencias

INTRODUCTION

Immigrants have a higher risk of contracting some infectious diseases. The aim of this study was to determine and compare the morbidity profile of immigrant children according to their country of origin.

MATERIAL AND METHODS

We performed a descriptive study of all immigrants aged less than 14 years old who attended the Tropical Medicine Unit of the Ramon y Cajal Hospital in Madrid between 1989 and 2001.

RESULTS

A total of 170 children were included (73 % from Africa, 19 % from Latin America, and 5 % from Asia). Seventy-five percent had at least one infectious disease (78 % of Africans and 62 % of Latin Americans) and 27 % were co-infected (> 2 pathogenic agents). The proportion of healthy children was higher (p < 0.05) among Latin Americans (21 %) than among Africans (9 %). The most frequent infectious diseases were malaria (35 %), intestinal parasites (48 %), filariasis (23 %), and viral hepatitis (19 %). Malaria, filariasis and hepatitis were more frequent in Africans than in Americans (p < 0.05). Other helminthic infections (15 %) were more frequent in Americans. In both groups intestinal parasites and tuberculosis (6 %) were prevalent. Of the 36 (21 %) asymptomatic children, 53 % had at least one infectious disease. The most frequently diagnosed diseases in Africans were intestinal parasitosis (35 %), malaria (7 %), cured hepatitis B (15 %), filariasis (12 %) and superficial mycosis (4 %). The most frequent infectious diseases in Latin Americans were intestinal parasitosis (38 %) and visceral toxocariasis (25 %).

CONCLUSIONS

Infectious diseases and co-infections are frequent in immigrant children, even in those who are asymptomatic. We propose screening of certain infectious diseases in these children according to their country of origin and their length of residence in Spain.

Assessing the HIV/AIDS health services needs of African immigrants to Houston

This study investigated HIV/AIDS knowledge, risk behaviors and perceptions, and access to services among Black immigrants from more than 20 African nations to Houston, Texas, United States. Three hundred nine respondents completed a 98-item self-administered questionnaire on HIV/AIDS knowledge, risk behaviors, access to services, and stigma. Data analysis revealed this population to be highly educated (70.9% had educational attainment levels beyond high school), with a plurality motivated to immigrate to the United States for academic reasons (45.0%). As a group they displayed a high level of knowledge about modes of HIV transmission. Generally, Christian background respondents had higher knowledge than those of Muslim background. Nevertheless, 36.3% reported that they had never used a condom, with the overwhelming majority of respondents reporting low self-perceived risk for contracting HIV (79.5%). These findings, together with the persistent practice of traditional rituals such as body scarring/tattooing by a significant minority (20.1%), a lack of awareness about vertical transmission (16.3% of women; 29.9% of men), and discouraging scores on an HIV stigma perception scale, suggest that a targeted campaign to raise awareness in this population is warranted.

[Imported hookworm infection in African immigrants in Spain: study of 285 patients]

BACKGROUND AND OBJECTIVE

Hookworm infection is a worldwide intestinal parasitic disease affecting more than one billion people. It represents an important public health problem in rural areas of developing countries. In our environment, it is generally considered an imported disease due to the immigration process.

PATIENTS AND METHOD

Retrospective observational study of African immigrants diagnosed with hookworm infection at the Immigration and Tropical Medicine Unit of the Hospital of Mataró over the period 1984-1999.

RESULTS

We identified 285 patients, mainly young males, from Gambia or Senegal, with a precarious job who had arrived in Spain 3 years earlier or less. Abdominal pain was the commonest reason for consultation (28.8%) cases. Non digestive symptoms were 35.6% and 4.6% remained assymptomatic. 60% had a concomitant infectious disease. Laboratory tests showed iron-deficiency anemia in 28.4% and eosinophilia in 52.3%. 70% of patients did not come to visit after treatment.

CONCLUSIONS

Microbiologic stool examination is recommended as part of the health assessment of immigrants from countries where hookworm infection is highly prevalent, even in the absence of abdominal symptoms or abnormalities of the red and white blood series.

[Imported diseases in African immigrants in Spain: study of 1,321 patients]

BACKGROUND

Immigrants can carry diseases characteristic from their countries of origin. These are known as imported diseases (ID) and can be classified into tropical diseases (TD) or cosmopolitan diseases (CD). The aim of this study was to analyse the ID in African immigrants and evaluate their repercussion in the Spanish Public Health.

PATIENTS AND METHOD

Observational study, retrospective protocol, carried from 1984 to 1994 in African immigrants seen in a reference Hospital. Not infectious chronic ID were excluded. The repercussion in public health was divided in 3 categories according to transmission risk to the host population: a) ID without current risk; b) ID with potential risk and, c) ID of risk.

RESULTS

1,321 African immigrants were considered. Most of them were from Sub-Saharan Africa. The most frequent TD were helminthiases and among CD, tuberculosis, sexually transmitted diseases and parasitoses. ID without transmission risk were 26.7% (2.4% CD and 24.3% TD), ID with potential risk 35.2% (33.6% CD and 1.6% TD) and ID with risk 38% (all CD).

CONCLUSIONS

The CD and their association with poverty suppose a higher risk of transmission to the host country population. Global policies of helping social and economic insertion of immigrant populations, combined with international health collaboration, will rebound positively in the general population's health.

AIDS policy modeling for the 21st century: an overview of key issues

Decisions about HIV prevention and treatment programs are based on factors such as program costs and health benefits, social and ethical issues, and political considerations. AIDS policy models--that is, models that evaluate the monetary and non-monetary consequences of decisions about HIV/AIDS interventions--can play a role in helping policy makers make better decisions. This paper provides an overview of the key issues related to developing useful AIDS policy models. We highlight issues of importance for researchers in the field of AIDS policy modeling as well as for policy makers. These include geographic area, setting, target groups, interventions, affordability and effectiveness of interventions, type and time horizon of policy model, and type of economic analysis. This paper is not intended to be an exhaustive review of the AIDS policy modeling literature, although many papers from the literature are discussed as examples; rather, we aim to convey the composition, achievements, and challenges of AIDS policy modeling.

Etiology of limited transmission diseases among drug users: does recent migration magnify the risk of sharing injection equipment?

Epidemiological studies have attributed area-specific changes in infectious disease prevalence to human migration. There is a paucity of research investigating the postmigration adjustment period as an effect on risk behaviors that are required in limited transmission diseases. A two-group typology, derived by cluster analysis, allowed for an analytical differentiation in the postmigration period. The cluster variable and other possible cofactors were included in linear and logistic regression modeling of sharing drug injection equipment among drug users in Alaska. The results indicate that among participants who have injected drugs, those in the postmigration adjustment period are nearly six times more likely to share injection equipment than those drug users who are not in a postmigration period. Further research is suggested and limitations are discussed.

Epidemiology and clinical profile of HIV/AIDS in Pakistan

This study reviews available data on HIV/AIDS in Pakistan and is the first to analyse a clinical series of HIV-infected patients thus giving a wider perspective of the epidemic in Pakistan. A retrospective analysis of all medical records of patients with HIV/AIDS since 1986 was conducted in March 1998 at a Karachi hospital. There were 67 patients. Twenty-two were overseas (Middle East) contract workers. None were sex workers or drug users. Fifty-four had travelled or lived abroad. High risk sexual behaviour was reported in 35 patients of whom 26 men reported contact with commercial sex workers, mostly in the Middle East (21). The most common AIDS indicator condition was chronic diarrhoea. HIV in Pakistan is currently a disease of those Pakistanis (and their sexual partners) who have travelled abroad, overseas contract workers and those who, prior to 1989, were transfused abroad or received imported blood products.