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Alkaissy Y, Serre-Delcor N, Vicente MA, Molina I, Norman FF, Goikoetxea AJ, de Dios B, Torrús D, Navarrete Lorite MN, Rodríguez-Guardado A, Lombide I, Calabuig E, Muriel A, Perez-Molina JA. Trends in imported infections among migrants and travellers to Spain: a decade of analysis through the +Redivi network (2012-2022). J Travel Med 2024; 31:taae067. [PMID: 38691427 DOI: 10.1093/jtm/taae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND High-speed global travel, increased trade, world population growth, migration, urbanization and climate change have favoured the emergence and spread of pathogens. We aimed to analyse the evolution of imported infections in Spain during 2012-2022 and the potential impact of some of the abovementioned factors on differential morbidity patterns. METHODS In this retrospective study (January 2012 to December 2022), we analysed data collected by the +Redivi network across 25 health centres. The network's standardised database records new cases of imported infections, including patient demographics, travel history, pre-travel advice and diagnostic information. To assess outcome rates over time and potential interactions, we constructed penalized weighted models to reduce the bias related to a low event rate and used weighted logistic regression for morbidity outcomes. RESULTS We recorded 25 632 episodes, comprising 13 913 migrants, 4047 visiting friends and relatives (VFR) immigrants, 392 VFR travellers and 7280 travellers. Most immigrants came from South America (48.3%), Sub-Saharan Africa (28.5%), North Africa (6.6%), South Central Asia (5.4%) and Central America/Caribbean (5.3%). The most common regions visited by travellers were Sub-Saharan Africa (33.5%), South America (24.5%), Central America/Caribbean (13.5%), Southeast Asia (12%) and South Central Asia (10%). The proportion of diagnoses of malaria, strongyloidiasis and unspecified self-limiting febrile syndrome < 3 weeks remained unchanged during the study period. An increased frequency of diagnosis was reported for schistosomiasis, blastocystosis, giardiasis, dengue, diarrhoea, new cases of HIV, latent and pulmonary tuberculosis, whereas a decrease was reported for syphilis, chikungunya fever, Chagas disease and eosinophilia. We detected interactions between time and sex or type of participant across the different diagnoses. CONCLUSIONS Our study underscores the importance of epidemiological data in understanding infectious diseases dynamics among travellers and migrants, emphasizing how demographic shifts, migration trends and healthcare policies affect disease profiles. Comprehensive data play an essential role in enhancing public health policies and travel advice.
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Affiliation(s)
- Yam Alkaissy
- Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - Nuria Serre-Delcor
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS, Calle de San Oleguer, 17, 08001 Barcelona, Spain
- CIBERINFEC. Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta baja, 28029 Madrid, Spain
| | - Marta Arsuaga Vicente
- CIBERINFEC. Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta baja, 28029 Madrid, Spain
- National Referral Unit for Imported Infectious Diseases, Hospital La Paz-Carlos III, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Israel Molina
- CIBERINFEC. Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta baja, 28029 Madrid, Spain
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS, Paseo de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Francesca F Norman
- CIBERINFEC. Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta baja, 28029 Madrid, Spain
- National Reference Centre for Imported Tropical Diseases. Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
| | | | - Begoña de Dios
- Department of Internal Medicine. Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain
| | - Diego Torrús
- Unidad de Referencia de Enfermedades Importadas y Salud Internacional, Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis de Alicante, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Miguel Nicolás Navarrete Lorite
- Unidad Clínica de Enfermedades Infecciosas y Microbiologia del Hospital Universitario Virgen Macarena, Avenida Dr. Fedriani, 3, 41009 Sevilla, Spain
| | - Azucena Rodríguez-Guardado
- Área de Gestión Clínica Medicina Interna. Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011 Oviedo, Spain
- Grupo de Microbiología Traslacional, Instituto de Investigación del Principado de Asturias, Avenida Hospital Universitario s/n, 33011 Oviedo, Spain
| | - Itxaso Lombide
- Basurto University Hospital, Avenida de Montevideo, 18, 48013 Bilbao, Spain
| | - Eva Calabuig
- La Fe University and Polytechnic Hospital, University of Valencia, Avenida de Fernando Abril Martorell, 106, 46026 València, Spain
| | - Alfonso Muriel
- Clinical Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- CIBERESP, Instituto de Salud Carlos III, Calle Monforte de Lemos, 3-5, Pabellón 11, Planta baja, 28029 Madrid, Spain
- Universidad de Alcalá, Plaza de San Diego, s/n, 28801 Alcalá de Henares, Spain
| | - Jose A Perez-Molina
- CIBERINFEC. Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta baja, 28029 Madrid, Spain
- National Reference Centre for Imported Tropical Diseases. Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
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Lovey T, Hasler R, Gautret P, Schlagenhauf P. Travel-related respiratory symptoms and infections in travellers (2000-22): a systematic review and meta-analysis. J Travel Med 2023; 30:taad081. [PMID: 37310895 PMCID: PMC10481419 DOI: 10.1093/jtm/taad081] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Respiratory tract infections (RTIs) are common in travellers due to the year-round or seasonal presence of respiratory pathogen and exposure to crowded environments during the itinerary. No study has systematically examined the burden of RTI infections among travellers. The aim of this systematic review and meta-analysis is to evaluate the prevalence of RTIs and symptoms suggestive of RTIs among travellers according to risk groups and/or geographic region, and to describe the spectrum of RTIs. METHODS The systematic review and meta-analysis was registered in PROSPERO (CRD42022311261). We searched Medline, Embase, Scopus, Cochrane Central, Web of Science, Science Direct and preprint servers MedRxiv, BioRxiv, SSRN and IEEE Xplore on 1 February 2022. Studies reporting RTIs or symptoms suggestive of RTIs in international travellers after 1 January 2000 were eligible. Data appraisal and extraction were performed by two authors, and proportional meta-analyses were used to obtain estimates of the prevalence of respiratory symptoms and RTIs in travellers and predefined risk groups. FINDINGS A total of 429 articles on travellers' illness were included. Included studies reported 86 841 symptoms suggestive of RTIs and 807 632 confirmed RTIs. Seventy-eight percent of reported respiratory symptoms and 60% of RTIs with available location data were acquired at mass gatherings events. Cough was the most common symptom suggestive of respiratory infections, and the upper respiratory tract was the most common site for RTIs in travellers. The prevalence of RTIs and respiratory symptoms suggestive of RTIs were 10% [8%; 14%] and 37% [27%; 48%], respectively, among travellers. Reporting of RTIs in travellers denoted by publication output was found to correlate with global waves of new respiratory infections. INTERPRETATION This study demonstrates a high burden of RTIs among travellers and indicates that travellers' RTIs reflect respiratory infection outbreaks. These findings have important implications for understanding and managing RTIs among travellers.
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Affiliation(s)
- Thibault Lovey
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Hirschengraben 84, 8001 Zürich Switzerland
| | - Robin Hasler
- HFR Fribourg – Cantonal Hospital, 1708 Fribourg, Switzerland
| | | | - Patricia Schlagenhauf
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Hirschengraben 84, 8001 Zürich Switzerland
- Department of Global and Public Health, MilMedBiol Competence Centre, Epidemiology Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers’ Health, Hirschengraben 84, 8001 Zürich, Switzerland
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3
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Arisco NJ, Peterka C, Castro MC. Imported malaria definition and minimum data for surveillance. Sci Rep 2022; 12:17982. [PMID: 36289250 PMCID: PMC9605982 DOI: 10.1038/s41598-022-22590-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/17/2022] [Indexed: 01/24/2023] Open
Abstract
The mobility of malaria-infected individuals poses challenges to elimination campaigns by way of spreading parasite drug resistance, straining country-to-country collaboration, and making routine data collection difficult, especially in resource-poor settings. Nevertheless, no concerted effort has been made to develop a common framework to define the spatial and temporal components of an imported malaria case and recommend the minimum data needed to identify it. We conducted a scoping review of imported malaria literature from 2010 to 2020 which showed that definitions vary widely, and local capabilities of detecting importation are often restricted in low-income countries. Following this, we propose a common definition for imported malaria and the minimum data required to identify a case, depending on the country's capability of conducting an epidemiological investigation. Lastly, we utilize the proposed definition using data from Brazil to demonstrate both the feasibility and the importance of tracking imported cases. The case of Brazil highlights the capabilities of regular surveillance systems to monitor importation, but also the need to regularly use these data for informing local responses. Supporting countries to use regularly collected data and adopt a common definition is paramount to tackling the importation of malaria cases and achieving elimination goals set forth by the World Health Organization.
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Affiliation(s)
- Nicholas J Arisco
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Cassio Peterka
- Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brazil
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Lόpez-Vélez R, Lebens M, Bundy L, Barriga J, Steffen R. Bacterial travellers' diarrhoea: A narrative review of literature published over the past 10 years. Travel Med Infect Dis 2022; 47:102293. [PMID: 35247581 DOI: 10.1016/j.tmaid.2022.102293] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
Travellers' diarrhoea (TD) is the most frequent illness experienced by international travellers to lower-income countries with bacterial agents considered to account for 80-90% of cases. In this review, we summarise evidence published on bacterial TD over the past 10 years, focusing on the epidemiology and aetiology of TD. Diarrhoeagenic Escherichia coli (DEC) continue to be the most commonly implicated bacteria in TD, although Enteropathogenic E. coli (EPEC) and Enteroaggregative E. coli (EAEC) now appear to be predominant where Enterotoxigenic E. coli (ETEC) was previously considered most prevalent globally. Where fluroquinolone resistance had primarily been documented for Campylobacter in Southeast Asia, widespread resistance has been observed in most regions of the world for multiple enteropathogens, including Shigella, Salmonella, ETEC and EAEC. Implementation of novel molecular methods for pathogen detection has led to identification of bacterial pathogens, including Clostridium difficile (with and without the use of prior antibiotics), Arcobacter species and Bacteroides fragilis, as aetiological agents in TD. The widespread resistance to first-line antibiotics in multiple bacterial enteropathogens warrants continued surveillance and re-evaluation of current treatment practices. Further investigations are required to determine the prevalence and geographical distribution of bacterial enteropathogens that have been more recently implicated in TD.
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Affiliation(s)
- Rogelio Lόpez-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034, Madrid, Spain.
| | - Michael Lebens
- Department of Microbiology and Immunology, University of Gothenburg, Box 435, SE-40530, Gothenburg, Sweden.
| | - Leah Bundy
- Elements Communications Ltd, Westerham, TN16 1RQ, UK.
| | - Juan Barriga
- Department of Medical Affairs Europe, Emergent BioSolutions, 1455, Madrid, Spain.
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, World Health Organization Collaborating Centre for Travelers' Health, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland; Epidemiology, Human Genetics and Environmental Sciences Division, University of Texas School of Public Health, Houston, TX 77030, Texas, USA.
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5
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Vijayan V. Vaccines for International Pediatric Travelers. Pediatr Clin North Am 2022; 69:171-184. [PMID: 34794673 DOI: 10.1016/j.pcl.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The pretravel management of the international pediatric traveler is based on provision of preventive education, chemoprophylaxis against malaria and traveler's diarrhea, as well as travel vaccinations. Immunization requirements are determined based on the traveler's pretravel immunization status, age, medical history, and destination. Immunization needs also vary depending on the exposures during the trip. Potential exposure to water, insects, or animals as well as duration of travel will help tailor risk avoidance education and travel immunizations. This review provides clinicians an overview of vaccines recommended for children traveling internationally.
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Affiliation(s)
- Vini Vijayan
- Division of Pediatric Infectious Diseases, Valley Children's Healthcare, Madera, CA, USA; Stanford University School of Medicine, Stanford, CA, USA.
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6
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Garcia-Ruiz de Morales A, Morcate C, Isaba-Ares E, Perez-Tanoira R, Perez-Molina JA. High prevalence of malaria in a non-endemic setting among febrile episodes in travellers and migrants coming from endemic areas: a retrospective analysis of a 2013-2018 cohort. Malar J 2021; 20:449. [PMID: 34838010 PMCID: PMC8627073 DOI: 10.1186/s12936-021-03984-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background The study aimed to analyse the likelihood of imported malaria in people with a suggestive clinical picture and its distinctive characteristics in a hospital in the south of Madrid, Spain. Methods Observational retrospective study that consisted of a review of all medical files of patients with any malaria test registered at Móstoles University Hospital between April 2013 and April 2018. All suspected malaria cases were confirmed by Plasmodium spp. polymerase chain reaction (PCR). Results Of the 328 patients with suspected malaria (53.7% migrant-travellers; 38.7% visitors; 7.6% travellers), 108 cases were confirmed (101 by Plasmodium falciparum), accounting for a 33% positive sample rate. Sixteen cases were diagnosed only by PCR. Patients with malaria, compared to those without, presented predominantly with fever (84% vs. 65%), were older (34 vs. 24 years), sought medical attention earlier (17d vs. 32d), had a greater number of previous malaria episodes (74% vs. 60%), lower levels of platelets (110,500µL vs. 250,000µL), and higher of bilirubin (0.6 mg/dL vs. 0.5 mg/dL). Severe malaria was present in 13 cases; no deaths were recorded. Malaria diagnosis showed a bimodal distribution with two peaks: June to September and November to January. Conclusions Malaria is still a common diagnosis among febrile patients coming from the tropics specially among migrant travellers. Fever, thrombocytopenia, and/or high bilirubin levels should raise suspicion for this parasitic infection. Prompt diagnosis is crucial to avoid severe cases and deaths. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03984-9.
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Affiliation(s)
- Alejandro Garcia-Ruiz de Morales
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Enfermedades Infecciosas, 28034, Madrid, Spain.,Internal Medicine Department, Móstoles University Hospital, Móstoles, Spain
| | - Covadonga Morcate
- Internal Medicine Department, Móstoles University Hospital, Móstoles, Spain
| | - Elena Isaba-Ares
- Internal Medicine Department, Móstoles University Hospital, Móstoles, Spain
| | - Ramon Perez-Tanoira
- Clinical Microbiology Department, Príncipe de Asturias University Hospital, Madrid, Spain.,Biomedicine and Biotechnology Department, Faculty of Medicine, Alcalá de Henares University, Alcalá de Henares, Spain
| | - Jose A Perez-Molina
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Enfermedades Infecciosas, 28034, Madrid, Spain.
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7
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Berto CG, Coyle CM, Friedman L, Walker PF. Where was my patient born? The Intersection of tropical medicine and migrant health. Curr Opin Infect Dis 2021; 34:447-454. [PMID: 34267044 DOI: 10.1097/qco.0000000000000773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There is unprecedented movement of people across international borders and parasitic infections, previously restricted to endemic regions, are now encountered in nonendemic areas of the world. RECENT FINDINGS Migrants may import parasitic infections acquired in their countries of origin. Increasingly, clinicians in nonendemic regions are faced with patients with neglected diseases such as Chagas disease, malaria and strongyloidiasis. There are gaps in knowledge among physicians in nonendemic regions, which lead to missed opportunities for preventive strategies and early treatment. Both primary care and infectious disease physicians should have a broad knowledge of common parasitic infections to improve health outcomes and decrease healthcare disparities through early identification and treatment of disease encountered in migrants. SUMMARY Migrant health is still a young field in medicine; clinicians should be aware of diseases seen in migrants, and access both educational and clinical resources, including experts in tropical medicine, in order to reduce health disparities among migrants. Collaboration between primary care and infectious disease/tropical medicine experts should be strengthened.
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Affiliation(s)
- Cesar G Berto
- Department of Medicine, NYC Health and Hospitals/Jacobi, Albert Einstein College of Medicine
| | - Christina M Coyle
- Department of Medicine, NYC Health and Hospitals/Jacobi, Albert Einstein College of Medicine
- Division of Infectious Disease, Albert Einstein College of Medicine, Bronx, New York
| | | | - Patricia F Walker
- Department of Medicine, Global Medicine, University of Minnesota, Minneapolis
- Health Partners Institute, Bloomington
- HealthPartners Travel and Tropical Medicine Center, St Paul, Minnesota, USA
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8
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Strongyloidiasis in Children Outside the Tropics: Do We Need to Increase Awareness? Microorganisms 2021; 9:microorganisms9091905. [PMID: 34576800 PMCID: PMC8465658 DOI: 10.3390/microorganisms9091905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022] Open
Abstract
Strongyloidiasis belongs to the group of neglected tropical diseases, due to diagnostic difficulties and the lack of systematic screening. Studies on strongyloidiasis prevalence are often heterogenous and mainly performed in adults in endemic countries. We retrospectively enrolled 2633 children referred to a tertiary care hospital in Italy between 2009 and 2020 and tested for S. stercoralis infection. Sixty-one (2.3%) had a positive serology and for 55 of them, clinical and epidemiological information were available. Thirteen cases (24%) were diagnosed in Italian children without history residency or travel to foreign countries, while the remaining were internationally adopted or migrant children. Seropositive patients were mostly asymptomatic, and often eosinophilia was the only sign of strongyloidiasis. Sero-reactivity to Toxocara canis was found in 1/3 of patients. Ivermectin was used in 37 (75.5%) treated patients. A significant reduction of eosinophil levels and IgG titer was seen after treatment. Our study confirms that strongyloidiasis is usually asymptomatic in children. However, due to the ability of the parasite to cause a life-long infection together with the risk of a severe form in case of immunosuppression, it is important to identify and treat infected children. Special consideration should be reserved to high-risk groups, such as immigrants and international adoptees, where screening for S. stercoralis is indicated. However, the study highlights that sporadic cases of autochthonous strongyloidiasis in Italy may occur. Therefore, pediatricians should be aware of this condition, which is often under-recognized.
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9
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Imported diseases and travel medicine. Med Clin (Barc) 2021; 156:558-560. [PMID: 33648722 DOI: 10.1016/j.medcli.2020.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/19/2020] [Accepted: 12/29/2020] [Indexed: 01/03/2023]
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10
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Diefenbach-Elstob TR, Alabdulkarim B, Deb-Rinker P, Pernica JM, Schwarzer G, Menzies D, Shrier I, Schwartzman K, Greenaway C. Risk of latent and active tuberculosis infection in travellers: a systematic review and meta-analysis. J Travel Med 2021; 28:taaa214. [PMID: 33225357 PMCID: PMC7788564 DOI: 10.1093/jtm/taaa214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Achieving tuberculosis (TB) elimination in low TB incidence countries requires identification and treatment of individuals at risk for latent TB infection (LTBI). Persons travelling to high TB incidence countries are potentially at risk for TB exposure. This systematic review and meta-analysis estimates incident LTBI and active TB among individuals travelling from low to higher TB incidence countries. METHODS Five electronic databases were searched from inception to 18 February 2020. We identified incident LTBI and active TB among individuals travelling from low (<10 cases/100 000 population) to intermediate (10-100/100 000) or high (>100/100 000) TB incidence countries. We conducted a meta-analysis and meta-regression using a random effects model of log-transformed proportions (cumulative incidence). Subgroup analyses investigated the impact of travel duration, travel purpose and TB incidence in the destination country. RESULTS Our search identified 799 studies, 120 underwent full-text review, and 10 studies were included. These studies included 1 154 673 travellers observed between 1994 and 2013, comprising 443 health care workers (HCW), 1 068 636 military personnel and 85 594 general travellers/volunteers. We did not identify any studies that estimated incidence of LTBI or active TB among people travelling to visit friends and relatives (VFRs). The overall cumulative incidence of LTBI was 2.3%, with considerable heterogeneity. Among individuals travelling for a mean/median of up to 6 months, HCWs had the highest cumulative incidence of LTBI (4.3%), whereas the risk was lower for military (2.5%) and general travellers/volunteers (1.6%). Meta-regression did not identify a difference in incident LTBI based on travel duration and TB incidence in the destination country. Five studies reported cases of active TB, with an overall pooled estimate of 120.7 cases per 100 000 travellers. CONCLUSIONS We found that travelling HCWs were at highest risk of developing LTBI. Individual risk activities and travel purpose were most associated with risk of TB infection acquired during travel.
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Affiliation(s)
- Tanya R Diefenbach-Elstob
- Centre for Clinical Epidemiology, Lady Davis Institute, 3755 Côte Ste-Catherine Road, Montreal, Quebec H3T 1E2, Canada
- Department of Medicine, McGill University, 1001 Decarie Boulevard, Suite D05-2212, Montreal, Quebec H4A 3J1, Canada
| | - Balqis Alabdulkarim
- Department of Internal Medicine, McGill University, 1001 Decarie Boulevard, Rm D05.5840, Montreal, Quebec H4A 3J1, Canada
| | - Paromita Deb-Rinker
- Public Health Agency of Canada, 130 Colonnade Road, A.L. 6501H, Ottawa, Ontario K1A 0K9, Canada
| | - Jeffrey M Pernica
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Straβe 26, 79104 Freiburg, Germany
| | - Dick Menzies
- McGill International TB Centre, 1001 Decarie Boulevard, Room EM3.3212, Montreal, Quebec, H4A 3J1, Canada
- Montreal Chest Institute, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada
- Research Institute of the McGill University Health Centre, 2155 Guy Street, Suite 500, Montreal, Quebec, H3H 2R9, Canada
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute, 3755 Côte Ste-Catherine Road, Montreal, Quebec H3T 1E2, Canada
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, 3rd floor, Montreal, Quebec H3S 1Z1, Canada
| | - Kevin Schwartzman
- McGill International TB Centre, 1001 Decarie Boulevard, Room EM3.3212, Montreal, Quebec, H4A 3J1, Canada
- Montreal Chest Institute, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada
- Research Institute of the McGill University Health Centre, 2155 Guy Street, Suite 500, Montreal, Quebec, H3H 2R9, Canada
| | - Christina Greenaway
- Centre for Clinical Epidemiology, Lady Davis Institute, 3755 Côte Ste-Catherine Road, Montreal, Quebec H3T 1E2, Canada
- Department of Medicine, McGill University, 1001 Decarie Boulevard, Suite D05-2212, Montreal, Quebec H4A 3J1, Canada
- Division of Infectious Diseases, SMBD-Jewish General Hospital, 3755 Côte Ste-Catherine Road, Montreal, Quebec H3T 1E2, Canada
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11
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Perez-Molina JA, Crespillo-Andújar C, Moreno S, Serrano-Villar S, López-Vélez R. Travelling with HIV in the XXI century: Case report and narrative review. Travel Med Infect Dis 2020; 38:101921. [PMID: 33220457 DOI: 10.1016/j.tmaid.2020.101921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/26/2022]
Abstract
The number of migrants and travellers has grown in recent decades. This phenomenon is also true of people living with HIV, given their much-improved life expectancy and quality of life. A significant number of travellers with HIV are migrants returning to their home countries to visit friends and relatives (VFRs). This population constitutes a high-risk group because they travel for longer and often to rural and remote areas and have closer contact with the local population. In this review we discuss the sociodemographic characteristics of travellers with HIV, the differences between conventional travellers and VFRs, and the risks of HIV acquisition and transmission during travel. We also present the most relevant travel-associated illnesses and highlight the particularities of pre-travel advice given to this population, including immunosuppression, responses to vaccines, high incidence of comorbidities, drug interactions, legal and language barriers. The need to integrate these factors based on far less evidence than that available for the general population makes pre-travel advice for travellers with HIV genuinely challenging.
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Affiliation(s)
- Jose A Perez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain.
| | - Clara Crespillo-Andújar
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain
| | - Santiago Moreno
- HIV Unit, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain
| | - Sergio Serrano-Villar
- HIV Unit, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain
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Soriano-Arandes A, Caylà JA, Gonçalves AQ, Orcau À, Noguera-Julian A, Padilla E, Solà-Segura E, Gordillo NR, Espiau M, García-Lerín MG, Rifà-Pujol MÀ, Jordi Gómez i Prat, Macia-Rieradevall E, Martin-Nalda A, Eril-Rius M, Santos Santiago J, Busquets-Poblet L, Martínez RM, Pérez-Porcuna TM. Tuberculosis infection in children visiting friends and relatives in countries with high incidence of tuberculosis: A study protocol. Medicine (Baltimore) 2020; 99:e22015. [PMID: 32899054 PMCID: PMC7478479 DOI: 10.1097/md.0000000000022015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) is a global infectious disease. In low-incidence countries, paediatric TB affects mostly immigrant children and children of immigrants. We hypothesize that these children are at risk of exposure to Mycobacterium tuberculosis when they travel to the country of origin of their parents to visit friends and relatives (VFR). In this study, we aim to estimate the incidence rate and risk factors associated to latent tuberculosis infection (LTBI) and TB in VFR children. METHODS AND ANALYSIS A prospective study will be carried out in collaboration with 21 primary health care centres (PCC) and 5 hospitals in Catalonia, Spain. The study participants are children under 15 years of age, either immigrant themselves or born to immigrant parents, who travel to countries with high incidence of TB (≥ 40 cases/100,000 inhabitants). A sample size of 492 children was calculated. Participants will be recruited before traveling, either during a visit to a travel clinic or to their PCC, where a questionnaire including sociodemographic, epidemiological and clinical data will be completed, and a tuberculin skin test (TST) will be performed and read after 48 to 72 hours; patients with a positive TST at baseline will be excluded. A visit will be scheduled eight to twelve-weeks after their return to perform a TST and a QuantiFERON-TB Gold Plus test. The incidence rate of LTBI will be estimated per individual/month and person/year per country visited, and also by age-group. ETHICS AND DISSEMINATION The study protocol was approved by the Clinical Research Ethics Committee of the Hospital Universitari Mútua Terrassa (code 02/16) and the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (code P16/094). Articles will be published in indexed scientific journals. TRIAL REGISTRATION Clinical-Trials.gov: NCT04236765.
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Affiliation(s)
- Antoni Soriano-Arandes
- Unitat de Patologia Infecciosa i Immunodeficiències Pediàtriques, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron
| | - Joan A. Caylà
- Fundació de la Unitat d’Investigació en Tuberculosi de Barcelona, Barcelona
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)
- Unitat Docent de Medicina de Familia i Comunitària, Tortosa-Terres de l’Ebre, Institut Català de la Salut, Tortosa, Tarragona
| | - Àngels Orcau
- Servei d’epidemiologia, Agència de Salut Pública de Barcelona, Barcelona
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid
| | - Antoni Noguera-Julian
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d’Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona
- Departament de Pediatria, Universitat de Barcelona, Barcelona
- Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid
| | | | | | | | - María Espiau
- Unitat de Patologia Infecciosa i Immunodeficiències Pediàtriques, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron
| | | | | | - Jordi Gómez i Prat
- Equip de Salut Pública i Comunitària de la Unitat de Salut Internacional Drassanes-Hospital Universitari Vall d’Hebron, Servei de Medicina Preventiva de Vall d’Hebron, Barcelona
| | | | - Andrea Martin-Nalda
- Unitat de Patologia Infecciosa i Immunodeficiències Pediàtriques, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron
- Grup de recerca infecció en el pacient pediàtric immunodeprimit, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Barcelona
- Centre de Diagnòstic i Investigació per a Immunodeficiències Primàries Jeffrey Modell, Barcelona
| | - Maria Eril-Rius
- Equip d’atenció primària La Vall del Ges, Institut Català de la Salut, Torelló
| | - José Santos Santiago
- Centre de Salut Internacional i Malalties Transmissibles Drassanes/Vall d’Hebron. Programa de Salut Internacional de l’ICS (PROSICS), Barcelona
| | | | - Raisa Morales Martínez
- Centre de Salut Internacional i Malalties Transmissibles Drassanes/Vall d’Hebron. Programa de Salut Internacional de l’ICS (PROSICS), Barcelona
| | - Tomàs Maria Pérez-Porcuna
- Atenció Primària, Fundació Assistencial Mútua Terrassa, Terrassa
- Unitat clínica de Tuberculosi i Salut Internacional, Fundació de Docència i Recerca Mútua Terrassa, Servei de Pediatria, Hospital Universitari Mútua Terrassa, Terrassa, Spain
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13
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Norman FF, Comeche B, Chamorro S, López-Vélez R. Overcoming challenges in the diagnosis and treatment of parasitic infectious diseases in migrants. Expert Rev Anti Infect Ther 2020; 18:127-143. [PMID: 31914335 DOI: 10.1080/14787210.2020.1713099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction: Recent increases in population movements have created novel health challenges in many areas of the World, and health policies have been adapted accordingly in several countries. However, screening guidelines for infectious diseases are not standardized and generally do not include comprehensive screening for parasitic infections.Areas covered: Malaria, Chagas disease, leishmaniasis, amebiasis, filariases, strongyloidiasis, and schistosomiasis are reviewed, focusing on the challenges posed for their diagnosis and management in vulnerable populations such as migrants. The methodology included literature searches in public databases such as PubMed.gov and Google Scholar and search of the US National Library of Medicine online database of privately and publicly funded clinical studies (ClinicalTrials.gov) until November 2019.Expert opinion: Parasitic infections which may remain asymptomatic for prolonged periods, leading to chronic infection and complications, and/or may be transmitted in non-endemic areas are ideal candidates for screening. Proposed strategies to improve diagnosis in vulnerable groups such as migrants include facilitating access to healthcare in a multi-dimensional manner considering location, individual characteristics, and timing. Limitations and availability of specific diagnostic techniques should be addressed and focus on drug and vaccine development for these neglected infections should be prioritized through collaborative initiatives with public disclosure of results.
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Affiliation(s)
- Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - Belen Comeche
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - Sandra Chamorro
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
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14
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Ferrara P, Masuet-Aumatell C, Ramon-Torrell JM. Pre-travel health care attendance among migrant travellers visiting friends and relatives (VFR): a 10-year retrospective analysis. BMC Public Health 2019; 19:1397. [PMID: 31660916 PMCID: PMC6819640 DOI: 10.1186/s12889-019-7722-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/09/2019] [Indexed: 01/29/2023] Open
Abstract
Background Travellers visiting friends and relatives (VFR) define a specific population of travellers exposed to higher risks for health and safety than tourists. The aim of this study was to assess differentials in pre-travel health care in VFR travellers compared to other travellers. Methods A retrospective cohort study was performed including attendees of the Travel Medicine Clinic of the Hospital Universitari de Bellvitge, Barcelona, Spain, between January 2007 and December 2017. Results Over the 10-year period, 47,022 subjects presented to the travel clinic for pre-travel health care, 13.7% of whom were VFR travellers. These showed higher rates of vaccination against yellow fever and meningococcus, but lower rates for hepatitis A, hepatitis B, influenza, rabies, cholera, polio, typhoid IM vaccine and tetanus vaccine boosters. Regarding malaria prevention measures, results highlighted that VFR travellers, when compared with tourists, were more likely to be prescribed with chemoprophylaxis, particularly with mefloquine, than with atovaquone/proguanil. Conclusions Findings from this large-scale study indicated differences in vaccination rates and completion, as well as in chemoprophylaxis for malaria, between VFR and non-VFR travellers, fostering specific interventions for promoting adherence to pre-travel health advice among migrant travellers.
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Affiliation(s)
- Pietro Ferrara
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", 5 Via Luciano Armanni, 80138, Naples, Italy
| | - Cristina Masuet-Aumatell
- Bellvitge Biomedical Research Institute (IDIBELL), Preventive Medicine Department, University Hospital of Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Catalonia, Spain. .,Clinical Science Department, School of Medicine, University of Barcelona, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Catalonia, Spain.
| | - Josep Maria Ramon-Torrell
- Bellvitge Biomedical Research Institute (IDIBELL), Preventive Medicine Department, University Hospital of Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Catalonia, Spain.,Clinical Science Department, School of Medicine, University of Barcelona, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Catalonia, Spain
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15
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16
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Godoy P, Carmona G, Manzanares S, Jane M, Borràs E, Camps N, Álvarez J, Barrabeig I, Sala MR, Rius C, Minguell S, Carol M, Ferras J, Domínguez A. Trends and risk factors of hepatitis A in Catalonia after the introduction of a hepatitis A+B vaccination programme. J Viral Hepat 2018; 25:1001-1007. [PMID: 29603832 DOI: 10.1111/jvh.12900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 01/23/2018] [Indexed: 01/26/2023]
Abstract
At the end of 1998, universal hepatitis A+B vaccination of 12 year olds was introduced in Catalonia. The aim was to examine trends in hepatitis A during 2005-2015 and assess risk factors by age group. We carried out an observational epidemiological study of the incidence and risk factors of hepatitis A reported to the surveillance system. Information on exposure was recorded for each case for the 2-6 weeks before symptom onset. Spearman's coefficient was used to evaluate the trends of rates. The chi-square test was used to compare categorical. We studied 2621 hepatitis A cases; the age mean was 26.6 years (SD=18.2), and >50% of cases were in the 20-49 years age group. The incidence decreased from 3.28/100 000 in 2005 to 1.50/100 000 in 2015. The rate for women decreased over time (P = .008), but the reduction was not significant in men (P = .234). Men consistently had higher rates than women with the biggest difference being in the 20-34 years age group (rate 8.8 vs 2.8). The greatest risk factor was travel to an endemic country (42.1%) in the 0-19 years age group and male-to-male sexual contact (18.6%) in the 20-49 years age group. The case fatality rate in adults aged >49 years was 0.4%. In conclusion, the vaccination programme of preadolescents resulted in a reduction in hepatitis A cases. However, a significant amount of cases still appear in immigrants and men who have sex with men. Hepatitis A in adults is an emerging health problem that will require new strategies.
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Affiliation(s)
- P Godoy
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Institut de Recerca Biomédica de Lleida. IRBLleida, Lleida, Spain
| | - G Carmona
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - S Manzanares
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - M Jane
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - E Borràs
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - N Camps
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - J Álvarez
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - I Barrabeig
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - M-R Sala
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - C Rius
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - S Minguell
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - M Carol
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - J Ferras
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - A Domínguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
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17
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Puca E, Qato M, Pipero P, Akshija I, Kote M, Kraja D. Two cases of imported hemorrhagic fever with renal syndrome and systematic review of literature. Travel Med Infect Dis 2018; 28:86-90. [PMID: 30114480 DOI: 10.1016/j.tmaid.2018.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/20/2018] [Accepted: 07/25/2018] [Indexed: 01/18/2023]
Abstract
Many factors are involved in the epidemiology of hemorrhagic fever with renal syndrome (HFRS). Imported cases, as well as those by emigrants, have been reported in literature worldwide. Our goal is to document two cases of HFRS, imported by two immigrants from two countries, and to make a review of the imported HFRS literature data. We performed a systematic literature review (PRISMA guidelines) of imported cases of HFRS and herein describe our two clinical cases. We found 20 published papers, with 16 of them in English and 4 in other languages. Twenty-three patients with travel- or immigration-associated HFRS, including our two cases, were identified. We included only papers that were in English. The average age of the patients was 35.9 ± 15.13 years, and the ratio of male to female was 8:1. Imported disease from Europe to Europe occurred in seven cases, America to Europe occurred in four cases, Europe to America occurred in two cases, America to America occurred in two cases, Asia to Asia in one case, Asia to Europe in one case, and Europe to Asia in one case. The results of the two cited cases are based on the clinical-laboratory, anamnestic, and serologic data for both the patients who tested positive for HFRS. Our systematic analysis shows that international travelers are important sources of infectious diseases. HFRS related to travel and immigration is a rare event. Principal risk factors for travelers and immigrants are camping outside recommended areas or under unsuitable conditions. In recent years, various publications have shown that international travelers and immigrants have expanded the spectrum of imported infectious diseases. The literature data show that the actual reported numbers of imported case of HFRS are limited.
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Affiliation(s)
- Edmond Puca
- Service of Infectious Diseases, University Hospital Center, Tirana, Albania; ESCMID Study Group for Infections in Travellers and Migrants (ESGITM), Albania.
| | - Migena Qato
- Service of Infectious Diseases, University Hospital Center, Tirana, Albania
| | - Pellumb Pipero
- Service of Infectious Diseases, University Hospital Center, Tirana, Albania
| | - Ilir Akshija
- Statistic Service, University Hospital Center, Tirana, Albania
| | | | - Dhimiter Kraja
- Service of Infectious Diseases, University Hospital Center, Tirana, Albania
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Zammarchi L, Vellere I, Stella L, Bartalesi F, Strohmeyer M, Bartoloni A. The diagnosis of neglected tropical diseases (NTDs) in Italy: reply. Intern Emerg Med 2017; 12:725-726. [PMID: 28470412 DOI: 10.1007/s11739-017-1672-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Lorenzo Zammarchi
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Largo Brambilla 3, 50134, Florence, Italy
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Iacopo Vellere
- Scuola di Scienze della Salute Umana, Corso di Studio in Medicina e Chirurgia, Università di Firenze, Florence, Italy
| | - Leonardo Stella
- Scuola di Scienze della Salute Umana, Corso di Studio in Medicina e Chirurgia, Università di Firenze, Florence, Italy
| | - Filippo Bartalesi
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Marianne Strohmeyer
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Largo Brambilla 3, 50134, Florence, Italy
| | - Alessandro Bartoloni
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Largo Brambilla 3, 50134, Florence, Italy.
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
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19
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Poddighe D, Gaviglio I, Trabatti C, Marseglia GL. The diagnosis of neglected tropical diseases (NTDs) in Italy: comment. Intern Emerg Med 2017; 12:721-723. [PMID: 28361354 DOI: 10.1007/s11739-017-1655-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/23/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Dimitri Poddighe
- Department of Pediatrics, ASST Melegnano e Martesana, via Pandina 1, Vizzolo Predabissi (MI), Italy.
- Departement of Pediatrics, University of Pavia, Pavia, Italy.
| | - Ivan Gaviglio
- Departement of Pediatrics, University of Pavia, Pavia, Italy
| | - Chiara Trabatti
- Departement of Pediatrics, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Departement of Pediatrics, University of Pavia, Pavia, Italy
- Department of Pediatrics, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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Abstract
BACKGROUND Gastrointestinal symptoms are a common cause of consultation about children traveling to or coming from developing countries. The aim of this study was to identify the risk factors associated with gastrointestinal syndrome in children who travel. METHODS A prospective observational analytical and multicenter study was performed within +Redivi, a Spanish Tropical Medicine network on imported infections, from January 2009 to December 2013. All participants aged 16 years and younger were included in the analysis. Ethical approval was obtained from all the participating centers. RESULTS A total of 606 children ≤16 years of age were registered in the +Redivi database during the study period. Median age was 8.7 years (interquartile range, 4.4-12.4 years), 65.8% (399/606) were immigrants, 90% were >2 years old and 54% were male. Median travel duration, excluding immigrants, was 50 days (interquartile range, 30-150 days). Children with gastrointestinal symptoms represented 13.5% (82/606) of total consultations. A significant association was found in bivariate analysis between gastrointestinal disorder and age <2 years (P < 0.01) and travel duration (P = 0.046). Immigrants had less gastrointestinal disorders than tourists (P < 0.05). The most prevalent infection was protozoan in 23.4% (142/606), and Giardia intestinalis was the most common pathogen in 10.1% (61/606) of total children. Independent risk factors for gastrointestinal symptoms were tourist and traveler child visiting friends and relatives (P = 0.03), travel duration <90 days (P = 0.008) and bacterial cause (P < 0.001). CONCLUSIONS Traveling children who developed a gastrointestinal syndrome represented 13.5% of the total pediatric consultations in +Redivi. Independent risk factors were tourist or traveler visiting friends and relatives, travel duration <90 days and bacterial infection. G. intestinalis was the most common infectious agent causing a gastrointestinal disorder in the traveler children.
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21
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Abu-Madi MA, Behnke JM, Boughattas S, Al-Thani A, Doiphode SH, Deshmukh A. Helminth infections among long-term-residents and settled immigrants in Qatar in the decade from 2005 to 2014: temporal trends and varying prevalence among subjects from different regional origins. Parasit Vectors 2016; 9:153. [PMID: 26984202 PMCID: PMC4793708 DOI: 10.1186/s13071-016-1433-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Travel and migration from developing regions, where tropical diseases are common, to more developed industrialised nations can contribute to the introduction and subsequent spread of infections. With its rapidly expanding economy, Qatar has attracted vast numbers of immigrant workers in the last two decades, often from countries with poor socio-economic levels. Many used to arrive with patent intestinal parasitic infections. METHODS We analysed the prevalence of helminth infections in a dataset of 29,286 records of subjects referred for stool examination at the Hamad Medical Corporation over the course of a decade (2005 to 2014, inclusive). RESULTS Overall prevalence of combined helminth infections was low (1.86 %) but there were significant temporal trends, age and sex effects and those arising from the region of origin of the subjects. The most common helminths were hookworms (overall prevalence 1.22 %), which accounted for 70.1 % of cases, and therefore patterns for combined helminth infections were largely driven by hookworms. In both cases, and also in Trichuris trichiura and Ascaris lumbricoides, prevalence peaked in 2008, since when prevalence has been steadily falling. Helminth infections were largely concentrated among subjects from five Asian countries (Nepal, Bangladesh, Sri Lanka, India and Pakistan), and there was a highly biased prevalence in favour of male subjects in all cases. Prevalence of all three nematodes peaked in age class 7 (mean age 25.5 years, range = 20-29) and there were significant interactions between region of origin, sex of subjects and prevalence of hookworms. CONCLUSION These results offer optimism that prevalence will continue to decline in the years ahead, especially if control is targeted at those most at risk of carrying infections.
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Affiliation(s)
- Marawan A Abu-Madi
- Department of Biomedical Sciences, College of Health Science, Biomedical Research Center, Qatar University, P.O. Box 2713, Doha, Qatar.
| | - Jerzy M Behnke
- School of Life Sciences, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Sonia Boughattas
- Department of Biomedical Sciences, College of Health Science, Biomedical Research Center, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Asma Al-Thani
- Department of Biomedical Sciences, College of Health Science, Biomedical Research Center, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Sanjay H Doiphode
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Qatar, P.O. Box 3050, Doha, Qatar
| | - Anand Deshmukh
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Qatar, P.O. Box 3050, Doha, Qatar
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22
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Helminthosis and eosinophilia in Spain (1990-2015). Enferm Infecc Microbiol Clin 2016; 36:120-136. [PMID: 26827134 DOI: 10.1016/j.eimc.2015.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/29/2015] [Accepted: 11/30/2015] [Indexed: 12/16/2022]
Abstract
The finding of blood eosinophilia in a patient is a relatively frequent reason to refer him/her to a Clinical Department of Infectious Diseases. The doctor usually intends to rule out a parasitic disease in the autochthonous population, travelers or immigrants. It is uncommon for an eosinophilia to be produced by protozoa infection, whereas helminth parasites are more frequently associated with an increase of eosinophil counts in the infected patient. Eosinophilia can be the only abnormal finding, or it could be part of more complex clinical manifestations suffered by the patient. Furthermore, many, but not all, helminth infections are associated with eosinophilia, and the eosinophil level (low, high) differs according to parasite stages, helminth species, and worm co-infections. The purpose of the present article is to carry out a systematic review of cases and case series on helminth infections and eosinophilia reported in Spain from 1990 to 2015, making a distinction between autochthonous and imported (immigrants and travelers) cases, and studying their relationship with immunodepression situations.
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Abstract
BACKGROUND Children travelling are potentially exposed to a wide spectrum of illness, which includes not only mild self-limiting disease but also severe illness requiring hospitalization. Risk factors for hospitalization need to be analyzed to inform prevention and treatment strategies for travel-related disease, to make travelling for children-from a medical perspective-more secure. METHODS We performed a cross-sectional analysis on children with travel-related disease presenting at the Emergency Room of University of Zurich Children's Hospital between July 2007 and December 2012. The profile of children being hospitalized was compared with that of children treated as outpatients. RESULTS Eight hundred and one children (57.4% male) were included in the study. Eighty-three children (10.4%) were treated as inpatients. Compared with outpatients, inpatients were significantly more likely to be male, to have travelled to Southern Asia, to have a diagnosis of Salmonella typhi or Salmonella paratyphi (3.6 % vs. 0.1%, P < 0.0001), pyogenic abscess (3.6% vs. 0.1 %, P < 0.0001) or malaria (1.4 % vs. 0.2%, P = 0.0384). Neurologic diagnoses (such as seizure disorder: 3.6% vs. 0.4%, P < 0.0001) were diagnosed more often among inpatients. Furthermore, inpatients presented more often with nonspecific findings such as dehydration (8.5% vs. 0.6%, P < 0.0001). No correlation with inpatient care was seen for visiting friends and relatives/immigrant travel. CONCLUSIONS Children acquire a wide spectrum of travel-related illness. A careful, detailed travel history is important in children presenting in the emergency room with symptoms suggesting infectious disease.
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Salazar-Austin N, Ordonez AA, Hsu AJ, Benson JE, Mahesh M, Menachery E, Razeq JH, Salfinger M, Starke JR, Milstone AM, Parrish N, Nuermberger EL, Jain SK. Extensively drug-resistant tuberculosis in a young child after travel to India. THE LANCET. INFECTIOUS DISEASES 2015; 15:1485-91. [PMID: 26607130 DOI: 10.1016/s1473-3099(15)00356-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/14/2015] [Accepted: 09/21/2015] [Indexed: 02/07/2023]
Abstract
Extensively drug-resistant (XDR) tuberculosis is becoming increasingly prevalent worldwide, but little is known about XDR tuberculosis in young children. In this Grand Round we describe a 2-year-old child from the USA who developed pneumonia after a 3 month visit to India. Symptoms resolved with empirical first-line tuberculosis treatment; however, a XDR strain of Mycobacterium tuberculosis grew in culture. In the absence of clinical or microbiological markers, low-radiation exposure pulmonary CT imaging was used to monitor treatment response, and guide an individualised drug regimen. Management was complicated by delays in diagnosis, uncertainties about drug selection, and a scarcity of child-friendly formulations. Treatment has been successful so far, and the child is in remission. This report of XDR tuberculosis in a young child in the USA highlights the risks of acquiring drug-resistant tuberculosis overseas, and the unique challenges in management of tuberculosis in this susceptible population.
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Affiliation(s)
- Nicole Salazar-Austin
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alvaro A Ordonez
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alice Jenh Hsu
- Department of Pharmacy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jane E Benson
- Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mahadevappa Mahesh
- Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Jafar H Razeq
- Maryland Department of Health and Mental Hygiene, Laboratories Administration, Baltimore, MD, USA
| | - Max Salfinger
- National Jewish Health Mycobacteriology Laboratory, Denver, CO, USA
| | - Jeffrey R Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Aaron M Milstone
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Hospital Epidemiology and Infection Control, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicole Parrish
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric L Nuermberger
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sanjay K Jain
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Pérez-Molina J. Viajar por trabajo. ¿Un nuevo perfil de viajero de alto riesgo? Rev Clin Esp 2015; 215:446-8. [PMID: 26318417 PMCID: PMC7130407 DOI: 10.1016/j.rce.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 07/26/2015] [Accepted: 07/27/2015] [Indexed: 11/20/2022]
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Godoy P, Broner S, Manzanares-Laya S, Martínez A, Parrón I, Planas C, Sala-Farré MR, Minguell S, de Olalla PG, Jané M, Dominguez A. Outbreaks of hepatitis A associated with immigrants travelling to visit friends and relatives. J Infect 2015; 72:112-5. [PMID: 26404744 DOI: 10.1016/j.jinf.2015.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/08/2015] [Accepted: 09/13/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Pere Godoy
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Sonia Broner
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sandra Manzanares-Laya
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agencia de Salut Pública de Barcelona, Barcelona, Spain
| | - Ana Martínez
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ignasi Parrón
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Caritat Planas
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | | | - Sofia Minguell
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Patricia Garcia de Olalla
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agencia de Salut Pública de Barcelona, Barcelona, Spain
| | - Mireia Jané
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Angela Dominguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departamento de Salud Pública, Universidad de Barcelona, Barcelona, Spain
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Norman FF, Monge-Maillo B, Martínez-Pérez Á, Perez-Molina JA, López-Vélez R. Parasitic infections in travelers and immigrants: part II helminths and ectoparasites. Future Microbiol 2015; 10:87-99. [PMID: 25598339 DOI: 10.2217/fmb.14.106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Travel and migration contribute to the emergence of certain parasites which may be imported into nonendemic areas. Noncontrolled importation of food products and animals may also contribute to the diagnosis of infections caused by helminths in nonendemic countries. Some helminth infections such as strongyloidiasis may be life-threatening, especially in immunocompromised patients, and outcome depends on correct diagnosis and treatment. Other helminth infections are neglected tropical diseases associated with chronic disease and/or disability. Major challenges concern the development of improved diagnostic techniques, safer and more effective drug therapies and identification of markers of response to treatment. The study of these imported infections in travelers and immigrants may provide opportunities for research which may not be readily available in resource-poor endemic countries. Updated reviews and guidelines are necessary as new data become available. The second part of this review focuses on infections in travelers and immigrants caused by helminths and ectoparasites.
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Affiliation(s)
- Francesca F Norman
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar Km 9.1, 28034 Madrid, Spain
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Käser AK, Arguin PM, Chiodini PL, Smith V, Delmont J, Jiménez BC, Färnert A, Kimura M, Ramharter M, Grobusch MP, Schlagenhauf P. Imported malaria in pregnant women: A retrospective pooled analysis. Travel Med Infect Dis 2015; 13:300-10. [PMID: 26227740 PMCID: PMC4627431 DOI: 10.1016/j.tmaid.2015.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/26/2015] [Accepted: 06/26/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Data on imported malaria in pregnant women are scarce. METHOD A retrospective, descriptive study of pooled data on imported malaria in pregnancy was done using data from 1991 to 2014 from 8 different collaborators in Europe, the United States and Japan. National malaria reference centres as well as specialists on this topic were asked to search their archives for cases of imported malaria in pregnancy. A total of 631 cases were collated, providing information on Plasmodium species, region of acquisition, nationality, country of residence, reason for travel, age, gestational age, prophylactic measures and treatment used, as well as on complications and outcomes in mother and child. RESULTS Datasets from some sources were incomplete. The predominant Plasmodium species was P. falciparum (78.5% of cases). Among the 542 cases where information on the use of chemoprophylaxis was known, 464 (85.6%) did not use chemoprophylaxis. The main reason for travelling was "visiting friends and relatives" VFR (57.8%) and overall, most cases of malaria were imported from West Africa (57.4%). Severe anaemia was the most frequent complication in the mother. Data on offspring outcome were limited, but spontaneous abortion was a frequently reported foetal outcome (n = 14). A total of 50 different variants of malaria treatment regimens were reported. CONCLUSIONS Imported cases of malaria in pregnancy are mainly P. falciparum acquired in sub-Saharan Africa. Malaria prevention and treatment in pregnant travellers is a challenge for travel medicine due to few data on medication safety and maternal and foetal outcomes. International, collaborative efforts are needed to capture standardized data on imported malaria cases in pregnant women.
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Affiliation(s)
- Annina K Käser
- University of Zürich Travel Clinic, Infectious Diseases, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Paul M Arguin
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Peter L Chiodini
- Public Health England, Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, UK; Department of Clinical Parasitology, Hospital for Tropical Diseases, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Valerie Smith
- Public Health England, Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, UK
| | - Jean Delmont
- University Hospital Institute for Infectious and Tropical Diseases, Hospital Nord, AP-HM, Marseille, France
| | - Beatriz C Jiménez
- Department of Internal Medicine, University Hospital Fuenlabrada, Madrid, Spain
| | - Anna Färnert
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mikio Kimura
- Department of Internal Medicine, Shin-Yamanote Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Michael Ramharter
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Patricia Schlagenhauf
- University of Zürich Travel Clinic, Infectious Diseases, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.
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Ma T, Heywood A, MacIntyre CR. Chinese travellers visiting friends and relatives--A review of infectious risks. Travel Med Infect Dis 2015; 13:285-94. [PMID: 26026478 PMCID: PMC7110956 DOI: 10.1016/j.tmaid.2015.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 03/31/2015] [Accepted: 05/04/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Travellers are potential vectors in the transmission of infectious diseases across international borders. Travellers visiting friends and relatives (VFR) have a particularly high risk of acquiring certain infections during travel. Chinese VFR travellers account for a substantial proportion of all travel in Western countries with high migrant populations. METHODS A literature review was undertaken regarding major infectious disease risks for VFR travellers visiting China. This included an examination of the previous pandemics arising in China, the likelihood of future outbreaks in China from H5N1 and H7N9 avian influenza viruses, the potential role of travellers in disease transmission, and the special risks for VFR travellers. RESULTS China has been the origin of several influenza pandemics in past few decades, and the origin of several emerging infectious diseases with pandemic potential, including SARS. Travel to and from China has the potential for global spread of emergent infectious diseases, as seen in the SARS outbreak in 2003. For VFR travellers, the risk of other infectious diseases may also be greater in China compared to their countries of migration, including hepatitis A and B, dengue fever, typhoid, and other diseases. CONCLUSIONS VFR travel to China may be associated with increased risk of acquiring a range of infectious diseases, and also poses a potential risk for importation of future pandemics to other countries. Chinese VFR travellers need to be cognisant of these risks and health professionals should consider educational interventions to minimise these risks.
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Affiliation(s)
- Tara Ma
- School of Public Health and Community Medicine, UNSW Australia, Kensington, NSW, Australia.
| | - Anita Heywood
- School of Public Health and Community Medicine, UNSW Australia, Kensington, NSW, Australia.
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Australia, Kensington, NSW, Australia; National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia.
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Characteristics of HIV infected individuals traveling abroad. Results from the +REDIVI Collaborative Network. Enferm Infecc Microbiol Clin 2015; 34:108-13. [PMID: 26021187 DOI: 10.1016/j.eimc.2015.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/22/2015] [Accepted: 03/24/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The improvement in the prognosis of HIV infection, coupled with the increase in international travel and migration, has led to a rising number of HIV infected travelers. The objective of this study was to describe the epidemiological and clinical features of returning travelers, according to their HIV status. METHODS An observational prospective study was conducted including travelers and immigrants who traveled to visit friends and relatives (VFRs) registered in the +REDIVI collaborative network (January-2009; October-2014). +REDIVI is a national network that registers information regarding infections imported by travelers and immigrants at 21 different centers using a standardized protocol. RESULTS A total of 3464 travellers were identified: 72 were HIV+ (2.1%) and 3.392 HIV- (98%). HIV+ vs. HIV- travelers were often older (40.5y vs. 34.2y P=.001), VFRs (79.1% vs. 44.4%; P<.001), and consulted less for pre-travel advice (27% vs. 37%; P=.078). The main destinations for both groups were sub-Saharan Africa and Latin America. The most frequent reasons for consultation after travel were fever, request for a health examination, gastrointestinal complaints, and abnormal laboratory tests (mainly eosinophilia and anemia), which differed between groups. The most frequent diagnoses in HIV+ travelers were malaria (38.8%), newly diagnosed HIV infection (25%), and intestinal parasites (19.4%), while for HIV- travelers the main diagnoses were "healthy" (17.9%), malaria (14%), and intestinal parasites (17.3%). CONCLUSIONS The typical profile of an HIV+ traveler in +REDIVI was that of a VFR traveler who did not seek pre-travel advice and made high-risk trips. This may increase the chance of acquiring travel-related infections which may pose a special risk for HIV-infected travelers. The post-travel visit was a good opportunity for HIV infection screening.
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Gironé G, Mateo C, Gaya V, Usó J, Mínguez C, Roca B, Ramos JM. Admissions for imported and non-imported parasitic diseases at a General Hospital in Spain: A retrospective analysis. Travel Med Infect Dis 2015; 13:322-8. [PMID: 26003567 DOI: 10.1016/j.tmaid.2015.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 04/27/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze imported and non-imported parasitic diseases as a cause of admission to a general hospital. METHODS A retrospective analysis of hospital admissions for parasitic diseases between 2004 and 2013 performed by means of hospital information systems at a public hospital in the city of Castellón (Spain). RESULTS During the period covered in this study, there were 204,349 admissions, 213 of which were for parasitic diseases (prevalence: 1.04/1000 admission). 129 were neglected parasitic tropical diseases and 61 were imported parasitic diseases. The main parasitic diseases were hydatidosis (24.9%), visceral leishmaniasis (22.5%) and malaria (12.2%). There was a decrease in admissions for visceral leishmaniasis in the 2004-2008 period from 27.7% to 15.9% in the 2009-2013 period (p < 0.001), and an increase in admissions for malaria from 5.0% to 21.3% (p < 0.001). 38 (20.3%) of the 187 patients with parasitic diseases were HIV infected. HIV infection was more common in patients with toxoplasmosis (94.1%; p < 0.001), cryptosporidiosis (66.7%; p < 0.02) and visceral leishmaniasis (46.4%; p = 0.003). There were 34 (18.2%) children with parasitic diseases. Twelve of the 28 patients with visceral leishmaniasis (42.9%; p < 0.001), and 11 of the 17 patients with soil-transmitted diseases were children (64.7%; p < 0.001). The cause of death in eight patients was parasitic disease related (mortality rate: 4.3%). The mortality rate for visceral leishmaniasis was significantly higher (14.3%; p = 0.01). CONCLUSION The main cause is endemic parasitic diseases such as hydatidosis. Visceral leishmaniasis decreased during the period covered by the study, but malaria increased.
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Affiliation(s)
- Guillermo Gironé
- Department of Internal Medicine, Hospital Universitari General de Castelló, Catelló, Spain
| | - Claudia Mateo
- Department of Internal Medicine, Hospital Universitari General de Castelló, Catelló, Spain
| | - Víctor Gaya
- Department of Internal Medicine, Hospital Universitari General de Castelló, Catelló, Spain
| | - Jordi Usó
- Department of Internal Medicine, Hospital Universitari General de Castelló, Catelló, Spain
| | - Carlos Mínguez
- Department of Internal Medicine, Hospital Universitari General de Castelló, Catelló, Spain
| | - Bernardino Roca
- Department of Internal Medicine, Hospital Universitari General de Castelló, Catelló, Spain
| | - José M Ramos
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain; Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain.
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Norman FF, Monge-Maillo B, Martínez-Pérez Á, Perez-Molina JA, López-Vélez R. Parasitic infections in travelers and immigrants: part I protozoa. Future Microbiol 2015; 10:69-86. [DOI: 10.2217/fmb.14.105] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
ABSTRACT The growth in international commerce, travel and migration contribute to the global emergence of certain parasitic infections. Importation of vectors and food products may contribute to the emergence of protozoan infections in nonendemic countries. Infections such as malaria are potentially fatal, especially in nonimmune patients, and outcome depends largely on timely diagnosis and treatment. Diagnosis/management of imported parasitic infections may be complex especially as some patients may have underlying immunosuppressive conditions such as HIV infection. Major challenges concern the development of improved diagnostic techniques, safer/more effective drug therapies and identification of biological markers of progression and response to treatment. Imported parasitic diseases which may be transmitted vertically or through blood transfusion/organ donation could become a public health priority in the near future. Climate change may affect arthropod distribution and facilitate the spread of protozoan vector-borne diseases. The first part of this review focuses on protozoan infections in travelers and immigrants.
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Affiliation(s)
- Francesca F Norman
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
| | - Begoña Monge-Maillo
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
| | - Ángela Martínez-Pérez
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
| | - Jose A Perez-Molina
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
| | - Rogelio López-Vélez
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
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Gergely A, Bechet S, Goujon C, Benabdelmoumen G, Consigny PH. Hepatitis B screening in travelers: a retrospective analysis. Travel Med Infect Dis 2014; 12:707-12. [PMID: 25086491 DOI: 10.1016/j.tmaid.2014.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/05/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Non-immune travelers are at risk of acquiring hepatitis B (HB) in high prevalence countries. METHOD At the Institut Pasteur Vaccination Center in a retrospective study we retrieved hepatitis B serological data from the vaccination database between 2008 and 2012. Serology (HBsAg, HBsAb and HBcAb) is proposed to travelers who have no information about their previous HB vaccination status if they travel to countries of high or intermediate prevalence of HB, for long or frequent trips. RESULTS Of 1093 people 53.1% were men, mean age was 39.6 ± 13.0 years. Prevalence of chronic HBV infection was 5.86% (64 subjects). Their mean age was 36.2 ± 7.3 years, 65.6% were men. Seroprevalence of people of sub-Saharan African origin was 9.2%, higher than the other geographic groups. Past, resolved HB infection was found in 320 subjects, 29.3% of the population; 90.3% were of sub-Saharan African origin. A subgroup of the "Past, resolved HB infection": 73 people (6.7% of the population) had isolated HB core antibodies. Vaccine induced immunity was found in 286 subjects (26.17% of the total population), 40% of people born in France. All three markers of HB were negative at 38.7% of our total population (423 people), and 54% of people of French origin. CONCLUSIONS HB seroprevalence was higher than in general French and European population, due to our large number of individuals with immigrant background. Pre-travel counseling allows screening and vaccination of non-immune travelers and detection of chronic HB infection cases.
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Affiliation(s)
- Anna Gergely
- Institut Pasteur, Centre Médical, 209 rue de Vaugirard, 75015 Paris, France.
| | - Stephane Bechet
- ACTIV (Association Clinique et Thérapeutique Infantile du Val de Marne), 27 rue d'Inkermann, 94100 Saint Maur des Fossés, France.
| | - Catherine Goujon
- Institut Pasteur, Centre Médical, 209 rue de Vaugirard, 75015 Paris, France.
| | | | - Paul-Henri Consigny
- Institut Pasteur, Centre Médical, 209 rue de Vaugirard, 75015 Paris, France.
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