¿La crisis económica condiciona la aparición de un nuevo perfil de riesgo en viajeros internacionales? / Has the economic crisis led to a new risk profile for international travelers?

Introducción. La crisis económica mundial condiciona la migración de trabajadores europeos hacia países en vías de desarrollo con alta incidencia de enfermedades infecciosas. El objetivo de este estudio es valorar si este contexto produce un aumento de los riesgos de los viajeros internacionales que se desplazan por motivos laborales (VML). Métodos. Estudio observacional retrospectivo. La población de estudio fueron los VML atendidos antes de su viaje en una Unidad de Salud Internacional durante los años 2007 (año anterior al inicio de la crisis europea) y 2012 (con la crisis estructural establecida). Se realizó un análisis comparativo sociodemográfico y de los factores de riesgo presentes entre ambos grupos. Resultados. En 2007 y 2012 se atendieron un total de 9.197 viajeros. Los VML fueron 344 (3,4%); en 2007, 101 (2,8%) y en 2012, 243 (4,5%) (p<0,001). La edad media de los viajeros fue de 38,1 (DE: 10,57) años. El destino más frecuente fue África subsahariana con 164 (47,6%) casos. Se prescribió quimioprofilaxis antipalúdica a 152 (44%) y presentaban comorbilidades 80 (23,25%). Los VML del 2012 presentaron significativamente mayor edad (p=0,05), más comorbilidades (p=0,018), y mayor proporción de estancias en zonas rurales (p=0,009) durante periodos más largos (p=0,001). Conclusiones. A 5 años del inicio de la crisis económica, existe una variación en el perfil del VML. Su número ha aumentado significativamente, así como la proporción de los que presentan factores de riesgo para contraer enfermedades importadas. Las Unidades de Salud Internacional deberían adaptarse a las nuevas circunstancias y adoptar medidas preventivas en dicho colectivo (AU)

Introduction. The economic world crisis has led to the migration of European workers to developing countries with a high incidence of infectious diseases. The objective of this study was to assess whether this context has produced an increase in the risks to international travelers for work reasons (TWR). Methods. Observational, retrospective study. The study population included TWR who were attended before traveling at an International Health Unit in the year 2007 (the year before the initiation of the European crisis) and in the year 2012 (when the structural crisis was established). A comparative socioeconomic analysis was performed as well as an analysis of the risk factors present in both groups. Results. In 2007 and 2012 a total of 9197 travelers were attended. Of these, there were 344 TWR (3.4%); 101 TWR (2.8%) in 2007 and 243 TWR (4.5%) in 2012 (p<.001). The average age of the travelers was 38.1 years (SD: 10.57). The most common destination was Sub-Saharan Africa, in 164 (47.6%) of the cases. Malaria chemoprophylaxis was prescribed to 152 travelers (44%) and 80 presented comorbidity (23.25%). The TWR from 2012 presented a significantly greater age (p=.05), more comorbidity (p=.018) and a greater proportion of stays in rural areas (p=.0009) for longer time periods (p=.001). Conclusions. At 5 years from the start of the economic crisis, there was a change in the profile of TWR. Their number has increased significantly, as has the proportion who present risk factors for contracting imported diseases. The International Health Units should adapt to these new circumstances and adopt preventive measures for this population (AU)

Has the economic crisis led to a new risk profile for international travellers? / ¿La crisis económica condiciona la aparición de un nuevo perfil de riesgo en viajeros internacionales?

INTRODUCTION: The economic world crisis has led to the migration of European workers to developing countries with a high incidence of infectious diseases. The objective of this study was to assess whether this context has produced an increase in the risks to international travellers for work reasons (TWR). METHODS: Observational, retrospective study. The study population included TWR who were attended before travelling at an International Health Unit in the year 2007 (the year before the initiation of the European crisis) and in the year 2012 (when the structural crisis was established). A comparative socioeconomic analysis was performed as well as an analysis of the risk factors present in both groups. RESULTS: In 2007 and 2012 a total of 9,197 travellers were attended. Of these, there were 344 TWR (3.4%); 101 TWR (2.8%) in 2007 and 243 TWR (4.5%) in 2012 (p<0.001). The average age of the travellers was 38.1 years (SD: 10.57). The most common destination was Sub-Saharan Africa, in 164 (47.6%) of the cases. Malaria chemoprophylaxis was prescribed to 152 travellers (44%) and 80 presented comorbidity (23.25%). The TWR from 2012 presented a significantly greater age (p=0.05), more comorbidity (p=0.018) and a greater proportion of stays in rural areas (p=0.0009) for longer time periods (p=0.001). CONCLUSIONS: At 5 years from the start of the economic crisis, there was a change in the profile of TWR. Their number has increased significantly, as has the proportion who present risk factors for contracting imported diseases. The International Health Units should adapt to these new circumstances and adopt preventive measures for this population.

Unidades de salud internacional centradas en atención primaria

La globalización económica, la aplicación de las nuevas tecnologías a los transportes y comunicación de información, bienes y personas junto con la incorporación de España a un marco de referencia europeo han conllevado un aumento muy considerable en el número de viajeros a destinos con condiciones sanitarias muy diferentes a las nuestras, así como a una llegada de abundante mano de obra inmigrada en un país sin tradición en salud internacional. El inevitable desarrollo de ésta a corto o medio plazo deberá contar con la atención primaria si quiere abordar el fenómeno de manera planificada y como estrategia para aumentar la eficiencia de unas actividades (consejo al viajero, vacunación internacional) que recaen de lleno en lo que son las funciones básicas de la atención primaria. El despliegue de unidades de salud internacional plenamente funcionantes sólo es posible dotando a la atención primaria, y estableciendo desde ella circuitos de apoyo por una parte a los profesionales de primera línea asistencial y por otra a los ámbitos hospitalarios y especializados de cada zona (AU)

[Incidence and etiology of viremia in 2,619 patients]. / Incidencia y etiología de la viremia en 2.619 pacientes.

BACKGROUND: Virus investigation, specially cytomegalovirus (CMV), in blood has increased such that the capacity of hospitalary laboratories is threatened with collapse. The causal agents of viremia are analyzed being correlated with the clinical symptoms and underlying disease to establish the selection criteria of patients for virologic study. METHODS: Two thousand six hundred nineteen patients suspected of having viral infection, fundamentally by CMV were studied over 6 years by 4,394 blood samples. Of these patients 1,646 were immunosuppressed, 824 were considered immunocompetent and this data was unknown in 149 patients. The leukocytes were separated using standardized techniques being seeded in cell cultures (human embryo lung fibroblasts). RESULTS: Three hundred forty-seven specimens corresponding to 242 patients were positive with isolation of the following pathogens: 327 strains of CMV, 4 enterovirus, 2 adenovirus, 1 herpes simplex virus, 1 varicella-zoster, another 5 unidentified cytopathic agents, 6 strains of toxoplasma and 1 Cryptococcus. With regard to the base disease, 302 positive samples to CMV pertained to 204 immunosuppressed patients: 103 (13.6% positives among the cases studied) AIDS or AIDS-related complex, 54 (21.3%) kidney transplant patients, 31 (24.8%) liver transplant patients, 2 (1.5%) lung transplant patients, and 2 (1.5%) bone marrow transplant patients. A non CMV microorganism was isolated in 13 samples from 12 immunosuppressed patients. Only 24 (2.5% of those studied) immunocompetent or with unknown immunity status had viremia by CMV, being detected in 25 samples. Non CMV cytopathic agents were isolated in another 7 samples from 6 patients. CONCLUSIONS: Analysis of blood cultures allows the isolation of cytomegalovirus and occasionally other unsuspected agents such as toxoplasma. This investigation is indicated in immunosuppressed patients but not in immunocompetent patients who present a febrile syndrome with no clinical suspicion of cytomegalovirus infection.