Epidemiological, clinical, diagnostic and economic features of an immigrant population of chronic schistosomiasis sufferers with long-term residence in a non-endemic country (North Metropolitan area of Barcelona, 2002-2016).

BACKGROUND: Schistosomiasis, one of the neglected tropical diseases (NTD) listed by the WHO, is an acute and chronic parasitic disease caused by blood flukes (trematode worms) of the genus Schistosoma. Complications of long-term infestation include liver cirrhosis, bladder tumors and kidney failure. The objective of this study was to carry out a clinical and epidemiological characterization of a schistosomiasis-diagnosed immigrant population with long-term residencein the EU as well as to evaluate the diagnostic methods available to date. METHODS AND RESULTS: A total of 61 individuals with Schistosoma infection who received medical attention between June 2002 and June 2016 at the North Metropolitan International Health Unit in Barcelona (Catalonia, Spain), were included in the study. All patients were sub-Saharan African immigrants. The majority were male (91.8%) with a median age of 34 years. Symptoms attributable to infection such as haematuria, abdominal pain and dysuria were recorded in up to 90% of patients. The percentage of eosinophils decreased amongst older patients (p = 0.002) and those with symptoms associated with urinary tract infections (p = 0.017). Serology was used for diagnosis in 80.3% of the cases, with microscopic examination showing the remaining 9.8% positive for parasite eggs. Direct microbiological diagnosis was more useful in patients with less than 5 years of residence in the EU (p = 0.05). Chronic complications were present in 22 (36%) of the patients, with renal failure affecting 20 (33%). Of these 20, 6(10%) developed terminal renal failure and required hemodialysis, while 3 (5%) received a renal transplantation. CONCLUSION: Morbidity associated with chronic long-term schistosomiasis is frequent among African immigrants in non-endemic countries. Better diagnostic tools and appropriate early treatment would prevent the development of visceral damage. Thorough screening in selected patients would also be useful to avoid chronic complications.

Risk of Active Tuberculosis among Index Case of Householders-A Long-Term Assessment after the Conventional Contacts Study.

OBJECTIVES: The aim of this study was to determine the incidence of active tuberculosis (TB) among household contacts of TB-index cases diagnosed during a 7-year period in a public Primary Care Center located in a high-incidence area. DESIGN AND SAMPLE: A retrospective cohort study was performed. Data collection was based on the capture-recapture method; the two main sources crossed information from TB-index and contact cases from the El Fondo Primary Care Center (Santa Coloma de Gramenet, Spain) and their reports to the National Epidemiologic Surveillance Service. MEASURES: Variables were divided into demographic and health data (result of the Mantoux test, chest X-ray, presence of risk factors, and indication for chemoprophylaxis). RESULTS: Community nurses identified 103 household contacts that underwent the conventional contact study. Overall, 60.19% were male; the mean age was 29.08 years. Only one case of secondary active TB was found, representing an incidence of 0.56% per TB-index case and year. CONCLUSION: The incidence of new secondary TB among household contacts with TB-index cases was of a case. Nevertheless, a long-term follow-up of these householders beyond the conventional contacts study should be considered in areas with higher incidences of TB or among specific high-risk populations.

Strongyloides stercoralis, the hidden worm. Epidemiological and clinical characteristics of 70 cases diagnosed in the North Metropolitan Area of Barcelona, Spain, 2003-2012.

BACKGROUND: The nematode Strongyloides stercoralis has a very particular autoinfection life-cycle which leads to chronic infections remaining undetected for decades. However, hyperinfection can occur in patients receiving immunotherapy resulting in high mortality rates. The main objective of this study was to assess the results of a 10-year multicenter surveillance program performed in an area with dense immigration in Barcelona, Spain. METHODS: From January 2003 to December 2012, all individuals with Strongyloides stercoralis infection attending the four centers with diagnostic capability in the North Metropolitan area of Barcelona were recorded. RESULTS: The annual detection rate was 0.2 new diagnosed cases x10 000 inhabitants/year and 1 case x10 000 immigrants/year. Many patients were immigrants (63; 90.0%), asymptomatic (45; 64.3%) and with a high eosinophil count (63; 90.0%). Immunosuppression was present in 11 (15.7%) patients, among whom two (2.8%) cases of disseminated hyperinfection were recorded. Ivermectin was prescribed in 45 (76.3%) and albendazole in 14 (23.7%). Following treatment seven patients (11.9%) receiving albendazole presented relapse, that is, albendazole failed to clear the parasite in 50% of these drug-treated patients (p < 0.001). CONCLUSIONS: During the study period, 90% of the cases of Strongyloides stercoralis diagnosed could be considered as imported by immigrants, most being asymptomatic and with eosinophilia. The infection is probably largely underestimated and population-based studies are needed to determine its true prevalence. Meanwhile, diagnosis must be based on active investigation of the helminth (serology and feces culture), especially in immunocompromised patients. The implementation of pre-immunosuppression protocols with the aim of identifying Strongyloides stercoralis is encouraged with empirical treatment with ivermectin being recommended in sites without diagnostic facilities.

Caracterización epidemiológica y factores de riesgo asociados a la peregrinación religiosa a Arabia Saudí. Resultados de una cohorte prospectiva 2008-2009 / Epidemiology and risk factors associated with religious pilgrimage to Saudi Arabia. Results of a prospective cohort 2008-2009

Introducción La peregrinación religiosa a Arabia Saudí o Hajj es un precepto básico en la doctrina islámica. Anualmente millones de peregrinos (un 5% procedente de la Unión Europea) se concentran en La Meca después del Ramadán, con los riesgos sanitarios que eso conlleva. Métodos Estudio observacional y prospectivo de una cohorte de peregrinos atendidos en visita de actividades preventivas predesplazamiento en la Unidad de Salud Internacional Metropolitana Norte (Santa Coloma de Gramenet, Barcelona, España) durante 2009-2010.ResultadosSe valoraron 193 peregrinos (135 hombres, 69,9%), con una edad media (DE) de 37,1 (16,9) años. Eran inmigrantes 176 (91,2%), originarios de Pakistán (54,9%), Marruecos (29%), Bangladesh (4,1%) y otros (7,2%). Se desplazaban a Arabia Saudí por una media (DE) de 16,3 (9,2) días; optaban por la peregrinación larga (Hajj) 80 (41,5%) y por la corta (Umra) 113 (58,5%). Presentaban antecedentes patológicos 29 (15%). Se obtuvo una cobertura vacunal superior al 75% para tétanos-difteria, antineumocócica y antimeningocócica tetravalente, y sólo de un 70,4% para la antigripal. Presentaron algún problema de salud 41 (13,5%), el 61% de ellos síntomas de vías respiratorias. Los factores de riesgo independientemente relacionados con presentar enfermedades fueron los días de estancia (odds ratio [OR]=1,06; intervalo de confianza del 95% [IC95%]: 1,01-1,11) y realizar el Hajj frente a la Umra (OR=1,08; IC95%: 1,07-1,12).Conclusiones Los peregrinos a Arabia Saudí procedentes de España son un colectivo fundamentalmente joven y sano. Presentaron un mayor número de enfermedades aquellos con estancias más largas (AU)

Introduction Religious pilgrimage to Saudi Arabia, or Hajj, is a basic tenet of the Islamic doctrine and, after Ramadan, annually represents the largest human concentration (with up to 5% of from the EU) around the world. Such a gathering entails health risks. Methods A prospective observational study was conducted of a cohort of pilgrims attended for pre-travel preventive activities in the North Metropolitan International Health Unit (Santa Coloma de Gramenet, Barcelona, Spain) from 2009-2010.ResultsA total of 193 pilgrims were assessed and 135 (69.9%) were men. Their mean age (SD) was 37.1 (16.9) years. Among the pilgrims, 176 (91.2%) were immigrants, mainly from Pakistan (54.9%), Morocco (29%), Bangladesh (4.1%) or other countries (7.2%). The pilgrims stayed in Saudi Arabia a mean (SD) of 16.3 (9.2) days. Eighty (41.5%) opted for the 1 month-long pilgrimage (Hajj) and 113 (58.5%) for the shorter Umra. One or more pathological antecedent was recorded in 29 (15%). Vaccination coverage was >75% for tetanus-diphtheria, pneumococcal and quadrivalent meningitis but was only 70.4% for influenza. After returning, 41 (13.5%) pilgrims reported some health problem; of these, 61% were respiratory tract symptoms. The risk factors independently correlated with the presence of diseases was the number of days in Saudi Arabia (OR=1.06; 95% CI: 1.01-1.11) and taking part in the Hajj compared with the Umra (OR=1.08; 95% CI: 1.07-1.12).Conclusions Religious pilgrims from Spain to Saudi Arabia are mainly young and healthy. Those with longer stays abroad contracted a higher number of diseases (AU)

[Epidemiology and risk factors associated with religious pilgrimage to Saudi Arabia. Results of a prospective cohort 2008-2009]. / Caracterización epidemiológica y factores de riesgo asociados a la peregrinación religiosa a Arabia Saudí. Resultados de una cohorte prospectiva 2008-2009.

INTRODUCTION: Religious pilgrimage to Saudi Arabia, or Hajj, is a basic tenet of the Islamic doctrine and, after Ramadan, annually represents the largest human concentration (with up to 5% of from the EU) around the world. Such a gathering entails health risks. METHODS: A prospective observational study was conducted of a cohort of pilgrims attended for pre-travel preventive activities in the North Metropolitan International Health Unit (Santa Coloma de Gramenet, Barcelona, Spain) from 2009-2010. RESULTS: A total of 193 pilgrims were assessed and 135 (69.9%) were men. Their mean age (SD) was 37.1 (16.9) years. Among the pilgrims, 176 (91.2%) were immigrants, mainly from Pakistan (54.9%), Morocco (29%), Bangladesh (4.1%) or other countries (7.2%). The pilgrims stayed in Saudi Arabia a mean (SD) of 16.3 (9.2) days. Eighty (41.5%) opted for the 1 month-long pilgrimage (Hajj) and 113 (58.5%) for the shorter Umra. One or more pathological antecedent was recorded in 29 (15%). Vaccination coverage was >75% for tetanus-diphtheria, pneumococcal and quadrivalent meningitis but was only 70.4% for influenza. After returning, 41 (13.5%) pilgrims reported some health problem; of these, 61% were respiratory tract symptoms. The risk factors independently correlated with the presence of diseases was the number of days in Saudi Arabia (OR=1.06; 95% CI: 1.01-1.11) and taking part in the Hajj compared with the Umra (OR=1.08; 95% CI: 1.07-1.12). CONCLUSIONS: Religious pilgrims from Spain to Saudi Arabia are mainly young and healthy. Those with longer stays abroad contracted a higher number of diseases.

Epidemiologic and biogeographic analysis of 542 VFR traveling children in Catalonia (Spain). A rising new population with specific needs.

BACKGROUND: Imported diseases recorded in the European Union (EU) increasingly involve traveling immigrants returning from visits to their relatives and friends (VFR). Children of these immigrant families can represent a population of extreme vulnerability. METHODS: A randomized cross-sectional study of 698 traveling children under the age of 15 was performed. VFR traveling children and non-VFR (or tourist) children groups were compared. RESULTS: A total of 698 individuals were analyzed: 354 males (50.7%) and 344 females (49.3%), with a median age (interquartile range) of 4 (2-9) years. Of these, 578 (82.8%) had been born in the EU with 542 (77.7%) being considered as VFR, whereas 156 (22.3%) were considered tourists. VFR children were younger (4.7 vs 8.2 yr; p < 0.001), they had more frequently been born in the EU (62.8% vs 20.1%; p < 0.01) and were more frequently lodged in private homes (76.6% vs 3.2%: p < 0.001) and rural areas (23.2% vs 1.6%; p < 0.001). Furthermore, VFR remained abroad longer (51.6 vs 16.6 d; p < 0.001), the visit/travel time interval was shorter (21.8 vs 32.2 d; p < 0.001) than tourists, and consultation was within 10 days prior to the departure (26.4% vs 2.7%; p < 0.001). The risk factor most differentiating VFR children from tourists was accommodation in a rural setting [odds ratio(OR) = 5.26;95%CI = 2.704-10.262;p < 0.001]. CONCLUSIONS: VFR traveling children showed a greater risk of exposure to infectious diseases compared with tourists. Immigrant families may represent a target group to prioritize international preventive activities.

Recomendaciones de vacunación contra la fiebre amarilla en viajeros con destino a África Oriental. Consenso de las unidades de vacunación internacional, Catalunya, 2009 / No disponible

Desde 2005, los países de África Oriental ya no exigen a los viajeros procedentes de la Unión Europea la certificación internacional de vacunación contra la fiebre amarilla. Ello es debido a la ausencia de casos de enfermedad en el área desde 2003.No obstante, se pueden esgrimir muchos argumentos a favor y en contra de su recomendación según se primen riesgos individuales de efectos secundarios de la vacuna o riesgos de salud pública debidos a no vacunar. En conjunto, el riesgo de enfermedad actualmente permanece muy bajo aunque su potencialidad epidémica es desconocida. En las poblaciones de mayor riesgo de efectos secundarios vacunales, especialmente viajeros de > 60 años, parece razonable una indicación cuidadosa e individualizable (AU)

Since 2005 the countries of Eastern Africa no longer demand to travellers coming from the European Union an international certification of vaccination against yellow fever. This fact is mainly due to the absence of recorded yellow fever cases in the area since 2003. However, many arguments pro and against its recommendation can be used according to prioritize individual risks of secondary vaccine effects or public health hazards due not to vaccinate. Altogether, the disease risk at the moment remains very low although its epidemic potentiality is not known. Among greater risk of vaccine side-effects populations, especially travellers of > 60 years, a careful and personal indication could be considered as the most reasonable attitude (AU)