ABSTRACT
Effective medicines exist to treat or alleviate many diseases which predominate in the developing world and cause high mortality and morbidity rates. Price should not be an obstacle preventing access to these medicines. Increasingly, drug donations have been established by drug companies, but these are often limited in time, place or use. Measures exist which are more sustainable and will have a greater positive impact on people's health. Principally, these are encouraging generic competition; adopting into national legislation and implementing TRIPS safeguards to gain access to cheaper sources of drugs; differential pricing; creating high volume or high demand through global and regional procurement; and supporting the production of quality generic drugs by developing countries through voluntary licenses if needed, and facilitating technology transfer.
Subject(s)
Drug Costs/trends , HIV Infections/economics , Leishmaniasis/economics , Meningitis, Cryptococcal/economics , Trachoma/economics , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Anti-HIV Agents/economics , Anti-HIV Agents/therapeutic use , Antiprotozoal Agents/economics , Antiprotozoal Agents/therapeutic use , Drug Industry , Drugs, Generic/economics , Global Health , HIV Infections/drug therapy , Health Services Accessibility/economics , Humans , Leishmaniasis/drug therapy , Meningitis, Cryptococcal/drug therapy , Trachoma/drug therapyABSTRACT
BACKGROUND: The number of Spanish travelers visiting malaria endemic areas, and the number of immigrants from malarial countries arriving in Spain are continuously increasing. However, little information about imported cases in Spain is available. METHODS: A prospective clinicoepidemiological study of imported cases of malaria diagnosed at a referral teaching hospital in Madrid, Spain. RESULTS: Of the 160 patients, sixty (37.5%) were immigrants and 100 (62.5%) Spanish nationals. Malaria was acquired in Africa by 98.3% of immigrants and in 83.0% of travelers. Falciparum malaria accounted for 71.8% of the cases, P. vivax for 11.9%, P. ovale for 10.6% and P. malarie for 5. 0%. Eleven (6.9%) patients, all immigrants, were asymptomatic. Severe complications were recorded in 17 (10.6%): 7, severe anemia; 3, cerebral malaria; 2, renal failure; 1, spontaneous splenic rupture; 1, acute pulmonary edema; 1, sepsis; 1, acute cerebrovascular accident; and 1, disseminated intravascular coagulation. There were no fatal cases. Among the 100 Spanish nationals, 44% did not follow any prophylaxis, 29% followed a correct prophylaxis, 27% were considered defaulters, and 39% took self-treatment without cure. CONCLUSIONS: There is a changing pattern of imported malaria in Madrid, with one third occurring in immigrants and two thirds in nationals. This data provides information about the reemergence of imported malaria to Europe.
Subject(s)
Emigration and Immigration , Malaria/epidemiology , Travel , Adolescent , Adult , Africa/ethnology , Aged , Female , Humans , Incidence , Malaria/drug therapy , Malaria/prevention & control , Male , Middle Aged , Prospective Studies , Spain/epidemiologyABSTRACT
Dengue is seldom recognized as an imported disease in Europe. A prospective clinical study was carried out in 37 travelers suspected to have dengue infection on their return from dengue-endemic areas. Anti-dengue antibodies were found in 24 of 37 patients (14 recent infections and 10 undetermined). The most common features among the recent infections were fever (100%), thrombocytopenia (61.5%), abnormal liver function tests (61.5%), and rash (53.8%). In one case, denguehemorrhagic fever grade III was confirmed and later followed by depression and suicide of the patient. The possibility of local transmission of dengue in Spain is discussed.
