Intervención comunitaria con población magrebí en Crevillent (Alicante): prevención de hepatitis A en migrantes viajeros / Community-based intervention with a Maghreb population in Crevillent (Alicante): hepatitis A prevention in immigrant travellers

Objetivos: En este artículo describimos una iniciativa surgida desde salud pública para prevenir casos de hepatitis A en población magrebí de Crevillent que fuese a viajar a su país próximamente. El objetivo principal fue contribuir a reducir la incidencia de casos importados de hepatitis A en migrantes viajeros magrebíes.Metodología. Iniciativa implementada en dos ámbitos: sanitario (envío de circular a centros de Atención Primaria con recomendaciones desde salud pública para identificar y vacunar de hepatitis A a migrantes viajeros no inmunes); comunitario (charlas grupales adaptadas a la población diana).Resultados. La intervención comunitaria (94 participantes) tuvo muy buena acogida y se involucraron tanto líderes comunitarios como mediadores interculturales. El número de primeras dosis de vacuna pediátrica de hepatitis A administradas el mes siguiente a la intervención fue muy superior al del mes previo.Conclusión. La intervención interdisciplinar aquí presentada mostró eficacia tanto a nivel sanitario como a nivel comunitario. (AU)

Objectives: In this article we report a public health initiative to prevent cases of hepatitis A in the Maghrebi population of Crevillent who were going to travel to their country in the near future. The main aim was to contribute to reduce the incidence of hepatitis A imported cases among Maghrebi immigrant travellers.Methods. The initiative was implemented in two areas: healthcare (by sending a circular to primary care centres with public health recommendations to identify and vaccinate non-immune migrant travellers against hepatitis A); community (informative group talks tailored to the target population).Results. The community intervention (94 participants) was very well received and involved both community leaders and intercultural mediators. The number of initial doses of paediatric hepatitis A vaccine administered in the month following the intervention was much higher than in the previous month.Conclusion. The interdisciplinary intervention presented here revealed efficacy at both healthcare and community levels. (AU)

Prototipo para el control sanitario internacional en el policlínico universitario "Pedro Borrás Astorga" / Prototype for international health control at Pedro Borras Astorga university polyclinic

RESUMEN Introducción: el programa de Control Sanitario Internacional implementado en Cuba permite el control y seguimiento, en todo el país, de las enfermedades endémicas y transmisibles por vectores, procedentes de otros países. Esto se realiza de forma manual, por teléfono y con el intercambio de documentos. Por ello, se decidió elaborar una herramienta informática que satisfaga las necesidades, en el Departamento de Higiene y Epidemiología del Policlínico. Objetivo: desarrollar el prototipo de una aplicación informática para el control sanitario internacional en el Departamento de Higiene y Epidemiología del Policlínico Universitario "Pedro Borrás Astorga". Métodos: la investigación obedece a un proyecto de innovación tecnológica para definir la arquitectura de la información que se gestiona durante el control sanitario internacional. Se ejecutaron las etapas de análisis y diseño de la aplicación, con el empleo de la metodología ágil para el desarrollo de software. Además, se han aplicado métodos teóricos y empíricos como el histórico-lógico, el analítico-sintético, el inductivo-deductivo, las entrevistas y el análisis documental. Resultados: se describen los primeros resultados de la investigación, a partir del estudio de las necesidades y las carencias actuales del personal del Departamento de Higiene y Epidemiología. Se desarrolló la arquitectura de la información que se gestiona para lograr el control sanitario internacional. Conclusiones: el prototipo obtenido, permitirá a los futuros programadores implementar el software necesario para apoyar al personal del departamento en la toma de decisiones, de forma significativa a la reducción de riesgos por graves epidemias, beneficiará a los profesionales con una herramienta informática que puede simplificar su trabajo, tributar a la optimización del tiempo, la gestión y la seguridad de la información.

ABSTRACT Introduction: the International Sanitary Control Program implemented in Cuba allows the control and follow-up, throughout the country, of endemic and vector-borne diseases from other countries. This is manually done, by telephone and with the exchange of documents. Therefore, it was decided to develop a computerized tool to meet the needs of the Department of Hygiene and Epidemiology of the Polyclinic. Objective: to develop the prototype of a computer application for international sanitary control in the Department of Hygiene and Epidemiology at Pedro Borras Astorga University Polyclinic. Methods: the research complies with a technological innovation project to define the architecture of the information managed during the international sanitary control. The stages of analysis and design of the application were carried out using the agile methodology for software development. In addition, theoretical and empirical methods such as historical-logical, analytical-synthetic, inductive-deductive, interviews and documentary analysis were applied. Results: the first results of the research are described, based on the study of the current needs and deficiencies found for the personnel of the Department of Hygiene and Epidemiology. The architecture of the information managed to achieve international sanitary control was developed. Conclusions: the prototype obtained, will allow future programmers to implement the necessary software to support the staff of the department in decision making, significantly reducing risks due to serious epidemics, it will benefit professionals with a computer tool that can simplify their work, contribute to the optimization of time, management and information security.

First importations of SARS-CoV-2 P.1 and P.2 variants from Brazil to Spain and early community transmission.

INTRODUCTION: SARS-CoV-2variants of concern (VOC) have been described in the UK (B.1.1.7), South Africa (B.1.351) and Brazil (P.1). Among them, the most scarce information has been obtained from the P.1 variant and more data on its global presence and about its spreading dynamics are needed. METHODS: Whole genome sequencing was performed prospectively on travellers arriving from Brazil and on a random selection of SARS-CoV-2 positive cases from our population. RESULTS: In this study we report the first SARS-CoV-2 P.1 and P.2 variants exported from Brazil to Spain. The case infected with the P.1 variant, who had only stayed in Rio de Janeiro, required hospitalisation. The two P.2 cases remained asymptomatic. A wider distribution for P.1 variant beyond the Brazilian Amazonia should be considered. The exportation of the P.2 variant, carrying the E484K mutation, deserves attention. One month after the first description of P.1 and P.2 importations from Brazil to Madrid, these variants were identified circulating in the community, in cases without a travel history, and involved in household transmissions CONCLUSION: Whole genome sequencing of SARS-CoV-2 positive travellers arriving from Brazil allowed us to identify the first importations of P.1 and P.2 variants to Spain and their early community transmission.

First importations of SARS-CoV-2 P.1 and P.2 variants from Brazil to Spain and early community transmission / Primeras importaciones de las variantes SARS-CoV-2 P.1 y P.2 de Brasil a Madrid y transmisión comunitaria

Introduction: SARS-CoV-2variants of concern (VOC) have been described in the UK (B.1.1.7), South Africa (B.1.351) and Brazil (P.1). Among them, the most scarce information has been obtained from the P.1 variant and more data on its global presence and about its spreading dynamics are needed.Methods: Whole genome sequencing was performed prospectively on travellers arriving from Brazil and on a random selection of SARS-CoV-2 positive cases from our population.Results: In this study we report the first SARS-CoV-2 P.1 and P.2 variants exported from Brazil to Spain. The case infected with the P.1 variant, who had only stayed in Rio de Janeiro, required hospitalisation. The two P.2 cases remained asymptomatic. A wider distribution for P.1 variant beyond the Brazilian Amazonia should be considered. The exportation of the P.2 variant, carrying the E484K mutation, deserves attention. One month after the first description of P.1 and P.2 importations from Brazil to Madrid, these variants were identified circulating in the community, in cases without a travel history, and involved in household transmissionsConclusion: Whole genome sequencing of SARS-CoV-2 positive travellers arriving from Brazil allowed us to identify the first importations of P.1 and P.2 variants to Spain and their early community transmission.

Introducción: Se han descrito «variantes de preocupación» (VOC) de SARS-CoV-2 en el Reino Unido (B.1.1.7), Sudáfrica (B.1.351) y Brasil (P.1). Entre ellas, se dispone de información más escasa para la variante P.1 y se necesitan más datos sobre su presencia global y sobre su dinámica de expansión.Métodos: Se realizó secuenciación del genoma completo de forma prospectiva de SARS-CoV-2 en viajeros procedentes de Brasil y en una selección aleatoria de casos positivos de SARS-CoV-2 de nuestra población.Resultados: En este estudio reportamos las primeras variantes de SARS-CoV-2 P.1 y P.2 exportadas desde Brasil a España. El caso infectado por la variante P.1, que solo había permanecido en Río de Janeiro, requirió hospitalización. Los 2 casos de la variante P.2 permanecieron asintomáticos. Se debe considerar una distribución más amplia para la variante P.1 más allá de la Amazonía brasileña. La exportación de la variante P.2, que porta la mutación E484K, merece asimismo atención adicional. Un mes después de la primera descripción de las importaciones de P.1 y P.2 de Brasil a Madrid, se identificaron estas variantes circulando en la comunidad, en casos sin antecedentes de viaje, e implicadas en transmisiones domiciliarias.Conclusión: La secuenciación de genoma completo de viajeros positivos para SARS-CoV-2 procedentes de Brasil nos permitió identificar las primeras importaciones de variantes P.1 y P.2 a España y su transmisión comunitaria precoz.

Una propuesta desde el centro de Cuba sobre la cuarentena turística en la nueva normalidad / A proposal from the center of Cuba on the tourist quarantine in the New Normality Phase

RESUMEN Una vez emitidas las alertas tempranas sobre la COVID-19, Cuba comenzó a revisar todos los protocolos de actuación en frontera y las tareas del Control Sanitario Internacional que estarían contenidas en el Plan para el control y la prevención del nuevo coronavirus; se reforzaron las tres líneas de vigilancia epidemiológica, el plan con nuevas medidas y los protocolos de actuación. Se establecieron los Protocolos de Control Sanitario Internacional en la atención primaria de salud y en las instalaciones turísticas. Implementar la cuarentena con características turísticas para los viajeros que arriben a Cuba, en Fase Epidémica, de Recuperación o en Fase de Nueva Normalidad, en hoteles o instalaciones destinadas al turismo de salud, es una propuesta organizativa que fortalece el Programa Nacional de Control Sanitario Internacional para la prevención del SARS-COV-2. Estas acciones contribuirán a controlar la pandemia, evitar los rebrotes, y mantener el turismo con ingresos a la economía nacional.

ABSTRACT Once the early warnings on COVID-19 were issued, Cuba began to review all action protocols at the border and International Sanitary Control tasks that would be contained in the Plan for the control and prevention of the new coronavirus; three lines of epidemiological surveillance, the plan with new measures and the action protocols were reinforced. International Health Control Protocols were established in primary health care and in tourist facilities. Implementing the quarantine with tourist characteristics for travelers arriving in Cuba, in the Epidemic, Recovery or New Normality Phase, in hotels or facilities for health tourism, is an organizational proposal that strengthens the National Program for International Sanitary Control to prevent SARS-COV-2. These actions will help to control the pandemic, prevent outbreaks, and maintain tourism with incomes to the national economy.

Entrada de viajeros y densidad poblacional en la propagación de la COVID-19 en Cuba / Arrival of travelers and population density in the spread of COVID-19 in Cuba

Introducción: El comportamiento no homogéneo de la cantidad de casos confirmados con COVID-19 en diferentes regiones de Cuba aún no se ha esclarecido, lo cual resultaría de utilidad para la toma de decisiones en futuras epidemias en el país. Objetivo: Determinar la influencia de la entrada de viajeros y la densidad poblacional sobre la distribución no homogénea de la cantidad de casos con COVID-19 por provincias en Cuba. Métodos: Se desarrolló un estudio ecológico, exploratorio, de grupos múltiples, comparando las provincias cubanas según variables del nivel global y agregado, relacionadas con la cantidad de casos con COVID-19, confirmados durante la epidemia en Cuba. Se aplicó el análisis de regresión lineal múltiple para seleccionar el modelo que mejor describe el comportamiento de los datos y el análisis de clúster para visualizar la agrupación de las provincias. Resultados: Se evidenció una correlación significativa entre la cantidad de casos con COVID-19 y la cantidad de viajeros con COVID-19, la cantidad total de viajeros que arribaron al país en marzo y los eventos de trasmisión. En el modelo de regresión resultaron significativas la densidad poblacional y las cantidades de viajeros total y con COVID-19. El análisis de clúster reveló la formación de cuatro grupos de provincias. Conclusiones: La cantidad de casos con COVID-19 por provincia se relaciona con la cantidad de viajeros que entraron al país, con y sin COVID-19, y la densidad poblacional. Se forman cuatro grupos de provincias por su similitud en los aspectos identificados en la regresión(AU)

Introduction: The non-homogeneous behavior of the number of COVID-19 confirmed cases in different regions of Cuba has not yet been clarified, which would be useful for decision-making in future epidemics in the country. Objective: To determine the influence of the arrival of travelers and the population density on the non-homogeneous distribution of the number of COVID-19 cases by provinces in Cuba. Methods: An ecological, exploratory, multiple group study was carried out, comparing Cuban provinces according to variables of the global and aggregate levels, related to the number of COVID-19 cases, confirmed during the epidemic in Cuba. Multiple linear regression analysis was applied to select the model that best describes the behavior of the data and cluster analysis to visualize the grouping of the provinces. Results: A significant correlation was proved between the number of COVID-19 cases and the number of travelers with COVID-19, the total number of travelers who arrived in Cuba in March, and transmission events. In the regression model, the population density and the total number of travelers and those with COVID-19 were significant. The cluster analysis revealed the formation of four groups of provinces. Conclusions: The number of cases with COVID-19 by province is related to the number of travelers who arrived in the country, with and with no COVID-19, and the population density. Four groups of provinces are formed by their similarity in the aspects identified at regression(AU)

A new emerging zoonotic virus of concern: the 2019 novel Coronavirus (SARS CoV-2) / Un nuevo virus zoonótico emergente de preocupación: el Coronavirus novel 2019

We review here the origin, outbreak characteristics and main epidemiological features of the novel Coronavirus (2019nCoV) responsible of a new coronavirus disease (COVID-19). Rapid global health authorities' responses are now in course and international scientific collaboration is urgently need. Previous outbreaks experiences with similar viral agents have increased the capacity to containment and control of these recurrent health menaces.

Revisamos aquí el origen, características del brote y la epidemiología del nuevo Coronavirus (2019nCoV) responsable de una nueva enfermedad por coronavirus (COVID-19). Una rápida respuesta de las autoridades de salud mundiales está en marcha y se ha hecho un llamado urgente para colaboración científica internacional. Las lecciones aprendidas de brotes previos con agentes virales similares han aumentado las capacidades para contener y controlar estas amenazas recurrentes a la salud global.

Vulvitis migratoria causada por gnatostomiasis importada / Migratory vulvitis caused by imported gnathostomiasis

Resumen La gnatostomiasis es una parasitosis emergente en países no endémicos. Este nematodo zoonótico requiere de agua dulce para su ciclo de vida, donde sus larvas se enquistan principalmente en peces. La migración subcutánea de las larvas produce habitualmente una paniculitis eosinofílica de rápido avance. Se describe un caso clínico de un paciente con una lesión migratoria, sin mejoría clínica con terapia antibacteriana. La búsqueda de factores de riesgo, sumado a la evolución y a los hallazgos de laboratorio hizo sospechar el diagnóstico. La gnatostomiasis debe ser sospechado en pacientes con lesiones de piel migratorias, que han consumido pescado crudo durante viajes a países endémicos en Sudamérica o Asia.

Gnathostomiasis is an emerging disease in non-endemic countries. This zoonotic nematode requires aquatic freshwater environments to complete its life cycle where larvae get encrusted in fishes. Typically, the infection manifests as migratory subcutaneous lesion caused by the larvae trak, which produces an eosinophilic panniculitis. Here we describe a patient who presented a migratory lesion with no response to antimicrobial therapy, a careful travel and food history together with specific laboratory tests led to the correct diagnosis. Gnathostomiasis should be suspected in patients with migratory skin lesions who have consumed raw freshwater fish during travel to endemic countries in South America or Asia.

Is Plague Globally Reemerging?: [Editorial] / ¿Está la Peste reemergiendo globalmente?: [Editorial]

Emerging and reemerging diseases are cause of concern for the World Health Organization (WHO). On February 2018, WHO releases its list of priority pathogens that have the potential to cause a public health emergency, given that for them there is no, or is insufficient, countermeasures, such as drugs and vaccines that help control outbreaks. Plague was discussed and considered for inclusion in the priority list, given the fact that poses major public health problem and further research and development is needed through existing major disease control initiatives, extensive R&D pipelines, existing funding streams, or established regulatory pathways for improved interventions. Experts recognized the need for improved diagnostics and vaccines for pneumonic plague.

Las enfermedades emergentes y reemergentes son motivo de preocupación para la Organización Mundial de la Salud (OMS). En febrero de 2018, la OMS publica su lista de patógenos prioritarios que tienen el potencial de causar una emergencia de salud pública, dado que para ellos no existen, o son insuficientes, las contramedidas, como los medicamentos y las vacunas que ayudan a controlar los brotes. Se debatió y consideró la posibilidad de incluir la peste en la lista de prioridades, dado que plantea un importante problema de salud pública y es necesario seguir investigando y desarrollando a través de las principales iniciativas de control de enfermedades existentes, los amplios canales de I+D, las vías de financiación existentes o las vías de regulación establecidas para mejorar las intervenciones. Los expertos reconocieron la necesidad de mejorar los diagnósticos y las vacunas para la peste neumónica.

Yellow Fever: still of concern for travelers of Colombia?: [Editorial] / Fiebre Amarilla: ¿aún una preocupación para viajeros de Colombia?: [Editorial]

During the last years, the world has witnessed significant yellow fever (YF) epidemics. The one that occurred in Africa, particularly in Angola, during 2016, is a clear example of that. This outbreak included not only locally-transmitted cases in this country, but also 11 imported cases, unprecedently in Asia, specifically in China. By the way, between Angola and Brazil, there is an increasing number of international travelers arriving to Latin America proceeding from Africa.

En los últimos años, el mundo ha sido testigo de importantes epidemias de fiebre amarilla. La ocurrida en África, particularmente en Angola, durante 2016, es un claro ejemplo de ello. Este brote incluyó no solo casos transmitidos localmente en este país, sino también 11 casos importados, sin precedentes en Asia, concretamente en China. Por cierto, entre Angola y Brasil, hay un número creciente de viajeros internacionales que llegan a América Latina procedentes de África.

Paludismo por Plasmodium falciparum. Presentación de un caso importado / Malaria due to Plasmodium falciparum. Presentation of an imported case

El paludismo o malaria es la enfermedad infecciosa tropical más frecuente del mundo y en dependencia del subtipo del Plasmodium se puede definir su distribución geográfica. La cantidad de casos reportados en los últimos años ha aumentado debido al incremento en el número de viajeros a zonas endémicas, falta de profilaxis adecuada y la prevalencia cada vez mayor de parásitos resistentes a los fármacos empleados para su tratamiento. Por tales razones se presenta el caso de un paciente con un síndrome febril agudo y antecedente epidemiológico de regresar de Angola, país donde la malaria se considera endémica, en el cual fue diagnosticado paludismo por Plasmodium falciparum. Resulta muy importante el control del paludismo importado, por el riesgo que este representa para las áreas receptivas que, como Cuba, han eliminado la enfermedad.

Malaria is the most frequent tropical infectious disease in the world and depending on the Plasmodium subtype it may be defined its geographical distribution. The number of imported cases in the last years has increased due to the augmentation of the number of travelers from endemic zones, lack of adequate prophylaxis an the prevalence of each time higher of parasites resistant to the drugs used for their treatment. For these reasons a case of acute febrile syndrome is presented and antecedent of having arrived from Angola, country where Malaria is considered endemic and he was diagnosed malaria produced by Plasmodium falciparum. The control of imported malaria is really necessary for the risk it represents on the receptive areas which, as in Cuba, have eliminated the disease.

Executive summary of imported infectious diseases after returning from foreign travel: Consensus document of the Spanish Society for Infectious Diseases and Clinical Microbiology (SEIMC).

In a global world, knowledge of imported infectious diseases is essential in daily practice, both for the microbiologist-parasitologist and the clinician who diagnoses and treats infectious diseases in returned travelers. Tropical and subtropical countries where there is a greater risk of contracting an infectious disease are among the most frequently visited tourist destinations. The SEIMC considers it appropriate to produce a consensus document that will be useful to primary care physicians as well as specialists in internal medicine, infectious diseases and tropical medicine who help treat travelers returning from tropical and sub-tropical areas with infections. Preventive aspects of infectious diseases and infections imported by immigrants are explicitly excluded here, since they have been dealt with in other SEIMC documents. Various types of professionals (clinicians, microbiologists, and parasitologists) have helped produce this consensus document by evaluating the available evidence-based data in order to propose a series of key facts about individual aspects of the topic. The first section of the document is a summary of some of the general aspects concerning the general assessment of travelers who return home with potential infections. The main second section contains the key facts (causative agents, diagnostic procedures and therapeutic measures) associated with the major infectious syndromes affecting returned travelers [gastrointestinal syndrome (acute or persistent diarrhea); febrile syndrome with no obvious source of infection; localized cutaneous lesions; and respiratory infections]. Finally, the characteristics of special traveler subtypes, such as pregnant women and immunocompromised travelers, are described.

Zika Virus: Cutaneous Manifestations in 3 Patients. / Virus Zika: manifestaciones cutáneas en 3 pacientes.

Zika virus infection should be suspected in travelers or immigrants with the signs or symptoms of a viral infection (rash, fever, joint pains, conjunctivitis, headache, etc.) and a compatible epidemiological history. Although cutaneous manifestations are among the most common clinical signs of Zika, they are not specific and very few images are available. We present 3 patients (2 travelers and 1 immigrant) in whom a rash was the presenting manifestation of Zika virus infection. Prompt diagnosis optimizes outcomes in these patients, improves the management of severe disease, and minimizes the risk of local transmission by Aedes albopictus, now a potential local vector for the virus due to its presence in areas along Spain's Mediterranean coast.

The occupational stress in International Business Travellers of a multinational of the automotive sector / O stress ocupacional em Viajantes de Negócios Internacionais de uma multinacional do setor automóvel / El estrés ocupacional en Viajeros de Negocios Internacionales en una multinacional del sector automotriz

International business travelers constitute an emerging type of international mobility, and there is a gap in terms of studies that address well-being. Based on the Holistic Model of Stress, we intend to explore the occupational stress associated with business travel through a qualitative case study using document analysis and semi-structured interviews. We verified a predominance of distress sources in the trip stage and the adoption of coping strategies focused on the problem. Personal and professional factors are assumed to be the main moderators of the stress experienced. We conclude that travel brings mostly negative personal consequences that are accentuated during the traveler's career, and confirm that the trips are a source of stress with impact on the personal and professional life of the traveler. The paper includes a discussion on the theoretical and practical implications of the findings for both the company and the travelers.

Os Viajantes de Negócios Internacionais constituem uma modalidade de mobilidade internacional emergente, existindo uma lacuna ao nível de estudos que abordem o seu bem-estar. Com base no Modelo Holístico de Stress pretendemos explorar o stress ocupacional associado às viagens de negócios através de um estudo de caso qualitativo com recurso à análise documental e à entrevista semiestruturada. Foram predominantes as fontes de distress na fase da viagem e da adoção de estratégias de coping focadas no problema. Fatores pessoais e profissionais assumem-se como principais moderadores do stress percecionado. Concluímos que a viagem tem maioritariamente consequências pessoais e negativas que se acentuam ao longo da carreira do viajante e confirmamos que as viagens são uma fonte de stress com impacto na sua vida pessoal e profissional do viajante. O artigo incluí a discussão acerca das implicações teóricas e práticas dos resultados para a organização e para os viajantes.

Los Viajeros de Negocios Internacionales constituyen una modalidad de movilidad internacional emergente, existiendo una laguna en el nivel de estudios que abordan su bienestar. Con base en el Modelo Holístico de Estrés pretendemos explorar el estrés ocupacional asociado a los viajes de negocios a través de un estudio de caso cualitativo, utilizando el análisis documental y la entrevista semiestructurada. Se verificó un predominio de fuentes de distress y la adopción de estrategias de coping enfocadas en el problema. Los factores personales y profesionales se asumen como principales moderadores del estrés percibido. Concluimos que el viaje tiene mayormente consecuencias personales y negativas, que se acentúan al través de la carrera de viajero. Confirmamos así que los viajes son una fuente de estrés con impacto en la vida personal y profesional. El artículo incluye la discusión sobre las implicaciones teóricas y prácticas de los resultados para la organización y para los viajeros.

[Clinical approach to imported eosinophilia]. / Aproximación clínica a la eosinofilia importada.

Eosinophilia is a common finding in international travelers and immigrants, being an helmintic infection its main etiology. The positive predictive value of eosinophilia for an helmintosis is low in travellers. Eosinophilia may be an incidental finding, or symptomatic, and it represents a clinical challenge due to the low sensitivity and specificity of direct and indirect parasitological diagnostic tests, respectively. It requires a structured approach based on geographical areas, environmental exposures and behavioral risks, and associated symptoms. The initial assessment should include a comprehensive and tailored anamnesis and physical examination, basic laboratory tests, a complete parasitological examination of stool samples and a Strongyloides stercoralis serology, supplemented with other explorations guided by epidemiological and clinical suspicion. Empiric treatment with albendazole and/or ivermectin (plus praziquantel if risk of schistosomiasis) is an option for unidentified persistent eosinophilia after study, and in persons in whom a proper assessment or follow-up can not be assured. In patients at risk for estrongiloidosis who are candidates for immunosuppressive therapies, it is indicated a prior screening and treatment to prevent a future hyperinfestation syndrome.

Características asociadas a la consulta pre viaje en turistas que visitan Cusco, Perú / Characteristics associated with pre travel medical consultation in tourists visiting Cuzco, Peru

Background: International tourism is increasing. Preventive Medicine remains important, especially the Pre-Travel Consultation (PTC). Objective: To determinate, the characteristics of tourists associated with PTC in tourists at Cuzco, Peru. Methods: A cross-sectional, analytical study, a secondary analysis of data from a database generated by survey of foreign tourists who visited Cuzco, in the waiting room of the airport was performed. The main variable was to have had a PTC at the tourist's country of residence, the area of residence was categorized according to health/risk of acquiring infectious diseases as traveler's diarrhea during their stay. These and other variables were analyzed and statistical association with generalized linear models were done. Results: Of the 1827 tourists, 875 (48%) were men, with a median age of 33 years (range 18-88 years); 42% had a PTC. In the multivariate analysis, it was found that a PTC lower frequency was associated with male gender (aPR: 0.84; 95% CI: 0.75-0.94), and a higher frequency was associated with have born (aPR: 1.77; 95% CI: 1.39-2.27) and reside in an area of low risk of acquiring infectious diseases (aPR: 1.95; 95% CI: 1.26-3.00), adjusted for the history of a disease. Conclusions: Sex, region of birth and residence of tourists (as risk of acquiring infectious diseases) are associated with having a PTC. These findings may serve the health and government attending tourists who come to our country.

Introducción: El turismo internacional continúa aumentando, siendo la medicina preventiva un pilar importante, como las consultas pre viaje (CPV). Objetivo: Determinar las características del turista asociadas a CPV en turistas que visitan Cusco. Materiales y Métodos: Estudio analítico transversal, de análisis de datos secundarios, a partir de una base de datos generada por encuesta aplicada a turistas extranjeros que visitaron el Cusco, en la sala de espera del aeropuerto. La variable principal fue haber tenido CPV en el país de residencia del turista. La zona de residencia se categorizó según la salubridad/riesgo de los turistas para adquirir enfermedades-infectocontagiosas como la diarrea del viajero durante su estadía. Estas y otras variables fueron analizadas y se obtuvieron estadísticos de asociación con los modelos lineales generalizados. Resultados: De los 1.827 turistas, 875 (48%) fueron hombres, con mediana de edad de 33 años (rango 18-88 años). El 42% tuvo una CPV. En el análisis multivariado, se encontró que estuvo asociado a una menor frecuencia de CPV el sexo masculino (RPa: 0,84; IC 95%: 0,750,94%), y a una mayor frecuencia de CPV el haber nacido (RPa: 1,77; IC 95%: 1,39-2,27) y residir en una zona de bajo riesgo para adquirir enfermedades infecciosas (RPa: 1,95; IC 95%: 1,26-3,00), ajustado por el antecedente de una enfermedad. Discusión: El sexo, la zona de nacimiento y residencia del turista (según riesgo de adquirir enfermedades infecciosas) son factores asociados a tener una CPV. Estos hallazgos pueden servir a las instituciones de salud y gubernamentales que atienden a turistas que vienen a nuestro país.

Characteristics of HIV infected individuals traveling abroad. Results from the +REDIVI Collaborative Network.

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.

[Diagnosis and treatment of imported malaria in Spain: Recommendations from the Malaria Working Group of the Spanish Society of Tropical Medicine and International Health (SEMTSI)]. / Diagnóstico y tratamiento de la malaria importada en España: recomendaciones del Grupo de Trabajo de Malaria de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI).

Malaria is a common parasitic disease diagnosed in the returned traveler. Mortality in travelers with imported malaria is around 2-3%, and one of the main factors associated with poor prognosis is the delay in the diagnosis and treatment. Imported malaria cases usually present with fever, headache and myalgia, but other symptoms may appear. The diagnosis should be performed as soon as possible, using thick smear or rapid diagnostic tests, and a blood smear. Treatment should be initiated urgently. In cases of severe malaria, the use of intravenous artemisinins has proved to be superior to intravenous quinine. This document reviews the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported malaria in Spain.

[Prior health advice to immigrants who travel to visit family and friends]. / Consejo sanitario previo a inmigrantes que viajan para visitar a familiares y amigos.

OBJECTIVE: Immigrants who make or plan journeys to visit their families in their countries of origin (immigrants -visiting friends and relatives, I-VFR) have a higher risk of acquiring travel-associated diseases than other travellers. The main aim of this study is to analyse the knowledge of the immigrant population on the need to receive health advice (HA) before making international journeys in general and in particular before travelling to their country of origin. DESIGN: Observational, multicentre study. SETTING: Ten Family Doctors from 10 Health Centres in Catalonia and Aragon participated PARTICIPANTS: A total of 555 immigrants ≥ 15 years of age, who consulted their Family Doctor and agreed to answer a questionnaire. Opportunity sampling was used. RESULTS: A total of 389 (70.1%) of those surveyed considered it necessary to receive HA before making an international journey, 406 (73.2%) were I-VFR and 145 (35.7%) had requested HA prior to the journey, mostly from their Family Doctor (n=60; 41.1%). Almost two-thirds (261, 65.2%) of the subjects did not seek HA, with the most common reason being that they did not consider it necessary (173, 42.6%). CONCLUSIONS: I-VFR do not usually request HA prior to travelling, basic due to considering it unnecessary. When they do request it, they are very often initially directed to their Family Doctor.

[Travelers attending an international vaccine center. Is the risk for the pediatric traveler increasing?]. / Viajeros atendidos en un centro de vacunación internacional. ¿Está aumentando el riesgo en el viajero pediátrico?

INTRODUCTION: There is a perception that the number of pediatric travelers is increasing, mainly due to the so-called visiting friends and relatives (VFRs) group. Both the demographic and trips characteristics in this group may lead to an increased risk and a greater complexity in vaccinations and other preventive recommendations. OBJECTIVE: To analyze the outcomes of different groups of pediatric travelers. To describe the demographic and travel characteristics within the pediatric population, and to analyze whether the VFRs differ from non-VFRs with regards to the factors that may contribute to a greater risk. METHODOLOGY: A cross sectional descriptive study of the characteristics of pediatric travelers treated in the International Pre-travel Consultation Unit of the University Hospital Vall d'Hebron, from July 2002 to January 2009. RESULTS: Of the 692 children analyzed, with a mean age of 8 years (SD 5.4), an increase in the overall number of travelers was identified, along with an initial increase in the number of VFR children in the early years of the study, although later on, the numbers of this group stabilized. The mean age of the VFR travelers was also found to be lower. A lack of planning prior to the start of the travel was also noted in the VFRs group, as well as longer trip durations. A routine vaccine was administered to 29.2% of children, and malaria prophylaxis was recommended for 52% of travelers. CONCLUSION: Despite the progressive increase in international travel and the initial increase in VFR travelers, the percentage of this group has remained stable in recent years. However, the perception of a low risk among the immigrant population suggests the need to encourage an adequate pre-travel consultation within this group.