Results from screening immigrants of low-income countries: data from a public primary health care.

BACKGROUND: A total of 3,132 immigrants from low- and middle-income countries were involved in a cross-sectional observational study to screen for infectious diseases among immigrants attending public primary health care (PHC) centers. The study was conducted to clarify the degree of demographic differences and risk predictors of these diseases. METHODS: Demographic and clinical variables, screening for infectious diseases [hepatitis B and C, human immunodeficiency virus infection, syphilis, and tuberculosis (TB)], and analytical data (anemia, hematuria, and liver function) were recorded from immigrants attending a public PHC unit in Barcelona. RESULTS: Global hepatitis B, including chronic and previous, reached 18.1%; Morocco as the country of origin [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.07-4.14] and gastrointestinal symptoms (OR 1.9, CI 1.18-3.02) were risk factors. Hepatitis C prevalence was 3.3% with elevated hepatic transaminase levels as a risk factor (OR 26.1, CI 8.68-78.37). Positive syphilis was 3.1%; latent and active TB rates were 28.1 and 5.8%, respectively. Concerning TB, we found remarkable differences both among WHO regions of origin (the Eastern Mediterranean region showed the highest rate of active TB, 8%) and the three categories of years of residence in Spain (6.5% for <1 year, 12.8% for 1-5 years, and 10% for >5 years). CONCLUSIONS: The data allowed recommendation of a minimal screening of TB in immigrants from low-income countries regardless of the years of residence in Spain, hepatitis C in patients with altered transaminase levels, and hepatitis B in patients with gastrointestinal symptoms and/or from Morocco.

Mumps: a year of enhanced surveillance in Catalonia, Spain.

Mumps is a vaccine-preventable disease candidate for elimination. Positive predictive value (PPV) of clinical case definition was assessed. During 2007, 410 suspected cases were reported in Catalonia: 348 fulfilled clinical case definition and 159 were laboratory confirmed. Incidence rate was 4.8 per 100,000 for cases that fulfilled the clinical definition, and 2.2 for laboratory confirmed cases. Global PPV was 44.5%; 38.5% in <15 years and 50% in > or =15 years (p=0.04). Most laboratory confirmed cases (72.3%) received at least one MMR dose. With sustained high MMR coverage, laboratory confirmation is necessary to control the disease and assess vaccine failure.

Changes in the evolution of meningococcal disease, 2001-2008, Catalonia (Spain).

Reported cases of meningococcal disease between 1997 and 2008 were analyzed to determine the evolution after the introduction of a conjugated vaccine. In <6 years, the incidence rate of serogroup C fell from 7.6 to 0.6 per 100,000 persons/year in the periods before (1997-2000) and after (2001-2007) the introduction of the conjugate vaccine. In serogroup B, the reduction was from 15.4 to 11.1. In <20 years case-fatality-rate increased only in serogroup B (3% and 7.4%, p=0.026). Serosubtype P1.15 was the most frequent in serogroup B (31%), mainly associated with serotype 4 (80%), and in serogroup C subtype P1.5 (36%), with serosubtype 2a (86%). Exhaustive surveillance of circulating meningococcal strains is essential.

Is the vaccination coverage established enough to control pertussis, or it is a re-emerging disease?

Although vaccination coverage is high in Catalonia, Spain, pertussis is still a significant cause of morbidity and mortality among infants, overall due to adolescent and adult contacts. An epidemiological study from voluntary health care centres to detect confirmed pertussis cases was carried out in Catalonia. From 465 pertussis-suspect-cases, we identified 126 confirmed events, 73 of them confirmed by laboratory tests. Most of cases were infants less than 4 months old 23 (18.3%), adolescents 22 (17.4%) and adults 46 (36.5%). Sixty-one cases (49.6%) presented paroxysmal cough, 33 (26.8%) post-tussive vomiting and inspiratory whoop, and 27 (22%) apnoea. The vaccination status was not known for 46 (36.5%) patients. Of the total vaccine status documented, 59 (73.8%) patients had received at least one dose. Sixty patients (47.6%) were considered index cases, 32 of them (53.3%) were children under 1-year old. Among contacts identified as pertussis cases, 63.6% (42/66) were older than 14 years of age. These contacts were parents (30), siblings (19), grandmother (4), and others (13). These results confirm protective efficacy of pertussis vaccine only during few time. Regular pertussis boosters in teenagers, and/or in adults who take care of young children, could decrease the incidence of the infection.

[Epidemiology of the meningococcal disease in Catalonia before and after vaccination against serogroup C]. / Epidemiología de la enfermedad meningocócica en Cataluña antes y después de la vacunación frente al serogrupo C.

BACKGROUNDS: Meningococcal disease remains a serious public health problem worldwide. In Catalonia, after implementing the vaccination program, there has been a significant decrease in cases caused by meningococcus C. METHODS: Reported cases of meningococcal disease between 1997 and 2008 were analyzed to determine the evolution after the introduction of a conjugated vaccine in Catalonia. RESULTS: In < 6 years, the incidence rate of serogroup C fell from 7.6 to 0.6 per 100,000 persons/year in the periods before (1997-2000) and after (2001-2007) the introduction of the conjugate vaccine. In serogroup B, the reduction was from 15.4 to 11.1. In < 20 years case-fatality-rate increased only in serogroup B (3% and 7.4%). Serosubtype P1.15was the most frequent in serogroup B (31%), mainly associated with serotype 4 (80%), and in serogroup C subtype P1.5 (36%), with serotype 2a (86%). During 2008, 5 apparently unrelated cases of B:2a:P1.5 were identified in the same geographic area, with a case-fatality-rate of 80%. CONCLUSIONS: Exhaustive surveillance of circulating meningococcal strains is essential.

Políticas para reducir el daño causado por el consumo de alcohol: una aproximación desde la salud pública / Policies to reduce harm caused by alcohol use: a public health perspective

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[Immigration and aging: new challenges in public health]. / Inmigración y envejecimiento, nuevos retos en salud pública.

Foreign migration in Spain is at present a priority in the social and demographic context the country. At a worldwide level, trends in the evolution of population and social, political and economical indicators, appear to maintain for the coming years, the present trends on migrations from poor countries to the rich ones. In the health area, considering migration as a relatively recent phenomena in Spain, and considering that is mainly constituted by young and healthy population, there are not still data available on the main health needs of migrants related to aging. Data from other countries with a longer migrant tradition, shows mental health disorders and social and cultural barriers for adaptation, as basic health determinants for older migrants. Related to the effects in the health system, the inclusion of the aging factor in general population and migrant needs, offer an optimistic panorama for future planning. Migrant aging in Spain, despite of its middle and long term perspective, do require a progressive adaptation of knowledge and resources to cover future needs. Considering this coming future, health professionals do need to be trained in intercultural skills and knowledge.

Inmigración y envejecimiento, nuevos retos en salud pública / Immigration and aging: new challenges in Public Health

La inmigración extranjera en el Estado español constituye un aspecto prioritario en la realidad social y demográfica del país. En el mundo, las tendencias en la evolución de la población y los indicadores económicos, sociales y políticos apuntan a que la inmigración de los países pobres hacia los más ricos seguirá produciéndose en los próximos años. En el ámbito de la salud, considerando que se trata de un fenómeno relativamente reciente, caracterizado por población joven y sana, todavía no se dispone de datos que caractericen sus necesidades en salud y principales trastornos vinculados a su envejecimiento. La información procedente de otros países con una tradición migratoria más dilatada apunta que los problemas de salud mental y los factores vinculados al desarraigo sociocultural son los principales elementos que deben añadirse a los principales determinantes de la salud de las poblaciones de mayor edad. Con relación a las repercusiones en el sistema sanitario, tanto del envejecimiento de la población en general como los datos sobre la población inmigrante, permite ver con optimismo elementos para la planificación y la incorporación de estas realidades. El envejecimiento de las poblaciones inmigrantes en España, aunque se plantee desde una perspectiva a medio y largo plazo, requiere la progresiva adaptación de recursos y conocimientos para cubrir las nuevas necesidades. La formación en aspectos de interculturalidad de los profesionales de la salud debe también incorporarse sobre la base de este futuro (AU)

Foreign migration in Spain is at present a priority in the social and demographic context the country. At a worldwide level, trends in the evolution of population and social, political and economical indicators, appear to maintain for the coming years, the present trends on migrations from poor countries to the rich ones. In the health area, considering migration as a relatively recent phenomena in Spain, and considering that is mainly constituted by young and healthy population, there are not still data available on the main health needs of migrants related to aging. Data from other countries with a longer migrant tradition, shows mental health disorders and social and cultural barriers for adaptation, as basic health determinants for older migrants. Related to the effects in the health system, the inclusion of the aging factor in general population and migrant needs, offer an optimistic panorama for future planning. Migrant aging in Spain, despite of it’s middle and long term perspective, do require a progressive adaptation of knowledge and resources to cover future needs. Considering this coming future, health professionals do need to be trained in intercultural skills and knowledge (AU)

[Health and immigration: new situations and challenges]. / Salud e inmigración: nuevas realidades y nuevos retos.

The new social and demographic framework in Spain that has appeared since the arrival of new migrant populations, raises the need to improve the knowledge of their health status and to identify preventive measures and priorities in heath services.A bibliographic review of the available information on migration and health in Spain is performed, together with an analysis of their contents from a Public Health point of view. The high proportion of new borns from foreign mothers, the mental needs, deficits in oral and dental health, and the increase of tuberculosis in migrants, together with limited vaccine coverage in children, define the main health needs of these populations. The analysis of health services, reveals a high use of pediatric, obstetric and gynecologic resources by migrant populations. Conclusions; although no particular health needs have been identified for migrants, special attention for tuberculosis, mother and child health and health promotion and prevention, have to be funded for specific migrant populations. Health resources and services have to be reinforced with health agents, human resources, and specialized education for health professionals.

Detection of pulmonary tuberculosis in Chiapas, Mexico.

PURPOSE: To estimate the prevalence of undiagnosed pulmonary tuberculosis (PTB) and the sensitivity of bacilloscopy in the border region of Chiapas, Mexico. METHODS: We actively sought individuals aged 15 years or more with chronic cough from the Border Region of Chiapas, Mexico in three settings: one regional hospital, seven Primary Care Centers (PCC), and 32 communities. Individuals (a total of 899) reporting chronic cough were asked to provide three samples of sputum for acid-fast smears and cultures. The quality of acid-fast smears was evaluated using culture as the gold standard. RESULTS: We obtained sputum specimens from 590 of 899 individuals with chronic cough. A diagnosis of PTB was confirmed in 78. A conservative estimate of the overall prevalence of PTB at the population level was 151 per 100,000 (95% CI: 88 to 241). In the regional hospital, the estimated case detection rate was 66% (29/44). The proportion of candidates for PTB therapy that were actually on treatment was 50% (14/28) at the PCC and 11% (2/19) in the communities. The sensitivity of the bacilloscopy was about 90% in the hospital, and slightly lower than 50% in the PCC and the communities. CONCLUSION: Improved procedures for PTB detection are required in the studied area to adequately control the disease and to provide therapy to affected patients.