Infection by Strongyloides stercoralis in immigrants with Chagas disease: evaluation of eosinophilia as screening method in primary care.

OBJECTIVES: To evaluate co-infection of Strongyloides stercoralis and Trypanosoma cruzi and to assess eosinophilia as a screening test for the detection of S. stercoralis infection in patients with Chagas disease (CD). METHODS: A retrospective diagnostic validation study was performed on serum samples from primary care patients diagnosed with CD in the southern Barcelona metropolitan area. All samples with eosinophilia (n = 87) and a random sample of non-eosinophilic sera (n = 180) were selected. Diagnosis of CD was based on positive serology by means of two tests: ORTHO® T. cruzi ELISA test, and BIO-FLASH® Chagas or Bioelisa CHAGAS. SCIMEDX ELISA STRONGY-96 was used to diagnose strongyloidiasis. RESULTS: Strongyloides stercoralis serology was positive in 15% of patients of whom 95% showed eosinophilia, vs. 21% of those with negative serology (P < 0.001), with differences in the mean eosinophil count (0.49 vs. 0.27 × 109 /l). Only 1.1% of patients with CD but without eosinophilia presented positive serology for S. stercoralis, whereas 44% of patients with CD and eosinophilia did (P < 0.001). Sensitivity and specificity values for eosinophilia were thus 95% and 79%, respectively. PPV was 42.5% and NPV, 98.9%. CONCLUSIONS: The prevalence of co-infection by T. cruzi and S. stercoralis is not negligible and has probably been underestimated for years in many areas, due to frequently subclinical infections. Therefore, serology seems mandatory for these patients and the use of eosinophilia as initial screening could facilitate the task, decreasing the number of analyses to be performed.

OBJECTIFS: Evaluer la coinfection par Strongyloides stercoralis et Trypanosoma cruzi et évaluer éosinophilie comme un test de dépistage pour la détection de l'infection à S. stercoralis chez les patients atteints de la maladie de Chagas (MC). MÉTHODES: Une étude de validation diagnostique rétrospective a été réalisée sur des échantillons de sérum de patients de soins primaires diagnostiqués avec la MC dans la région métropolitaine du sud de Barcelone. Tous les échantillons avec éosinophilie (n = 87) et un échantillon aléatoire de sérums non éosinophiliques (n = 180) ont été sélectionnés. Le diagnostic de la MC était basé sur une sérologie positive au moyen de deux tests: le test ELISA ORTHO® T. cruzi et le test BIO-FLASH® Chagas ou Bioelisa CHAGAS. SCIMEDX ELISA STRONGY-96 a été utilisé pour diagnostiquer la strongyloïdose. RÉSULTATS: La sérologie de S. stercoralis était positive chez 15% des patients dont 95% présentaient une éosinophilie, contre 21% de ceux avec une sérologie négative (P <0,001), avec des différences dans le taux moyen d'éosinophiles (0,49 contre 0,27 × 109 /L). Seuls 1,1% des patients avec la MC mais sans éosinophilie présentaient une sérologie positive pour S. stercoralis ; contrairement à 44% des patients atteints de la MC avec une éosinophilie (p <0,001). Les valeurs de sensibilité et de spécificité pour l'éosinophilie étaient ainsi respectivement de 95% et 79%. La VPP était de 42,5% et la VPN, 98,9%. CONCLUSIONS: La prévalence de la coinfection par T. cruzi et S. stercoralis n'est pas négligeable et a probablement été sous-estimée depuis des années dans de nombreuses régions, en raison d'infections fréquemment infracliniques. Par conséquent, la sérologie semble obligatoire pour ces patients et l'utilisation de l'éosinophilie comme dépistage initial pourrait faciliter la tâche, diminuant le nombre d'analyses à effectuer.

Biogeographical origin and varicella risk in the adult immigration population in Catalonia, Spain (2004-2006).

Immigrants to the European Union may have a higher susceptibility to varicella-zoster virus primo-infection than the indigenous population. There is no evidence as yet that this is caused by genetic or social factors. Therefore, susceptibility could be due to a lesser transmission of the virus in their ecosystems of origin. A multicentre observational study was performed from July 2004 to June 2006 in four primary healthcare centres in Catalonia, Spain, monitoring varicella incidences and comparing standardised incidence rates and standardised rate ratios among different populations classified according to their biogeographical origin (holarctic, Asian paleotropical, African paleotropical or neotropical). Overall, 516 varicella cases were recorded. The standardised incidence rates per 1,000 inhabitants per year were: holarctic: 2.17 (95% confidence interval (CI): 1.95-2.39); autochthonous 2.26 (95% CI: 2.03-2.49); immigrants 3.59 (95% CI: 2.92-4.26); neotropical 4.50 (95% CI: 3.28-5.71); non-holarctic 5.38 (95% CI: 4.27-6.14); Asian paleotropical 7.03 (95% CI: 4.77-9.28); and African paleotropical 7.05 (95% CI: 1.12-23.58). The difference to the autochthonous population was greatest in immigrants of neotropical origin (standardised rate ratio = 2.07 (95% CI: 1.61-2.64) or 4.5 excess cases per 1,000 inhabitants per year) and Asian paleotropical origin (standardised rate ratio = 3.24 (95% CI: 2.47-4.11) or 9.6 excess cases per 1,000 inhabitants per year). Biogeographical origin may therefore account for the vulnerability of certain immigrant populations to varicella, in particular those from Asian paleotropical (Indostan and Southeast Asia) and neotropical (South America and the Caribbean) ecosystems. Vaccination of immigrants at high risk (fertile women, healthcare workers) could be recommendable.

[Seroprevalence of chronic viral hepatitis markers in 791 recent immigrants in Catalonia, Spain. Screening and vaccination against hepatitis B recommendations]. / Seroprevalencia de marcadores de hepatitis crónica vírica en 791 inmigrantes recientes en Cataluña, España. Recomendaciones de cribado y de vacunación contra la hepatitis B*

INTRODUCTION: The prevalence of chronic viral hepatitis in the European Union (EU) will vary because of the immigrants coming from countries having an elevated with a higher endemicity of hepatitis B (HBV) and C virus (HCV). Serologic screening in healthy immigrants is a subject that has been discussed in the areas of feasibility, ethics and cost-effectiveness. The main study aims were: a) to know the prevalence of chronic hepatitis markers and, b) to determine the best cost-effectiveness strategy of vaccination against hepatitis B. POPULATION AND METHOD: An observational, perspective and multicenter study was performed on the Primary Care level in Catalonia (Spain) among healthy immigrants who had lived in the EU for less than 5 years. RESULTS: Data from 791 individuals were analyzed. They presented anti-HBc+ 33% (95% CI 29.6 -36.1), and anti-HBs+ 16.1% (95% CI 11.4 -20.8). HBsAg+ was 5.9% (95% CI 3-8.7), of those were HBeAg+ 15.62% (95% CI 5.3-32.8). The sub-Saharan group presented the higher prevalence of anti-HBc+ (77.3%) and HBsAg+ (18.2%), whereas the Latin American-origin population displayed the lowest one (12.5% and 1.2%, respectively). Determination of antibodies prior to vaccination was found as cost-effective from a seroprevalence anti-HBc+> 48.72%; only overcome by the CI of sub-Saharan population (95% CI 5.3-32.8). The prevalence of anti-HC+ was 6.1% (95% CI 4.3-7.8), especially high among the Eastern European (19.6%) and Indostanic (14.9%) population. The Latin American group had the lowest prevalence (1.4%). CONCLUSIONS: The prevalence of chronic viral hepatitis markers is found to be at an intermediate level between those described by primary and specialized care levels. The prevalences of HBsAg+ and anti-HC+ in the immigrant population, on the whole, are such that it is advisable to screening for them, with the exception of the Latin American community. Previous serologic determination of markers is only cost-effective among the sub-Saharan community.

Seroprevalencia de marcadores de hepatitis crónica vírica en 791 inmigrantes recientes en Cataluña, España. Recomendaciones de cribado y de vacunación contra la hepatitis B* / Seroprevalence of chronic viral hepatitis markers in 791 recent immigrants in Catalonia, Spain. Screening and vaccination against hepatitis B recommendations

Introducción. La prevalencia de las hepatitiscrónicas víricas en la Unión Europea variará debidoa la recepción de inmigrantes procedentes de paísescon elevada endemia de infección crónica por virusde la hepatitis B (VHB) y C (VHC). La inclusión desu cribado en inmigrantes sanos es un temadebatido en los planos de factibilidad, ética y decoste-efectividad.Los objetivos del estudio fueron: a) conocer laprevalencia de marcadores contra la hepatitiscrónica y, b) determinar una estrategia costeefectivade vacunación contra la hepatitis B.Población y método. Estudio observacionalprospectivo y multicéntrico a nivel de AtenciónPrimaria en Cataluña (España), definido sobrela población de inmigrantes sanos con menos de 5años de residencia en la Unión Europea.Resultados. Se estudiaron 791 individuos.Presentaron HBcAc+ 33% (intervalo de confianza[IC] 95% 29,6-36,1) y HBsAc+ 16,1% (IC 95%11,4-20,8). Presentaron antígeno de superficiepositivo (HBsAg+) 5,9% (IC 95% 3-8,7), de loscuales el antígeno soluble positivo (HBeAg+)15,62% (IC 95% 5,3-32,8). La poblaciónsubsahariana presentó la mayor prevalencia deHBcAc+ (77,3%) y de HBsAg+ (18,2%) y la latinoamericana, la menor (12,5% y 1,2%, respectivamente). La determinación serológica prevacunación se mostró coste-efectiva a partir de una seroprevalencia HBcAc+ >48,72%, valor sólo superado por el IC de la población subsahariana (IC 95% 68,6-86). Presentaron anticuerpos contra el virus de la hepatitis C (HCAc+) 6,1% (IC 95%4,3-7,8), especialmente el colectivo de EuropaOriental (19,6%) e Indostán (14,9%). La comunidadcon menor prevalencia fue asimismo lalatinoamericana (1,4%).Discusión. La prevalencia de marcadores dehepatitis crónica vírica se sitúa en un nivelintermedio entre las descritas en los ámbitos deAtención Primaria y especializada. La poblacióninmigrante en su conjunto muestra prevalencias demarcadores HBsAg+ y HCAc+ que hacenrecomendable su cribado excepto para el colectivolatinoamericano. La determinación serológica previaa la vacunación sólo es coste-efectiva en el colectivosubsahariano

Introduction. The prevalence of chronic viralhepatitis in the European Union (EU) will varybecause of the immigrants coming from countrieshaving an elevated with a higher endemicity ofhepatitis B (HBV) and C virus (HCV). Serologicscreening in healthy immigrants is a subject that hasbeen discussed in the areas of feasibility, ethics andcost-effectiveness. The main study aims were: a) toknow the prevalence of chronic hepatitis markersand, b) to determine the best cost-effectivenessstrategy of vaccination against hepatitis B.Population and Method. An observational,perspective and multicenter study was performed onthe Primary Care level in Catalonia (Spain) amonghealthy immigrants who had lived in the EU for lessthan 5 years.Results. Data from 791 individuals were analyzed.They presented anti-HBc+ 33% (95% CI 29.6 -36.1),and anti-HBs+ 16.1% (95% CI 11.4 -20.8). HBsAg+was 5.9% (95% CI 3-8.7), of those were HBeAg+15.62% (95% CI 5.3-32.8). The sub-Saharan grouppresented the higher prevalence of anti-HBc+(77.3%) and HBsAg+ (18.2%), whereas the LatinAmerican-origin population displayed the lowest one(12.5% and 1.2%, respectively). Determination ofantibodies prior to vaccination was found ascost-effective from a seroprevalence anti-HBc+>48.72%; only overcome by the CI of sub-Saharanpopulation (95% CI 5.3-32.8). The prevalence ofanti-HC+ was 6.1% (95% CI 4.3-7.8), especially highamong the Eastern European (19.6%) and Indostanic(14.9%) population. The Latin American group hadthe lowest prevalence (1.4%).Conclusions. The prevalence of chronic viralhepatitis markers is found to be at an intermediatelevel between those described by primary andspecialized care levels. The prevalences of HBsAg+and anti-HC+ in the immigrant population, on thewhole, are such that it is advisable to screening forthem, with the exception of the Latin Americancommunity. Previous serologic determination ofmarkers is only cost-effective among the sub-Saharan community

[Prevention of diseases in the traveller; the returning traveller]. / Prevención de enfermedades del viajero; el viajero que regresa.

In recent years there has been a spectacular increase in international journeys and the WHO calculates that by the year 2015 the number of long distance journeys will have doubled in comparison with twenty years before. Travelling involves a series of risks, which become higher the poorer the social and health situation of the country of destination. According to different studies, between 20 and 70% of travellers suffer from some type of health problem during their journey. The main causes of mortality during a journey are, in order of importance, accidents, cardiovascular diseases and transmissible diseases. This article sets out the current criteria and recommendations regarding general health advice, recommended vaccinations, anti-malaria chemoprophylaxis and special physiological (children and the pregnant women) and clinical (chronic diseases) situations of interest to travellers, in order to prevent health problems and as far as possible to guarantee a safe and profitable journey.

[Codevelopment and health. Prevention of HIV transmission in Ghana: the Brothers in Work Programme]. / Codesarrollo y salud. Prevención de la transmisión del VIH en Ghana: el programa Brothers in Work.

OBJECTIVE: To design a health programme, as part of a codevelopment programme, aimed at reducing the occurrence of HIV-AIDS in a rural African population. DESIGN: The Catalan Society of Community and Family Medicine developed the Brothers in Work Health Programme (BWP) through a working party of Spanish and Ghanaian doctors. The programme has two consecutive stages. The first ("being safe") aims to stop transmission of the virus caused by accidents with health material. The second, intervention stage ("being active") focuses on introducing voluntary antenatal screening for HIV, counselling and a protocol for administering nevirapine to a cohort of 600 seropositive women whilst giving birth. The results will be compared with another cohort of 600 seronegative pregnant women. SETTING: Three Area Hospitals in the Central Region of Ghana. PARTICIPANTS: 876,000 people from 3 districts. MAIN MEASUREMENTS: Assessment of HIV-AIDS prevalence and survival of newborns at 18 months. Monitoring of the cost-efficiency relationship of the interventions. RESULTS: Estimated direct costs are: a) for diagnosis of each seronegative patient, 2.43 euros (1.75 co-payment), and b) for diagnosis, counselling, and nevirapine treatment of each seropositive patient, 6.6 euros (4.65). Estimated cost-efficiency relationship of the programme is: a) for every patient diagnosed, counselled and included in the programme, 23.5 euros (15.3), and b) for each case of intra-delivery infection of baby avoided, 20.03 euros (15.5). HIV transmission to 54 children would be avoided (9% of the deliveries of seropositive women; 6.3 of the total women tested). CONCLUSIONS: The BWP has a good cost/benefice relationship in the interruption of HIV transmission.

Prevención de enfermedades del viajero; el viajero que regresa / Prevention of diseases in the traveller; the returning traveller

En los últimos años se ha producido un aumento espectacular de los viajes internacionales y la OMS calcula que hacia el año 2015 se habrá duplicado el número de viajes de larga distancia que hubo 20 años atrás. El hecho de viajar implica una serie de riesgos, mayores cuanto más pobres son las condiciones sociosanitarias del país de destino. Según diferentes estudios, entre el 20 y el 70 % de los viajeros sufre algún problema de salud durante el viaje. Las principales causas de mortalidad durante un viaje son, por este orden, los accidentes, las enfermedades cardiovasculares y las enfermedades transmisibles. En el presente artículo se exponen los criterios y recomendaciones actuales sobre consejos sanitarios generales, vacunaciones recomendadas, quimioprofilaxis antipalúdica y situaciones especiales fisiológicas (el niño y la mujer embarazada) y clínicas (enfermedades crónicas) de interés en viajeros, para prevenir problemas de salud y garantizar en lo posible un viaje seguro y provechoso

In recent years there has been a spectacular increase in international journeys and the WHO calculates that by the year 2015 the number of long distance journeys will have doubled in comparison with twenty years before. Travelling involves a series of risks, which become higher the poorer the social and health situation of the country of destination. According to different studies, between 20 and 70% of travellers suffer from some type of health problem during their journey. The main causes of mortality during a journey are, in order of importance, accidents, cardiovascular diseases and transmissible diseases. This article sets out the current criteria and recommendations regarding general health advice, recommended vaccinations, anti-malaria chemoprophylaxis and special physiological (children and the pregnant women) and clinical (chronic diseases) situations of interest to travellers, in order to prevent health problems and as far as possible to guarantee a safe and profitable journey

Codesarrollo y salud. Prevención de la transmisión del VIH en Ghana: el programa Brothers in Work / Co-development and health. Prevention of HIV transmission in Ghana: the brothers in work programme

Objetivo. Diseñar un programa de salud, en régimen de codesarrollo, destinado a dismuir la incidencia de VIH-sida en población rural africana. Diseño. La Societat Catalana de Medicina Familiar i Comunitària ha desarrollado el programa de salud Brothers in Work (PBW) mediante un grupo de trabajo de médicos españoles y ghaneses. El programa consta de dos fases consecutivas. La primera ­seguridad (being safe)­ destinada a interrumpir la transmisión viral debida a accidentes biológicos con material sanitario. La segunda fase ­intervención (being active)­ se centra en introducir el cribado antenatal voluntario del VIH, el consejo y un protocolo de administración de nevirapina durante el parto a una cohorte de 600 embarazadas seropositivas. Los resultados serán comparados con los de otra cohorte compuesta de 600 embarazadas seronegativas. Emplazamiento. Tres hospitales de distrito de la Región Central (Ghana). Participantes. Un total de 876.000 personas de 3 distritos. Mediciones principales. Valoración de la prevalencia de VIH-sida y supervivencia de los neonatos a los 18 meses. Control de la realación coste-eficacia de las intervenciones. Resultados. Los costes directos estimados son: a) por diagnóstico de paciente seronegativa, 2,43 e (1,75 de copago), y b) por diagnóstico, consejo y tratamiento con nevirapina de paciente seropositiva, 6,6 e (4,65). La relación coste-eficacia estimada del programa es: a) por paciente diagnosticado, aconsejado e incluido en el programa, 23,5 e (15,3), y b) por caso de infección infantil intraparto evitado, 20,03 e (15,5). Se evitaría la transmisión del VIH a 54 niños (el 9% de los partos de mujeres seropositivas; el 6,3‰ del total de mujeres testadas). Conclusiones. El PBW tiene una buena relación baja de coste-beneficio en la interrupción de la transmisión del VIH

Objective. To design a health programme, as part of a codevelopment programme, aimed at reducing the occurrence of HIV-AIDS in a rural African population. Design. The Catalan Society of Community and Family Medicine developed the Brothers in Work Health Programme (BWP) through a working party of Spanish and Ghanaian doctors. The programme has two consecutive stages. The first ("being safe") aims to stop transmission of the virus caused by accidents with health material. The second, intervention stage ("being active") focuses on introducing voluntary antenatal screening for HIV, counselling and a protocol for administering nevirapine to a cohort of 600 seropositive women whilst giving birth. The results will be compared with another cohort of 600 seronegative pregnant women. Setting. Three Area Hospitals in the Central Region of Ghana. Participants. 876 000 people from 3 districts. Main measurements. Assessment of HIV-AIDS prevalence and survival of newborns at 18 months. Monitoring of the cost-efficiency relationship of the interventions. Results. Estimated direct costs are: a) for diagnosis of each seronegative patient, e2.43 (1.75 co-payment), and b) for diagnosis, counselling, and nevirapine treatment of each seropositive patient, e6.6 (4.65). Estimated cost-efficiency relationship of the programme is: a) for every patient diagnosed, counselled and included in the programme, e23.5 (15.3), and b) for each case of intra-delivery infection of baby avoided, e20.03 (15.5). HIV transmission to 54 children would be avoided (9% of the deliveries of seropositive women; 6.3‰ of the total women tested). Conclusions. The BWP has a gool cost/benefice relationship in the interruption of HIV transmission

Codesarrollo y salud: prevención de la transmisión del VIH en Ghana: el programa Brothers in Work

Objetivo. Diseñar un programa de salud, en régimen de codesarrollo, destinado a disminuir la incidencia de VIH-sida en población rural africana. Diseño. La Societat Catalana de Medicina Familiar i Comunitária ha desarrollado el programa de salud Brothers in Work (PBW) mediante un grupo de trabajo de médicos españoles y ghaneses. El programa consta de dos fases consecutivas. La primera ûseguridad (being safe)- destinada a interrumpir la transmisión viral debida a accidentes biológicos con material sanitario. La segunda fase ûintervención (being active)- se centra en introducir el cribado antenatal voluntario del VIH, el consejo y un protocolo de administración de nevirapina durante el parto a una cohorte de 600 embarazadas seropositivas. Los resultado serán comparados con los de otra cohorte compuesta de 600 embarazadas seronegativas. Emplazamiento. Tres hospitales de distrito de la Región Central (Ghana). Participantes. Un total de 876.000 personas de 3 distritos. Mediciones principales. Valoración de la prevalencia de VIH-sida y supervivencia de los neonatos a los 18 meses. Control de la relción coste-eficacia estimada de las intervenciones. Resultados Los costes directos estimados son: a) por diagnóstico de paciente seronegativa, 2,43 Ç (1,75 de copago), y b) por diagnóstico, consejo y tratamiento com nevirapina de paciente seropositiva, 6,6 Ç (4,65). La relación coste-eficacia estimada del programa es: a) por paciente diagnosticado, aconsejado e incluido en el programa, 23,5 Ç (15,3), y b) por caso de infección infantil intraparto evitado, 20,03 Ç (15,5). Se evitaría la transmisión del VIH a 54 niños (el 9 por ciento de los partos de mujeres seropositivas; el 6,3 por ciento del total de mujeres testadas). Conclusiones. El PBW tiene una buena relación baja de coste-beneficio en la interrupción de la transmisión del VIH.(AU)