Screening of imported infectious diseases among asymptomatic sub-Saharan African and Latin American immigrants: a public health challenge.

Migrants from developing countries are usually young and healthy but several studies report they may harbor asymptomatic infections for prolonged periods. Prevalence of infections were determined for asymptomatic immigrants from Latin America and sub-Saharan Africa who ettended to a European Tropical Medicine Referral Center from 2000 to 2009. A systematic screening protocol for selected infections was used. Data from 317 sub-Saharan Africans and 383 Latin Americans were analyzed. Patients were mostly young (mean age 29 years); there were significantly more males among sub-Saharan Africans (83% versus 31.6%) and pre-consultation period was longer for Latin Americans (5 versus 42 months). Diagnoses of human immunodeficiency virus (HIV), chronic hepatitis B and C virus infection, and latent tuberculosis were significantly more frequent in sub-Saharan Africans (2.3% versus 0.3%; 14% versus 1.6%; 1.3 versus 0%; 71% versus 32.1%). There were no significant differences in prevalence for syphilis and intestinal parasites. Malaria and schistosomiasis prevalence in sub-Saharan Africans was 4.6% and 5.9%, respectively, and prevalence of Chagas disease in Latin Americans was 48.5%. Identifying and treating asymptomatic imported infectious diseases may have an impact both for the individual concerned and for public health. Based on these results, a systematic screening protocol for asymptomatic immigrants is proposed.

[1]  E. Hershfield,et al.  Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection , 2013, Pediatric Clinical Practice Guidelines & Policies.

[2]  M. I. González-Tomé,et al.  Recomendaciones para el diagnóstico, seguimiento y tratamiento de la embarazada y del niño con enfermedad de Chagas , 2013 .

[3]  J. Semenza,et al.  Mapping Environmental Suitability for Malaria Transmission, Greece , 2013, Emerging infectious diseases.

[4]  M. Cetron,et al.  Spectrum of illness in international migrants seen at GeoSentinel clinics in 1997-2009, part 2: migrants resettled internationally and evaluated for specific health concerns. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[5]  J. Real,et al.  Análisis comparativo de las serologías realizadas a los inmigrantes en la región sanitaria de Lleida , 2012, Atencion primaria.

[6]  M. Plana,et al.  Very late initiation of HAART impairs treatment response at 48 and 96 weeks: results from a meta-analysis of randomized clinical trials. , 2012, The Journal of antimicrobial chemotherapy.

[7]  M. Norredam,et al.  Mortality from infectious diseases among refugees and immigrants compared to native Danes: a historical prospective cohort study , 2012, Tropical medicine & international health : TM & IH.

[8]  R. López-Vélez,et al.  Plasmodium falciparum in Asymptomatic Immigrants from Sub-Saharan Africa, Spain , 2012, Emerging infectious diseases.

[9]  R. López-Vélez,et al.  Changes in the epidemiology of tuberculosis: the influence of international migration flows. , 2011, Enfermedades infecciosas y microbiologia clinica.

[10]  W. Bortel,et al.  Autochthonous Plasmodium vivax malaria in Greece, 2011. , 2011, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[11]  R. López-Vélez,et al.  Targeted screening and health education for Chagas disease tailored to at-risk migrants in Spain, 2007 to 2010. , 2011, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[12]  P. Tugwell,et al.  Evidence-based clinical guidelines for immigrants and refugees , 2011, Canadian Medical Association Journal.

[13]  G. Barbarini,et al.  Recommendations for the prevention, diagnosis, and treatment of chronic hepatitis B and C in special population groups (migrants, intravenous drug users and prison inmates). , 2011, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[14]  R. López-Vélez,et al.  Chagas disease in Latin American migrants: a Spanish challenge. , 2011, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[15]  N. Low,et al.  Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. , 2011, The Lancet. Infectious diseases.

[16]  E. Schiff,et al.  Cost-effectiveness of screening for chronic hepatitis C infection in the United States. , 2011, Clinical Infectious Diseases.

[17]  O. Kon,et al.  Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis , 2011, The Lancet. Infectious diseases.

[18]  R. López-Vélez,et al.  Clinical, epidemiological characteristics and indications for liver biopsy and treatment in immigrants with chronic hepatitis B at a referral hospital in Madrid , 2011, Journal of viral hepatitis.

[19]  Juliana Inoue,et al.  Transfusion-transmitted malaria: case report of asymptomatic donor harboring Plasmodium malariae. , 2011, Revista do Instituto de Medicina Tropical de Sao Paulo.

[20]  Ana Belén Peinado Lozano,et al.  [Hepatitis B virus (HBV) infection in Sub-Saharan immigrants in Almería (Spain)]. , 2011, Enfermedades infecciosas y microbiologia clinica.

[21]  M. Sierra-Moros,et al.  First autochthonous malaria case due to Plasmodium vivax since eradication, Spain, October 2010. , 2010, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[22]  A. Buxó,et al.  Indicación de la determinación de los anticuerpos para los virus de la hepatitis C y de la hepatitis A en los protocolos de atención a los niños inmigrantes , 2010 .

[23]  R. López-Vélez,et al.  Imported Infectious Diseases in Mobile Populations, Spain , 2009, Emerging infectious diseases.

[24]  D. Isaacs,et al.  The epidemiology of health conditions of newly arrived refugee children: A review of patients attending a specialist health clinic in Sydney , 2009, Journal of paediatrics and child health.

[25]  I. Abubakar,et al.  The impact of immigration on tuberculosis rates in the United Kingdom compared with other European countries. , 2009, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[26]  M. Reis,et al.  Analysis of discordance between the tuberculin skin test and the interferon-gamma release assay. , 2009, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[27]  M. Ghany,et al.  Diagnosis, management, and treatment of hepatitis C: An update , 2009, Hepatology.

[28]  K. Gibney,et al.  Isolated core antibody hepatitis B in sub‐Saharan African immigrants , 2008, Journal of medical virology.

[29]  S. Benoit,et al.  Tuberculosis among foreign-born persons in the United States. , 2008, JAMA.

[30]  J. Le bras,et al.  Prolonged Plasmodium falciparum Infection in Immigrants, Paris , 2008, Emerging infectious diseases.

[31]  B. Ogutu,et al.  Pilot assessment of the sensitivity of the malaria thin film , 2008, Malaria Journal.

[32]  E. Flagg,et al.  High prevalence and presumptive treatment of schistosomiasis and strongyloidiasis among African refugees. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[33]  R. Romi,et al.  An outbreak of chikungunya fever in the province of Ravenna, Italy. , 2007, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[34]  David N. Williams,et al.  Financial implications of refugee malaria: the impact of pre-departure presumptive treatment with anti-malarial drugs. , 2007, The American journal of tropical medicine and hygiene.

[35]  M. Purswani,et al.  Congenital Malaria, an Important Differential Diagnosis to Consider When Evaluating Febrile Infants of Immigrant Mothers , 2007, Pediatric emergency care.

[36]  R. Murray,et al.  Outpatient treatment of malaria in recently arrived African migrants , 2006, The Medical journal of Australia.

[37]  J. Rosenblatt,et al.  EVALUATION OF MALARIA SCREENING IN NEWLY ARRIVED REFUGEES TO THE UNITED STATES BY MICROSCOPY AND RAPID ANTIGEN CAPTURE ENZYME ASSAY , 2006, The Pediatric infectious disease journal.

[38]  K. Leder,et al.  Illness in returned travelers and immigrants/refugees: the 6-year experience of two Australian infectious diseases units. , 2006, Journal of travel medicine.

[39]  J. Parsonnet,et al.  Risk of intestinal helminth and protozoan infection in a refugee population. , 2005, The American journal of tropical medicine and hygiene.

[40]  J. Barbara,et al.  Documented cases of post‐transfusion malaria occurring in England: a review in relation to current and proposed donor‐selection guidelines , 2005, Vox sanguinis.

[41]  D. Menzies,et al.  Cost-effectiveness of tuberculosis control strategies among immigrants and refugees , 2005, European Respiratory Journal.

[42]  P. Muennig,et al.  The cost-effectiveness of ivermectin vs. albendazole in the presumptive treatment of strongyloidiasis in immigrants to the United States , 2004, Epidemiology and Infection.

[43]  T. Gyorkos,et al.  Comparison of Blood Smear, Antigen Detection, and Nested-PCR Methods for Screening Refugees from Regions Where Malaria Is Endemic after a Malaria Outbreak in Quebec, Canada , 2004, Journal of Clinical Microbiology.

[44]  R. Horsburgh,et al.  Priorities for the treatment of latent tuberculosis infection in the United States. , 2004, The New England journal of medicine.

[45]  K. Holmes,et al.  Update on syphilis: resurgence of an old problem. , 2003, JAMA.

[46]  L. Chiche,et al.  Posttransplant malaria: first case of transmission of Plasmodium falciparum from a white multiorgan donor to four recipients. , 2003, Transplantation.

[47]  K. Khan,et al.  Global drug-resistance patterns and the management of latent tuberculosis infection in immigrants to the United States. , 2002, The New England journal of medicine.

[48]  W. Stauffer,et al.  Screening of international immigrants, refugees, and adoptees. , 2002, Primary care.

[49]  A. Lifson,et al.  Prevalence of Tuberculosis, Hepatitis B Virus, and Intestinal Parasitic Infections among Refugees to Minnesota , 2002, Public health reports.

[50]  M. Rogers,et al.  Treatment of latent tuberculosis infection in patients aged > or =35 years. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[51]  H. Saconato,et al.  Interventions for treating schistosomiasis mansoni. , 1999, The Cochrane database of systematic reviews.

[52]  A. Weissman Preventive Health Care And Screening Of Latin American Immigrants In The United States , 1994, The Journal of the American Board of Family Medicine.

[53]  Y. C. Chen,et al.  Plasmodium vivax infection in a renal transplant recipient: report of a case. , 1994, Journal of the Formosan Medical Association = Taiwan yi zhi.

[54]  C. Kaiser,et al.  Ultrasonographical investigation of periportal fibrosis in children with Schistosoma mansoni infection: reversibility of morbidity seven months after treatment with praziquantel. , 1991, The American journal of tropical medicine and hygiene.

[55]  H. Popper American Association for the Study of Liver Diseases: Symposium on Toxic Hepatic Injury , 1960 .

[56]  M. I. González-Tomé,et al.  [Recommendations for the diagnosis, treatment and follow-up of the pregnant woman and child with Chagas disease. Sociedad Española de Infectología Pediátrica. Sociedad de Enfermedades Infecciosas y Microbiología Clínica. Sociedad Española de Ginecología y Obstetricia]. , 2013, Enfermedades infecciosas y microbiologia clinica.

[57]  M. Eckman,et al.  The cost-effectiveness of screening for chronic hepatitis B infection in the United States. , 2011, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[58]  R. M. Masvidal Aliberch,et al.  [Indication of determination of antibodies against hepatitis C and A viruses in the protocol for the care of young immigrants]. , 2010, Gaceta sanitaria.

[59]  C. Manzardo,et al.  Communicable diseases in the immigrant population attended to in a tropical medicine unit: epidemiological aspects and public health issues. , 2008, Travel medicine and infectious disease.

[60]  Marcel Tanner,et al.  Questionnaires for rapid screening of schistosomiasis in sub-Saharan Africa. , 2002, Bulletin of the World Health Organization.

[61]  Eter,et al.  THE COST EFFECTIVENESS OF STRATEGIES FOR THE TREATMENT OF INTESTINAL PARASITES IN IMMIGRANTS , 2000 .

[62]  J. Ehrich,et al.  Ultrasonographical investigation of periportal fibrosis in children with Schistosoma mansoni infection: reversibility of morbidity twenty-three months after treatment with praziquantel. , 1992, The American journal of tropical medicine and hygiene.