La crisi econòmica condiciona l'aparició d'un nou perfil de risc en viatgers internacionals?

La crisi econòmica ha comportat un augment dels viatges de treballadors europeus cap a països de renda baixa amb economies emergents. Un estudi pioner ha observat que aquests viatgers tenen més factors de risc d'emmalaltir durant el viatge perquè, en comparació amb els viatgers que es desplaçaven per motius laborals abans de la crisi econòmica, aquests tenen més edat, més malalties associades i realitzen viatges de major durada i a zones rurals. També s'ha produït un increment dels viatges a l'Àfrica, on hi ha més risc d'adquirir malalties greus com ara la malària.La crisis económica ha comportado un aumento de los viajes de trabajadores europeos hacia países de renta baja con economías emergentes. Un estudio pionero ha observado que estos viajeros tienen más factores de riesgo de enfermar durante el viaje porque, en comparación con los viajeros que se desplazaban por motivos laborales antes de la crisis económica, éstos tienen más edad, más enfermedades asociadas y realizan viajes de mayor duración y a zonas rurales. También se ha producido un incremento de los viajes a África, donde hay más riesgo de adquirir enfermedades graves como la malaria

Approach to amoebic colitis: Epidemiological, clinical and diagnostic considerations in a non-endemic context (Barcelona, 2007-2017)

Amoebic colitis; Non-endemic; BarcelonaColitis amèbica; No-endèmic; BarcelonaColitis Amebiana; No-endémico; BarcelonaBACKGROUND: Amoebic colitis is the most frequent clinical manifestation of invasive intestinal infection due to Entamoeba histolytica and a common cause of diarrhoea worldwide. Since higher transmission rates are usually related to poor health and exposure to unhygienic conditions, cases reported in Europe usually involve immigrants and international travellers. The goal of this study was to characterise both the clinical and the epidemiological features of a European population diagnosed with amoebic colitis and then to evaluate the diagnostic tools and therapeutic options applied. METHODS AND RESULTS: This was a retrospective observational study in which data from all patients diagnosed with amoebic colitis attending at the International Health Units of two tertiary referral hospitals, Germans Trias i Pujol University Hospital (Badalona, North Barcelona Metropolitan Area) and Vall d'Hebron University Hospital (Barcelona city) between 2007 and 2017 were analysed. During the study period 50 patients were diagnosed with amoebic colitis. Thirty-six (72%) were men, and immigrants accounted for 46% of all cases. Antecedents of any international travel were reported for 28 (56%), the most frequent destinations having been the Indian subcontinent, South and Central America and sub-Saharan Africa. Preexisting pathological conditions or any kind of immunosuppression were identified in 29 (58%) patients; of these, 13 (26%) had HIV infection-all of them men who have sex with men-and 5 (10%) had inflammatory bowel disease. Diarrhoea, abdominal pain and dysentery were the most frequently recorded symptoms of invasive amoebae. Diagnosis was made through microbiological study in 45 (90%) and/or histological identification of amoebae in colon biopsies in 10 (20%). After treatment with metronidazole (82%) or tinidazole (8%), all patients had good outcomes. Post-acute intraluminal treatment was indicated in 28 (56%). CONCLUSIONS: Amoebic colitis should be suspected in patients with diarrhoea and compatible epidemiological risk factors (immigration, travelling abroad or men who have sex with men), especially if some degree of immunosuppression concurs. These risk factors must be taken into account in any diagnostic approach to inflammatory bowel disease (IBD), and active searches for stool parasites should be performed in such cases to rule out misdiagnosis or simultaneous amoebic infection. Treatment should include intraluminal anti-amoebic treatment in order to avoid relapse and prevent further spread of the disease

Schistosomiasis Among Female Migrants in Non-endemic Countries : Neglected Among the Neglected? A Pilot Study

Schistosomiasis among migrant populations in Europe is an underdiagnosed infection, yet delayed treatment may have serious long-term consequences. In this study we aimed to characterize the clinical manifestations of Schistosoma infection among migrant women, and the degree of underdiagnosis. We carried out a prospective cross-sectional study among a migrant population living in the North Metropolitan Barcelona area and coming from schistosomiasis-endemic countries. We obtained clinical, laboratory and socio-demographic data from electronic clinical records, as well as information about years of residence and previous attendance at health services. Blood sample was obtained and schistosomiasis exposure was assessed using a specific ELISA serological test. Four hundred and five patients from schistosomiasis-endemic regions were screened, of whom 51 (12.6%) were female. Seropositivity prevalence was 54.8%, but considering women alone we found a prevalence of 58.8% (30 out of 51). The median age of the 51 women was 41.0 years [IQR (35-48)] and the median period of residence in the European Union was 13 years [IQR (10-16)]. Schistosoma -positive women (N = 30) showed a higher prevalence of gynecological signs and symptoms compared to the seronegative women (96.4 vs. 66.6%, p = 0.005). Among seropositive women, the median number of visits to Sexual and Reproductive Health unit prior to diagnosis of schistosomiasis was 41 [IQR (18-65)]. The high prevalence of signs and symptoms among seropositive women and number of previous visits suggest a high rate of underdiagnosis and/or delayed diagnosis of Schistosoma infection, particularly female genital schistosomiasis, among migrant females

Vigilancia epidemiológica intensificada de arbovirosis : primer caso de dengue autóctono en Cataluña (España), zona Metropolitana Norte de Barcelona, 2018-2019

La Plataforma Integral para control de las arbovirosis en Cataluña (PICAT) es un proyecto realizado con el apoyo del Departamento de Salud de la Generalitat de Catalunya y ha sido financiada mediante una beca del Pla Estratègic de Recerca i Innovació en Salut (PERIS) 2016-2020, cod. exp. SLT002/16/00466Valorar los resultados obtenidos por una red de vigilancia epidemiológica y asistencial de arbovirosis compuesta por médicos y profesionales de enfermería de hospital y atención primaria (AP) formados en su identificación, confirmación diagnóstica y manejo clínico. Zona Sanitaria Metropolitana Norte de Barcelona (1.400.000 habitantes; Cataluña, España) durante un año natural. Diecisiete médicos (7 de AP y 10 hospitalarios) más 4 enfermeros/as de AP. Estudio observacional prospectivo. Se definieron variables demográficas, epidemiológicas (caso autóctono/importado, sospechoso/probable/confirmado) y asistenciales (síntomas, perfil serológico, periodo virémico). De los 34 pacientes identificados cumplían criterios de estudio 26 (76,5%) casos; de ellos, se confirmó alguna arbovirosis en 14 (53,8%): 13 fiebres dengues más 1 chikungunya. No se registraron casos de fiebre de zika. Existían antecedentes de viaje a zonas endémicas (23; 88,4%), pero no en 3 casos (11,6%), en los que se consideró la posibilidad de una transmisión autóctona; de ellos, se confirmó un caso de dengue. La incidencia estimada de arbovirosis fue de 0,4 (IC 95%: 0,33-0,51) casos × 10.000 hab./año, que, comparada con la incidencia estimada en la misma área geográfica durante el periodo 2009-2013 (0,19 casos × 10.000 hab./año; IC 95%: 0,07-0,31), mostró un incremento significativo (p = 0,044). Los pacientes en periodo de viremia al momento de la primera visita médica fueron 11 (42,3%). Un programa de vigilancia epidemiológica intensificada definido a nivel de AP y hospitalario es capaz de detectar significativamente más casos de arbovirosis importadas y transmitidas autóctonamente. Posiblemente asistimos a un aumento en la incidencia de arbovirosis importadas, por lo que las medidas encaminadas a su identificación y confirmación deben reforzarse

Epidemiological, clinical, diagnostic and economic features of an immigrant population of chronic schistosomiasis sufferers with long-term residence in a nonendemic country (North Metropolitan area of Barcelona, 2002-2016)

Background. Schistosomiasis, one of the neglected tropical diseases (NTD) listed by the WHO, is an acute and chronic parasitic disease caused by blood flukes (trematode worms) of the genus Schistosoma. Complications of long-term infestation include liver cirrhosis, bladder tumors and kidney failure. The objective of this study was to carry out a clinical and epidemiological characterization of a schistosomiasis-diagnosed immigrant population with long-term residencein the EU as well as to evaluate the diagnostic methods available to date. Methods and results. A total of 61 individuals with Schistosoma infection who received medical attention between June 2002 and June 2016 at the North Metropolitan International Health Unit in Barcelona (Catalonia, Spain), were included in the study. All patients were sub-Saharan African immigrants. The majority were male (91.8%) with a median age of 34 years. Symptoms attributable to infection such as haematuria, abdominal pain and dysuria were recorded in up to 90% of patients. The percentage of eosinophils decreased amongst older patients (p = 0.002) and those with symptoms associated with urinary tract infections (p = 0.017). Serology was used for diagnosis in 80.3% of the cases, with microscopic examination showingthe remaining 9.8% positive for parasite eggs. Direct microbiological diagnosis was more useful in patients with less than 5 years of residence in the EU (p = 0.05). Chronic complications were present in 22 (36%) of the patients, with renal failure affecting 20 (33%). Of these 20, 6(10%) developed terminal renal failure and required hemodialysis, while 3 (5%) received a renal transplantation. Conclusion. Morbidity associated with chronic long-term schistosomiasis is frequent among African immigrants in non-endemic countries. Better diagnostic tools and appropriate early treatment would prevent the development of visceral damage. Thorough screening in selected patients would also be useful to avoid chronic complications

La crisi econòmica condiciona l'aparició d'un nou perfil de risc en viatgers internacionals?

La crisi econòmica ha comportat un augment dels viatges de treballadors europeus cap a països de renda baixa amb economies emergents. Un estudi pioner ha observat que aquests viatgers tenen més factors de risc d'emmalaltir durant el viatge perquè, en comparació amb els viatgers que es desplaçaven per motius laborals abans de la crisi econòmica, aquests tenen més edat, més malalties associades i realitzen viatges de major durada i a zones rurals. També s'ha produït un increment dels viatges a l'Àfrica, on hi ha més risc d'adquirir malalties greus com ara la malària.La crisis económica ha comportado un aumento de los viajes de trabajadores europeos hacia países de renta baja con economías emergentes. Un estudio pionero ha observado que estos viajeros tienen más factores de riesgo de enfermar durante el viaje porque, en comparación con los viajeros que se desplazaban por motivos laborales antes de la crisis económica, éstos tienen más edad, más enfermedades asociadas y realizan viajes de mayor duración y a zonas rurales. También se ha producido un incremento de los viajes a África, donde hay más riesgo de adquirir enfermedades graves como la malaria

Malalties infeccioses emergents a la zona Metropolitana Nord de Barcelona

Els canvis socioeconòmics i climàtics, que pateix el món globalitzat condueixen a un canvi d’escenari de la patologia infecciosa que s’atén en l’àmbit sanitari i que requerirà una especialització i expertesa que intentem reflectir en aquest treball. La present tesi estudia i analitza dades sanitàries de la població viatgera i immigrant establerta a la zona Metropolitana Nord de Barcelona, majoritàriament de la comunitat resident a Badalona i a Santa Coloma de Gramenet durant el període fonamentalment 2007 al 2013. La majoria de dades s’han recollit tan a nivell de l’atenció primària (Unitat de Salut Internacional Metropolitana Nord) com a nivell d’un hospital de tercer nivell (Hospital Germans Trias i Pujol), ambdós conformant la Unitat territorial de Salut Internacional Metropolitana Nord del Programa de Salut Internacional de l’ Institut Català de la Salut (PROSICS) aprovat al 2012. La tesi s’ha dividit en quatre treballs que responen a quatre premisses: 1. A 5 anys de la crisi econòmica existeix una variació en el perfil de risc del viatger internacional que es desplaça per motiu laboral. N’ha augmentat el número, així com els factors de risc als que s’exposa per adquirir malalties infeccioses 2. La incidència de dengue i chikungunya està en augment en l’àrea Metropolitana Nord de Barcelona a expenses de casos importats per viatgers internacionals. Malgrat que fins al moment no ha aparegut cap cas autòcton la zona està densament poblada pel vector Ae.albopictus. 3. Un 90% dels casos de infeccions per Strongyloides stercolaris que es diagnostiquen a la nostra zona són importades per immigrants. Majoritàriament es tracta de infeccions asimptomàtiques i el diagnòstic es basa en la sospita clínica i/o analítica, i en la cerca activa del paràsit. Caldrà implementar protocols de cribatge en immigrants immunodeprimits per l’alta mortalitat que pot comportar la reactivació de la infecció. 4. La malaltia de Chagas és la malaltia emergent més important en el nostre territori per la gran quantitat de persones que procedeixen d’àrees endèmiques. En la nostra zona roman infradiagnosticada ja que s’han detectat molts menys casos dels esperats. La sèrie però té un elevat número de malalts amb afectació visceral. Donat el risc de transmissió no vectorial en un país no endèmic i les complicacions cròniques de la malaltia, s’hauria de fomentar la informació i el cribatge en la població de risc. Així doncs, amb l’ increment dels viatges internacionals i la immigració, a Catalunya, ha augmentat el número de pacients amb malalties infeccioses emergents, moltes d’elles importades des de zones tropicals i subtropicals. El risc que representen per a la salut pública sembla ser baix, encara que els canvis que s’estan produint en relació a la crisi econòmica mundial, a la introducció biogeogràfica de vectors, al canvi climàtic i sobretot a l’aparició de reservoris naturals d’aquestes infeccions, ens situen en un context imprevisible. Un accés universal a l’assistència sanitària, que aquesta sigui d’expertesa i qualitat per garantir un diagnòstic i tractament immediat, junt a una vigilància epidemiològica estreta i les intervencions en Salut Pública corresponents, són peces clau per a preservar la Salut de la nostra població.Nowadays, the health care of infectious diseases urgently demands a change of scenario due to socioeconomic and climatic changes as a consequence of the globalized world, and requires a specialization and particular expertises from the health community. This issue is dealt in this study. The present doctoral thesis focuses on the analyses of health data of international travellers and immigrants in the area of Nothern Metropolitan Barcelona residing in Badalona and Santa Coloma de Gramanet from 2007 to 2013. Data was collected in primary care (International Nothern Metropolitan Health Unit) and in a tertiary level hospital (Hospital Germans Trias i Pujol), which shapes the territorial unit of International Health Northern Metropolitan Health Program of the International Catalan Institute of Helath (PROSICS) approved in 2012. The doctoral thesis is divided into four projects which are based on four premises: 1. After 5-years of economic crisis, it has been a change in the risk profile of the international traveller who travels for work. The number of travellers as well as the risk factors to which they are exposed to acquire infectious diseases have increased. 2. The incidence of dengue and chikungunya is increasing in the Metropolitan area north of Barcelona at the expense of imported cases from international travellers. So far, have not appeared cases of dengue and chikungunya in the local area, although it is densely populated by the vector Ae.albopictus. 3. 90% of cases of infections Strongyloides stercolaris diagnosed in our area are imported by immigrants. Partly, it is an asymptomatic infectious and diagnosis is based on clinical suspicion and / or analysis, and the active search for parasites. We will have to implement screening protocols in immunocompromised immigrants for the high mortality that can lead to reactivation of the infection. 4. Chagas’ disease is the most important emerging disease in our country due to people who come from endemic areas. In our area, this infectious disease remains underdiagnosed, because of fewer cases detected than expected. However, Chagas’ patients have a remarkable incidence of visceral involvement. Given the risk of non-vector transmission in a country which is not endemic as well as for the chronic complications of the disease, it should be promoted the information and screening in the population at risk. So, the number of patients with emerging infectious diseases, of which many of them are imported from tropical and subtropical areas, has grown in Catalonia with the increase in international travels and immigration. The risk that they represent to public health appears to be low, although the changes taking place in relation to the global economic crisis, with the introduction of biogeographic vectors, particularly climate change, and the occurrence of natural reservoirs of these infections, lead us to an unexpected context. Finally, the key for preserving the health of our population is the universal access to health care, being of expertise and quality to ensure immediate diagnosis and a precise treatment, along with a narrow epidemiological surveillance and the public health interventions related

Schistosomiasis screening in non-endemic countries from a cost perspective: knowledge gaps and research priorities: the case of African long-term residents in a Metropolitan Area, Spain

Background: Imported schistosomiasis is an emerging issue in European countries as a result of growing global migration from schistosomiasis-endemic countries, mainly in sub-Saharan Africa. Undetected infection may lead to serious long-term complications with an associated high cost for public healthcare systems especially among long-term migrants. Objective: To evaluate from a health economics perspective the introduction of schistosomiasis screening programs in non-endemic countries with high prevalence of long-term migrants. Methodology: We calculated the costs associated with three approaches—presumptive treatment, test-and-treat and watchful waiting—under different scenarios of prevalence, treatment efficacy and the cost of care resulting from long-term morbidity. Costs were estimated for our study area, in which there are reported to reside 74,000 individuals who have been exposed to the infection. Additionally, we methodically reviewed the potential factors that could affect the cost/benefit ratio of a schistosomiasis screening program and need therefore to be ascertained. Results: Assuming a 24% prevalence of schistosomiasis in the exposed population and 100% treatment efficacy, the estimated associated cost per infected person of a watchful waiting strategy would be €2,424, that of a presumptive treatment strategy would be €970 and that of a test-and-treat strategy would be €360. The difference in averted costs between test-and-treat and watchful waiting strategies ranges from nearly €60 million in scenarios of high prevalence and treatment efficacy, to a neutral costs ratio when these parameters are halved. However, there are important gaps in our understanding of issues such as the efficacy of treatment in infected long-term residents, the natural history of schistosomiasis in long-term migrants and the feasibility of screening programs. Conclusion: Our results support the roll-out of a schistosomiasis screening program based on a test-and-treat strategy from a health economics perspective under the most likely projected scenarios, but important knowledge gaps should be addressed for a more accurate estimations among long-term migrants

Malalties infeccioses emergents a la zona Metropolitana Nord de Barcelona

Els canvis socioeconòmics i climàtics, que pateix el món globalitzat condueixen a un canvi d'escenari de la patologia infecciosa que s'atén en l'àmbit sanitari i que requerirà una especialització i expertesa que intentem reflectir en aquest treball. La present tesi estudia i analitza dades sanitàries de la població viatgera i immigrant establerta a la zona Metropolitana Nord de Barcelona, majoritàriament de la comunitat resident a Badalona i a Santa Coloma de Gramenet durant el període fonamentalment 2007 al 2013. La majoria de dades s'han recollit tan a nivell de l'atenció primària (Unitat de Salut Internacional Metropolitana Nord) com a nivell d'un hospital de tercer nivell (Hospital Germans Trias i Pujol), ambdós conformant la Unitat territorial de Salut Internacional Metropolitana Nord del Programa de Salut Internacional de l' Institut Català de la Salut (PROSICS) aprovat al 2012. La tesi s'ha dividit en quatre treballs que responen a quatre premisses: 1.A 5 anys de la crisi econòmica existeix una variació en el perfil de risc del viatger internacional que es desplaça per motiu laboral. N'ha augmentat el número, així com els factors de risc als que s'exposa per adquirir malalties infeccioses 2.La incidència de dengue i chikungunya està en augment en l'àrea Metropolitana Nord de Barcelona a expenses de casos importats per viatgers internacionals. Malgrat que fins al moment no ha aparegut cap cas autòcton la zona està densament poblada pel vector Ae.albopictus. 3.Un 90% dels casos de infeccions per Strongyloides stercolaris que es diagnostiquen a la nostra zona són importades per immigrants. Majoritàriament es tracta de infeccions asimptomàtiques i el diagnòstic es basa en la sospita clínica i/o analítica, i en la cerca activa del paràsit. Caldrà implementar protocols de cribatge en immigrants immunodeprimits per l'alta mortalitat que pot comportar la reactivació de la infecció. 4.La malaltia de Chagas és la malaltia emergent més important en el nostre territori per la gran quantitat de persones que procedeixen d'àrees endèmiques. En la nostra zona roman infradiagnosticada ja que s'han detectat molts menys casos dels esperats. La sèrie però té un elevat número de malalts amb afectació visceral. Donat el risc de transmissió no vectorial en un país no endèmic i les complicacions cròniques de la malaltia, s'hauria de fomentar la informació i el cribatge en la població de risc. Així doncs, amb l' increment dels viatges internacionals i la immigració, a Catalunya, ha augmentat el número de pacients amb malalties infeccioses emergents, moltes d'elles importades des de zones tropicals i subtropicals. El risc que representen per a la salut pública sembla ser baix, encara que els canvis que s'estan produint en relació a la crisi econòmica mundial, a la introducció biogeogràfica de vectors, al canvi climàtic i sobretot a l'aparició de reservoris naturals d'aquestes infeccions, ens situen en un context imprevisible. Un accés universal a l'assistència sanitària, que aquesta sigui d'expertesa i qualitat per garantir un diagnòstic i tractament immediat, junt a una vigilància epidemiològica estreta i les intervencions en Salut Pública corresponents, són peces clau per a preservar la Salut de la nostra població.Nowadays, the health care of infectious diseases urgently demands a change of scenario due to socioeconomic and climatic changes as a consequence of the globalized world, and requires a specialization and particular expertises from the health community. This issue is dealt in this study. The present doctoral thesis focuses on the analyses of health data of international travellers and immigrants in the area of Nothern Metropolitan Barcelona residing in Badalona and Santa Coloma de Gramanet from 2007 to 2013. Data was collected in primary care (International Nothern Metropolitan Health Unit) and in a tertiary level hospital (Hospital Germans Trias i Pujol), which shapes the territorial unit of International Health Northern Metropolitan Health Program of the International Catalan Institute of Helath (PROSICS) approved in 2012. The doctoral thesis is divided into four projects which are based on four premises: 1. After 5-years of economic crisis, it has been a change in the risk profile of the international traveller who travels for work. The number of travellers as well as the risk factors to which they are exposed to acquire infectious diseases have increased. 2. The incidence of dengue and chikungunya is increasing in the Metropolitan area north of Barcelona at the expense of imported cases from international travellers. So far, have not appeared cases of dengue and chikungunya in the local area, although it is densely populated by the vector Ae.albopictus. 3. 90% of cases of infections Strongyloides stercolaris diagnosed in our area are imported by immigrants. Partly, it is an asymptomatic infectious and diagnosis is based on clinical suspicion and / or analysis, and the active search for parasites. We will have to implement screening protocols in immunocompromised immigrants for the high mortality that can lead to reactivation of the infection. 4. Chagas' disease is the most important emerging disease in our country due to people who come from endemic areas. In our area, this infectious disease remains underdiagnosed, because of fewer cases detected than expected. However, Chagas' patients have a remarkable incidence of visceral involvement. Given the risk of non-vector transmission in a country which is not endemic as well as for the chronic complications of the disease, it should be promoted the information and screening in the population at risk. So, the number of patients with emerging infectious diseases, of which many of them are imported from tropical and subtropical areas, has grown in Catalonia with the increase in international travels and immigration. The risk that they represent to public health appears to be low, although the changes taking place in relation to the global economic crisis, with the introduction of biogeographic vectors, particularly climate change, and the occurrence of natural reservoirs of these infections, lead us to an unexpected context. Finally, the key for preserving the health of our population is the universal access to health care, being of expertise and quality to ensure immediate diagnosis and a precise treatment, along with a narrow epidemiological surveillance and the public health interventions related