Accuracy of diagnostic tests for Schistosoma mansoni infection in asymptomatic Eritrean refugees: serology and POC-CCA against stool microscopy

The unprecedented increase in number of African refugees arriving in Europe is confronting clinicians and general practitioners with the question of whether or not and how to screen migrants from endemic regions for Schistosoma mansoni infection.; We assessed the accuracy of 3 different diagnostic tests for S. mansoni infection (stool microscopy [samples prepared by sedimentation technique], serology, and point-of-care circulating cathodic antigen [POC-CCA] urine cassette test) in 107 newly arrived asymptomatic Eritrean refugees in Switzerland.; Sixty-three study participants (59%) tested positive by at least 1 of the 3 methods. Thirty-seven participants (35%) were considered to have active schistosomiasis, either due to the detection of parasite eggs in stool and/or the presence of a concordant positive serology and urine POC-CCA test, which we consider to be a suitable surrogate marker of active infection. Of 23 microscopy-positive participants, 22 were positive by serology (95.7% sensitivity) and 21 were positive by the urine POC-CCA test (91.3% sensitivity). The combination of serology and urine POC-CCA testing detected all 23 microscopy-positive study participants (100% sensitivity).; With a sensitivity of 100% (95% confidence interval, 82.2%-100%), the combination of serology plus urine POC-CCA testing appears to be the most sensitive screening option for asymptomatic S. mansoni infection in Eritrean refugees, compared with stool sedimentation microscopy

Cardiovascular diseases risk factors among recently arrived Eritrean refugees in Switzerland

For the past 10 years, refugees from Eritrea represented the majority of asylum seekers in Switzerland. However, data on their health status remains limited. In this cross-sectional survey followed by a 1-year cohort study, we screened newly arrived Eritrean refugees for cardiovascular risk factors at arrival and 1-year post registration.; Among 107 participants (88.8% male; median age 25, 9 (9%) had a body mass index ≥ 25 kg/m; 2; , one (1%) had elevated blood pressure, one (1%) had diabetes, 19% smoked and two (2%) had a low density lipoprotein (LDL) cholesterol ≥ 4.1 mmol/l. Among the 48 participants (5 females, 43 males) followed, there were no significant changes in cardiovascular risk profile 1 year post-arrival

Women's sexual health and contraceptive needs after a severe obstetric complication ("near-miss"): a cohort study in Burkina Faso

BACKGROUND: Little is known about the reproductive health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect reproductive events in the first year postpartum. METHODS: Data were collected from a prospective cohort of women who either experienced life threatening (near-miss) pregnancy-related complications or an uncomplicated childbirth, followed from the end of pregnancy to one year postpartum or post-abortum. Documented outcomes include menses resumption, sexual activity resumption, dyspareunia, uptake of contraceptives, unmet needs for contraception and women's reproductive intentions.Participants were recruited in seven hospitals between December 2004 and March 2005 in six towns in Burkina Faso. RESULTS: Reproductive events were associated with pregnancy outcome. The frequency of contraceptive use was low in all groups and the method used varied according to the presence or not of a live baby. The proportion with unmet need for contraception was high and varied according to the time since end of pregnancy. Desire for another pregnancy was highest among near-miss women with perinatal death or natural abortion. Women in the near-miss group with induced abortion, perinatal death and natural abortion had significantly higher odds of subsequent pregnancy. Unintended pregnancies were observed mainly in women in the near-miss group with live birth and the uncomplicated delivery group. CONCLUSIONS: Considering the potential deleterious impact (on health and socio-economic life) of new pregnancies in near-miss women, it is important to ensure family planning coverage includes those who survive a severe complication

Seroprotection rates of vaccine-preventable diseases among newly arrived Eritrean asylum seekers in Switzerland: a cross-sectional study.

BACKGROUND According to 2016 WHO/UNICEF country estimates Eritrea has overall high vaccination coverage with immunisation rates for 3 doses of diphtheria/tetanus/pertussis and polio vaccine of 95%, for 2 doses measles vaccine of 85%, and for 3 doses Hepatitis B vaccine of 85%. If confirmed, this could imply that routine basic vaccination of newly arrived Eritreans could be safely omitted. METHODS We used stored serum samples from two cross-sectional studies that screened newly arrived Eritrean refugees for infectious diseases. Consenting refugees aged 16 years and older who registered in one of three neighbouring cantons in northwestern Switzerland were enrolled between January 2016 and December 2017. Antibody titers against the following vaccine-preventable diseases were measured (applied thresholds for seroprotection in brackets): diphtheria (> 0.1 IU/ml), tetanus (> 0.1 IU/ml), measles (> 150 mIU/ml), rubella (only for women,> 11 IU/ml), varicella (> 50 mIU/ml), hepatitis B (HbsAg Index > 0.9, antiHBc Index > 0.9 and antiHBs > 10 IE/L). Differences between sex and age groups (≤ 25 and >25 years) were measured by Fisher's exact test. RESULTS We analysed samples of 133 study participants (20 women, 15%) with a median age of 25 years (range 16-61). Rates of sero-positivity were as follow for women / men respectively: diphtheria 57.9% / 74.8% (difference non significant), tetanus 94.8% / 41.1% (p<0.001), measles 73.7% / 76.6% (non sig.), rubella in women 78.9%, varicella 89.5% / 95.3% (non sig.), anti-HBc 15.8% / 26.2% (non sig.), and anti-HBs 15.8% / 17.8% (non sig.). CONCLUSIONS Sero-prevalence for vaccine-preventable infections did not meet levels required to confer herd-immunity in any of the human-to-human transmissible diseases that were studied. In general, the strategy proposed by the Federal Office of Public Health to offer basic immunization to all newly arrived refugees, including newly arriving Eritrean refugees, is justified

Impact of alcohol-based hand-gel sanitizer and hand hygiene advice on travellers' diarrhoea and colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae: a randomised, controlled trial

Travellers' diarrhoea (TD) is the most common health problem in international travellers. Besides being bothersome for the individual and a considerable economic burden for the public, TD is also known to be associated with becoming colonized with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriacea. Despite the high frequency of TD cases, easy and effective preventive measures are lacking. The aim of this study was to assess the impact of using hand gel sanitizer on the incidence of TD and colonization with ESBL-producing Enterobacteriaceae.; A multicentre randomized intervention trial studying the effect of hand gel sanitizer on the incidence of TD and colonization with ESBL-producing Enterobacteriaceae in travellers to Southeast Asia was performed.; The intention to treat analysis showed a reduction in the incidence of WHO TD in the intervention group (OR 0.54 (95% CI 0.30-0.97), p = 0.04). No effect was seen or the incidence of becoming colonized with ESBL-producing Enterobacteriaceae.; Using hand gel sanitizer might have a protective effect on the occurrence of TD. Based on the current data, education on the proper use appears to play a key role for its effectiveness

Performance of the point-of-care circulating cathodic antigen (POC-CCA) urine cassette test for follow-up after treatment of S. mansoni infection in Eritrean refugees

Point-of-care circulating cathodic antigen (POC-CCA) urine cassette testing has become a popular approach to screen for Schistosoma infection. Since the test is also increasingly used for following-up of treatment success, we assessed the assay's diagnostic accuracy after praziquantel treatment of S. mansoni infection among Eritrean refugees in Switzerland.; In our preceding study, 107 asymptomatic Eritrean refugees in Switzerland were screened for schistosomiasis by stool microscopy, serology, and POC-CCA urine testing. Individuals screened positive by any method were treated with praziquantel and invited for a follow-up visit, repeating the same diagnostic procedures one year after treatment. The POC-CCA baseline and follow-up results were analyzed against the 'baseline microscopy positive cases' (= the most reliably true positive cases) and the 'baseline microscopy plus serology negative cases at baseline and follow-up' (= the most reliably true negative cases).; Complete diagnostic baseline and follow-up sampling was available from 48 participants. Compared to most reliably true positive cases at baseline, POC-CCA testing had a sensitivity of 90%. Compared to most reliably true negative cases, POC-CCA testing had a specificity of 73.9%.; We conclude that the POC-CCA urine test is valuable for screening but its use is not suitable for routine follow-up after treatment

Serum 25-hydroxyvitamin D levels and intramuscular vitamin D3 supplementation among Eritrean migrants recently arrived in Switzerland

In a cross-sectional screening programme, we assessed serum vitamin D levels in adult Eritrean refugees recently arrived in Switzerland. Median vitamin D level among 107 participants (95 males and 12 females) was 27 nmol/l (interquartile range 23-42 nmol/l), 86% had insufficient vitamin D levels (≤50 nmol/l) and 36% severe deficiency (&lt;25 nmol/l). In 29 participants who received single-dose intramuscular vitamin D substitution (300 000 IU), median vitamin D levels increased from 25 to 35 nmol/l after 3 months (p = 0.005); only 11 (38%) reached sufficient vitamin D levels. Eritrean migrants should be routinely screened for vitamin D deficiency. Single-dose intramuscular supplementation appeared to be insufficient to achieve optimal levels in the majority of participants

Spectrum of infectious diseases among newly arrived Eritrean refugees in Switzerland : a cross-sectional study

Our study aimed at determining the prevalence of selected infectious diseases among recently arrived Eritrean refugees in Switzerland.; In this cross-sectional study, asymptomatic Eritrean migrants aged ≥16 years who arrived &lt;24 months ago were recruited at refugee centres in Switzerland. Infectious disease screening included serology for HIV, hepatitis B and C, syphilis and schistosomiasis, polymerase chain reaction (PCR) for malaria, stool microscopy for helminths and intestinal protozoa and circulating cathodic antigen (CCA) testing in urine for schistosomiasis.; Among 107 participating Eritrean refugees, point-of-care CCA urine test for Schistosoma mansoni was positive in 43 patients (40.2%; 95% CI 31.9-49.5). Stool microscopy detected eggs of S. mansoni in 23 (21.5%; 95% CI 13.7-29.3), Hymenolepis nana in 11 (10.3%; 95% CI 4.5-16.0), and cysts of Giardia intestinalis in 7 participants (6.5%: 95% CI 1.9-11.2). Two tested positive for hepatitis B (1.9%; 95% CI 0.0-4.4) and one for syphilis (0.9%; 95% CI 0.0-2.8), none tested positive for HIV or hepatitis C. Malaria PCR was positive in six participants (5.6%; 95% CI: 1.2-9.9).; Given the high prevalence of S. mansoni infection and potentially severe long-term sequelae of untreated schistosomiasis, routine screening for schistosomiasis in refugees from Schistosoma-endemic regions should be recommended

Impfungen bei erwachsenen Flüchtlingen

Die wenigsten Asylsuchenden kommen komplett ungeimpft in der Schweiz an, aber ein Impfausweis liegt nur selten vor. In der Regel sollen Flüchtlinge daher als ungeimpft betrachtet und baldmöglichst gemäss aktueller Version des Schweizerischen Impfplans des Bundesamtes für Gesundheit geimpft werden (Nachholimpfungen bei ungeimpften bzw. unvollständig geimpften Personen). In diesem Artikel geben wir Empfehlungen für ein sinnvolles Impfen beim ärztlichen Erstkontakt und den Folgekonsultationen