Infectious diseases at different stages of migration: an expert review

Determinants of uptake of influenza, zoster and pneumococcal vaccines in patients with cardiovascular diseases

BACKGROUND

Globally, cardiovascular disease (CVD) is the leading cause of death and illness. Vaccine-preventable infections may increase acute coronary vascular disease events and the risk of complications. Low vaccine coverage has been reported among adults at high risk of complications from vaccine-preventable infections. There is a gap in research evidence around determinants of uptake of vaccines among adults with CVD. This study examined the uptake of influenza, pneumococcal and zoster vaccines and the determinants of uptake of the vaccines among cardiac patients.

METHOD

A prospective cross-sectional study was carried out among hospitalised cardiac patients through an interviewer-administered questionnaire. Descriptive statistics were used to investigate self-reported uptake of influenza, pneumococcal and zoster vaccines. Univariate and multivariate analyses of participants' social demographic and clinical characteristics were conducted to identify factors for receiving influenza vaccine.

RESULTS

Low vaccination rates among 104 participants were found for influenza (45.2%), pneumococcal (13.5%) and zoster (5.8%) vaccines. The most common reason for not receiving influenza vaccine was concern about side effects. Lack of awareness about the pneumococcal and zoster vaccines was the main reason for the poor uptake of these vaccines. Australia-born participants were more likely to receive influenza vaccine than overseas-born participants. Working-age participants and, interestingly, people living with a current smoker were less likely to receive influenza vaccine.

CONCLUSION

Influenza, pneumococcal and zoster vaccine uptake among cardiac patients was low. Encouraging physician recommendations for vaccination for cardiac patients under 65 years of age and addressing vaccination challenges among people from culturally and linguistically diverse backgrounds and pharmacy, workplace, and hospital vaccination may help increase vaccination uptake among cardiac patients.

Navigating Evolving Challenges in Blood Safety

Blood safety remains a paramount public health concern, and health authorities maintain a high level of vigilance to prevent transfusion-transmitted infections (TTIs) [...].

Pulmonary Tuberculosis Following Immune Checkpoint Inhibitor Treatment for Recurrent Maxillary Squamous Cell Carcinoma

Immune checkpoint inhibitors (ICIs) like nivolumab and pembrolizumab are effective treatments for recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). However, they can lead to immune-related adverse events (irAEs) and tuberculosis (TB) reactivation. We present a case of a 79-year-old male with recurrent maxillary squamous cell carcinoma treated with pembrolizumab, cisplatin, and 5-fluorouracil. The patient developed a fever, and pulmonary TB development was confirmed. Prolonged TB treatment was required, and ICI treatment was discontinued. The patient ultimately opted for palliative care due to aggressive tumor growth. TB development during ICI treatment is a rare but important concern, especially in TB-endemic areas. Vigilant monitoring and screening might be essential to manage this risk in cancer patients with R/M SCCHN receiving ICIs.

Multi-infection screening for migrant patients in UK primary care: Challenges and opportunities

Background

Migrants in Europe face a disproportionate burden of undiagnosed infection, including tuberculosis, blood-borne viruses, and parasitic infections and many belong to an under-immunised group. The European Centre for Disease Control (ECDC) has called for innovative strategies to deliver integrated multi-disease screening to migrants within primary care, yet this is poorly implemented in the UK. We did an in-depth qualitative study to understand current practice, barriers and solutions to infectious disease screening in primary care, and to seek feedback on a collaboratively developed digitalised integrated clinical decision-making tool called Health Catch UP!, which supports multi-infection screening for migrant patients.

Methods

Two-phase qualitative study of UK primary healthcare professionals, in-depth semi-structured telephone-interviews were conducted. In Phase A, we conducted interviews with clinical staff (general practitioners (GPs), nurses, health-care-assistants (HCAs)); these informed data collection and analysis for phase B (administrative staff). Data were analysed iteratively, using thematic analysis.

Results

In phase A, 48 clinicians were recruited (25 GPs, 15 nurses, seven HCAs, one pharmacist) and 16 administrative staff (11 Practice-Managers, five receptionists) in phase B. Respondents were positive about primary care's ability to effectively deliver infectious disease screening. However, we found current infectious disease screening lacks a standardised approach and many practices have no system for screening meaning migrant patients are not always receiving evidence-based care (i.e., NICE/ECDC/UKHSA screening guidelines). Barriers to screening were reported at patient, staff, and system-levels. Respondents reported poor implementation of existing screening initiatives (e.g., regional latent TB screening) citing overly complex pathways that required extensive administrative/clinical time and lacked financial/expert support. Solutions included patient/staff infectious disease champions, targeted training and specialist support, simplified care pathways for screening and management of positive results, and financial incentivisation. Participants responded positively to Health Catch-UP!, stating it would systematically integrate data and support clinical decision-making, increase knowledge, reduce missed screening opportunities, and normalisation of primary care-based infectious disease screening for migrants.

Conclusions

Our results suggest that implementation of infectious disease screening in migrant populations is not comprehensively done in UK primary care. Primary health care professionals support the concept of innovative digital tools like Health Catch-UP! and that they could significantly improve disease detection and effective implementation of screening guidance but that they require robust testing and resourcing.

Infections with long latency in international refugees, immigrants, and migrants seen at GeoSentinel sites, 2016-2018

BACKGROUND

The continued increase in global migration compels clinicians to be aware of specific health problems faced by refugees, immigrants, and migrants (RIM). This analysis aimed to characterize RIM evaluated at GeoSentinel sites, their migration history, and infectious diseases detected through screening and diagnostic workups.

METHODS

A case report form was used to collect data on demographics, migration route, infectious diseases screened, test results, and primary infectious disease diagnosis for RIM patients seen at GeoSentinel sites. Descriptive statistics were performed.

RESULTS

Between October 2016 and November 2018, 5,319 RIM patients were evaluated at GeoSentinel sites in 19 countries. Africa was the region of birth for 2,436 patients (46 %), followed by the Americas (1,644, 31 %), and Asia (1,098, 21 %). Tuberculosis (TB) was the most common infection screened and reported as positive (853/2,273, 38 % positive by any method). TB, strongyloidiasis, and hepatitis B surface antigen positivity were observed across all migration administrative categories and regions of birth. Chagas disease was reported only among RIM patients from the Americas (393/394, 100 %) and schistosomiasis predominantly in those from Africa (480/510, 94 %). TB infection (694/5,319, 13 %) and Chagas disease (524/5,319, 10 %) were the leading primary infectious disease diagnoses.

CONCLUSIONS

Several infections of long latency (e.g. TB, hepatitis B, and strongyloidiasis) with potential for long-term sequelae were seen among RIM patients across all migration administrative categories and regions of origin. Obtaining detailed epidemiologic information from RIM patients is critical to optimize detection of diseases of individual and public health importance, particularly those with long latency periods.

Response to provide key health services to Ukrainian refugees: The overview and implementation studies

BACKGROUND

The outbreak of war in Ukraine has contributed to the largest migration crisis in this part of Europe since the Second World War. In a short period of time, several million refugees of different ages and with different health needs have arrived in Poland. This study aims to assess the health problems of Ukrainian refugees, evaluate the barriers faced by primary care physicians (PCPs), and analyse and evaluate the system solutions available (including the use of modern information technology) to address them.

METHODOLOGY

For this purpose, an original questionnaire distributed to PCPs in Poland was created and a literature review of implemented system solutions was conducted. The survey was conducted between the 3rd-10th April 2022-45 days after the outbreak of the war. The survey was repeated between 20th January and February 15, 2023.

RESULTS

The survey was completed by 402 physicians who provided health care to refugees at that time. There were 252 respondents in the first stage of the study while 150 PCPs took part in the repeat survey. The findings of the survey revealed that the most common health problems among refugees were infections, regardless of age. The biggest barrier to providing care to refugees was the lack of available medical records and language difficulties. During the first months of the refugee influx in Poland, many - both systemic and grassroot - solutions were implemented to improve the quality of health care for refugees.

CONCLUSIONS

According to PCPs, the language barrier and the lack of previous medical records are key constraints when providing medical care to refugees. The health needs of refugees and the difficulties in providing care for them require constant monitoring and implementation of appropriate systemic solutions that can reduce the limitations in the daily work of medical staff.

Five Decades of HBV Infection in Italy: A Continuous Challenge

In Italy, Hepatitis B virus (HBV) infection has been characterized by several changes over the last five decades. In 2019, the incidence of acute HBV among subjects targeted by the vaccination campaign was 0 cases in the age group 0-14 years and 0.1/100,000 in the age group 15-24. Nowadays, the burden of different stages of HBV-related chronic liver diseases is minimal. Intravenous drug use is no longer a risk factor (O.R. 0.7; 95% C.I. 0.5-1.02) for acquiring acute HBV; the proportion of cases reporting this exposure fell from 29.8% to 3.3% over the last two decades. The key public health intervention has been the compulsory vaccination campaign started in 1991 for infants 3 months old and 1-2 years old (the latter group for the first 12 years of the campaign). Moreover, non-immunogenic factors and the availability of effective oral antiviral drugs have played and continue to play a prominent role. The potential availability of new oral antiviral drugs with the inherent ability to eliminate the genomic HBV reservoirs may represent a further crucial step in the elimination of the virus in people that are already infected.

Neurologic Care of Forcibly Displaced Persons: Emerging Issues in Neurology

There is a growing number of forcibly displaced persons (FDPs) worldwide. With more than 100 million people forcibly displaced today, there is an urgent mandate to understand the neurologic care needs of this population and how neurologists and other health care workers can most effectively provide that care. In this Emerging Issues in Neurology article, we attempt to (1) define the scope of the problem of providing neurologic care to FDPs, (2) highlight commonly encountered clinical challenges related to neurologic care of FDPs, and (3) provide useful clinical information for neurologists and other clinicians who deliver care to FDPs with neurologic needs. We address the terminology of forcible displacement and how terms may differ across a person's migration journey. Common challenges encountered by FDPs with neurologic needs across settings include loss of support systems, loss of personal health information, language barriers and differing expression of symptoms, differing belief systems, epidemiologic patterns of disease unfamiliar to the clinician, and patients' fear and perceived risks of engaging with health systems. Practical approaches are shared for clinicians who encounter an FDP with a neurologic presentation. Finally, the article discusses many unmet neurologic needs of FDPs, which require significant investment. These include addressing lapses in neurologic care during displacement and understanding the effects of forcible displacement on people with chronic neurologic conditions. Future research and educational resources should focus on improving epidemiologic intelligence for neurologic conditions across geographies, developing curricula for optimizing the neurologic care of FDPs, and evaluating the most appropriate and effective uses of health technologies in humanitarian settings.

The Honduran diaspora and infectious diseases: An urgent need for action

Recently, there has been a significant increase in irregular migration from Central America's northern triangle (Honduras, Guatemala and El Salvador). Hondurans who migrate to North America face numerous risks to their lives and health. Infectious diseases are one of the most serious threats to migrants both during the migration process and once they arrive in the host country. The major infectious diseases affecting both migrants and the health services in non-endemic countries that care for these migrants are discussed.

Prevalence of digestive disorders associated with imported Chagas disease (PADChI study): an observational study

BACKGROUND

Chagas disease (CD) is a parasitic disease caused by Trypanosoma cruzi, in which up to 10-20% of those affected may suffer digestive disorders. Multiple studies have been carried out on CD in non-endemic countries, mainly related to cardiological involvement. However, digestive disorders have not been analyzed in such depth. The objective of the study was to determine the prevalence of digestive disorders in imported CD at the time of first care.

METHODS

An observational cross-sectional descriptive analysis of imported CD was performed. Chagasic structural damage and infectious digestive comorbidity were evaluated. The association between Chagasic structural damage and heart disease in Chagas patients was also investigated.

RESULTS

After reviewing a total of 1,216 medical records, those of 464 patients were selected for analysis. Globally, the prevalence of digestive disorders in imported Chagas was 57.76%, 95% CI (53.25-62.27). The prevalence of comorbidity of infectious diseases was 40.73% CI 95% (36.25-45.22). Colonic abnormalities were found in 84 of 378 barium enema patients. CD-related esophageal abnormalities were present in 63 of 380 patients studied with esophagogram.

CONCLUSIONS

The prevalence of digestive disorders associated with CD is high, so the presence of infectious diseases (mainly parasitic and H. pylori infection) should be ruled out. It is important to exclude structural involvement in all symptomatic patients, and asymptomatic patients should also be considered and offered.

Uptake of influenza, pneumococcal and herpes zoster vaccines among people with heart failure and atrial fibrillation

BACKGROUND

Cardiovascular diseases are the major cause of hospitalisation and death globally. Infections exacerbate cardiovascular events among cardiac patients, contributing to all-cause mortality. Vaccination is a cheap and effective intervention that can prevent infection. In Australia, influenza, pneumococcal and herpes zoster vaccines are recommended and funded for high-risk adults such as cardiac patients. There is high prevalence of high-risk adults in Western Sydney.

OBJECTIVES

This study investigates the uptake of influenza, pneumococcal and herpes zoster vaccines in patients admitted with heart failure and atrial fibrillation in a tertiary hospital in Western Sydney and factors associated with the uptake of the vaccines.

METHODS

Consecutive patients' hospitalised between 2014 and 2018 with heart failure or atrial fibrillation as principal diagnoses were identified. Information on patients' social demographic, clinical and vaccination status was collected and described using descriptive analysis. Univariate and multivariate analyses were conducted to determine factors associated with the uptake of the vaccines.

RESULTS

Low uptake for pneumococcal (40-45 %) and herpes zoster (15 %) vaccines were found. Prevalence of influenza vaccination was lower among participants younger than 65 (51-72 %) than in older ones (78-96 %). Australia-born participants were more likely to receive pneumococcal vaccine than those born overseas (OR 2.02, 95 % CI 1.05-3.89). Participants 65 years or older and those with comorbidities such as hypertension, COPD and chronic renal impairment were more likely to receive the vaccines.

CONCLUSION

Multidisciplinary strategies are needed to improve access to vaccination, community knowledge, community engagement, and healthcare provider support to provide appropriate care to migrants and younger cardiac patients and reduce morbidity and mortality in this high-risk group.

Mesenchymal Stem Cells and MSCs-Derived Extracellular Vesicles in Infectious Diseases: From Basic Research to Clinical Practice

Mesenchymal stem cells (MSCs) are attractive in various fields of regenerative medicine due to their therapeutic potential and complex unique properties. Basic stem cell research and the global COVID-19 pandemic have given impetus to the development of cell therapy for infectious diseases. The aim of this review was to systematize scientific data on the applications of mesenchymal stem cells (MSCs) and MSC-derived extracellular vesicles (MSC-EVs) in the combined treatment of infectious diseases. Application of MSCs and MSC-EVs in the treatment of infectious diseases has immunomodulatory, anti-inflammatory, and antibacterial effects, and also promotes the restoration of the epithelium and stimulates tissue regeneration. The use of MSC-EVs is a promising cell-free treatment strategy that allows solving the problems associated with the safety of cell therapy and increasing its effectiveness. In this review, experimental data and clinical trials based on MSCs and MSC-EVs for the treatment of infectious diseases are presented. MSCs and MSC-EVs can be a promising tool for the treatment of various infectious diseases, particularly in combination with antiviral drugs. Employment of MSC-derived EVs represents a more promising strategy for cell-free treatment, demonstrating a high therapeutic potential in preclinical studies.

Improving screening and treatment for infectious diseases in migrant populations

Many migrants living in high-income countries have increased morbidity and mortality due to undetected and untreated infections. Improving and strengthening the care continuum (screening and linkage to care and treatment) and building migrant-friendly health systems that improve access to care will be required to address this health disparity.

Disaster Microbiology-a New Field of Study

Natural and human-made disasters can cause tremendous physical damage, societal change, and suffering. In addition to their effects on people, disasters have been shown to alter the microbial population in the area affected. Alterations for microbial populations can lead to new ecological interactions, with additional potentially adverse consequences for many species, including humans. Disaster-related stressors can be powerful forces for microbial selection. Studying microbial adaptation in disaster sites can reveal new biological processes, including mechanisms by which some microbes could become pathogenic and others could become beneficial (e.g., used for bioremediation). Here we survey examples of how disasters have affected microbiology and suggest that the topic of "disaster microbiology" is itself a new field of study. Given the accelerating pace of human-caused climate change and the increasing encroachment of the natural word by human activities, it is likely that this area of research will become increasingly relevant to the broader field of microbiology. Since disaster microbiology is a broad term open to interpretation, we propose criteria for what phenomena fall under its scope. The basic premise is that there must be a disaster that causes a change in the environment, which then causes an alteration to microbes (either a physical or biological adaptation), and that this adaptation must have additional ramifications.

Indonesian Migrant Workers: The Migration Process and Vulnerability to COVID-19

Indonesia is one of the largest sources of migrant workers in Southeast Asia. Presently, these workers are vulnerable to COVID-19 due to the prolonged migration process, which requires them to relocate from their villages to another country and back to Indonesia on completion of their working contract. Therefore, this study describes and discusses the vulnerability of Indonesian migrant workers (IMWs) to the pandemic at various phases of the migration process. It is related to the implementation and practice of health protocols, ignorance and indifference to the dangers and transmission of the virus, and also to the national vaccination program. The analysis is based on the review of literature studies, such as studies related to the topic, international and national regulations on migrant workers, and official data and statistics published by the Indonesian government. The materials and data were collected from search engines such as Google Search and Google Scholar and also relevant published reports available. Several policies have been implemented by the government of Indonesia and other destination countries where the prospective IMWs intend to work, to protect and prevent the transmission of COVID-19. However, there is still a contagion among IMWs willing to leave abroad and those returning home after completing their employment contract. Therefore, both countries need to be responsible for each migration process, specifically related to providing health protection, increasing awareness of the danger and transmission of the virus, and applying polymerase chain reaction (PCR) tests and COVID-19 vaccination for migrant workers.

Migrating Populations and Health: Risk Factors for Cardiovascular Disease and Metabolic Syndrome

PURPOSE OF REVIEW

To summarize results of recent studies of migrants in Europe and North America and ongoing efforts to adapt strategies to provide them with inclusive sensitive health care.

RECENT FINDINGS

Major predisposing factors for developing hypertension, obesity, diabetes, and the metabolic syndrome in migrating populations and refugees were identified. Susceptibility to the metabolic syndrome is predominantly due to environmental factors and psychological stress. Acculturation also contributes to the emergence of cardiovascular (CV) risk factors in first-generation adult immigrants. Increased risk for later development of hypertension and dyslipidemia has also been detected in adolescent immigrants. Targets for public health efforts were based on data that show important differences in CV risk factors and prevalence of the metabolic syndrome among ethnic immigrant groups. Studies in young adults focused on lifestyle and dietary behaviors and perceptions about weight and body image, while the focus for older adults was end-of-life issues. Two important themes have emerged: barriers to health care, with a focus on cultural and language barriers, and violence and its impact on immigrants' mental health.

Health status assessment of a population of asylum seekers in Northern Italy

Background

Since 2011 Italy has faced an extraordinary increase in migrants arrivals, mainly from the Mediterranean route, one of the world’s most dangerous journeys. The purpose of the present article is to provide a comprehensive picture of the migrants' health status in the "T. Fenoglio" centre, Settimo Torinese (Turin, Italy).

Methods

A retrospective cross-sectional study was conducted using data collected from June 2016 to May 2018 on adult migrants (over 18 years old) from Africa, Middle East and South East Asia (Bangladesh, Cambodia, India, Nepal). Data was collected through the migrants' medical records. Descriptive statistics were performed on socio-demographic variables. The diagnosed diseases were anonymously registered and classified according to the International Classification of Primary Care (ICPC-2).

Conditional Inference Trees were used to perform a descriptive analysis of the sample and to detect the covariates with the strongest association with the variables Disease on arrival, Disease after arrival, ICPC on arrival and ICPC after arrival.

Results

Analyzed observations were 9 857. 81.8% were men, median age was 23 (Interquartile range: 20.0–27.4). 70.3% of the sample came from Sub-Saharan Africa. 2 365 individuals (24%) arrived at the centre with at least one disease. On arrival, skin (27.71%), respiratory (14.46%), digestive (14.73%) and generic diseases (20.88%) were the most frequent. During the stay respiratory diseases were the most common (25.70%). The highest probability of arriving with a disease occurred in 2018 and during the period September–November 2016, in particular for people from the Horn of Africa. During this period and also in the first half of 2017, skin diseases were the most reported. In seasons with lower prevalence of diseases on arrival the most common disease code was generic for both men and women (usually fever or trauma).

Conclusions

This study provides information on the diverse diseases that affect the asylum seekers population. In our sample, the Horn of Africa was the most troubled area of arrival, with severe conditions frequently reported regarding skin diseases, in particular scabies. 2018 was the most critical year, especially for migrants from the Horn of Africa and Sub-Saharan Africa. During the stay at the camp, the prevalence of respiratory diseases increased. However, skin diseases remained the main issue for people from the Horn of Africa. Overall, the most reported diseases in the sample were dermatological, respiratory, digestive and generic diseases, both on arrival and during the stay.

A better understanding of the health status of asylum seekers is an important factor to determine a more efficient reception and integration process and a better allocation of economic resources in the context of migrants' health care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-022-00846-0.

Gender, migration and violence among third country nationals accessing the sexual health clinic in Malta

BACKGROUND

In 2020 the number of displaced people worldwide reached 41.3 million (IOM, 2020). Among them, are many migrants and refugees at risk of sexual and gender-based violence (SGBV). Healthcare providers have a key role to play in identifying migrant victims/survivors of violence.

OBJECTIVES

This paper seeks to assess STIs prevalence, sexual health and sexual violence among third country nationals (TCNs) attending the GUC in Malta.

METHODS

This is a mixed methods study carried out at the Genitourinary Clinic (GUC), which is the only public sexual health clinic in Malta. Demographic data, sexual history and diagnoses of patients attending the GUC between January 2018 and December 2019 were collected and retrospectively analysed. A SGBV risk assessment was performed through a semi-structured questionnaire.

RESULTS

In the 24-month study period, a total of 12,654 patients accessed the GUC in Malta. Demographic data was collected on age, gender, nationality, marital status, and sexual orientation. 16.4% (n=2,064) of these were extra-European migrants, predominantly male. 80 different nationalities were recorded, with the 5 most common being Nigerian, Filipino, Libyan, Syrian and Brazilian. The average age was 32.6 years. Over 110 sex workers were visited at the GUC in the study period - 20 were foreign, primarily from China. The presence of a "massage parlour owner" during consultation, lack of control over passports and other factors were identified as warning signs of trafficking. 5 cases of sexual violence and forced prostitution involving girls from Sub-Saharan Africa and, in 2 cases, boys recently arrived in Malta by boat, were encountered. 6 African women accessing the service exhibited a type of female genital mutilation (FGM).

CONCLUSIONS

Migration, sexual health and SGBV overlap in important ways. Further research and training in SGBV and migration in the healthcare setting and awareness-raising about existing services among the migrant population are required.

Twenty Important Research Questions in Microbial Exposure and Social Equity

Social and political policy, human activities, and environmental change affect the ways in which microbial communities assemble and interact with people. These factors determine how different social groups are exposed to beneficial and/or harmful microorganisms, meaning microbial exposure has an important socioecological justice context. Therefore, greater consideration of microbial exposure and social equity in research, planning, and policy is imperative. Here, we identify 20 research questions considered fundamentally important to promoting equitable exposure to beneficial microorganisms, along with safeguarding resilient societies and ecosystems. The 20 research questions we identified span seven broad themes, including the following: (i) sociocultural interactions; (ii) Indigenous community health and well-being; (iii) humans, urban ecosystems, and environmental processes; (iv) human psychology and mental health; (v) microbiomes and infectious diseases; (vi) human health and food security; and (vii) microbiome-related planning, policy, and outreach. Our goal was to summarize this growing field and to stimulate impactful research avenues while providing focus for funders and policymakers.

Advocating for Greater Inclusion of Marginalized and Forgotten Populations in COVID19 Vaccine Rollouts

Objectives: Many countries recently approved a number of SARS-CoV-2 vaccines. There is therefore growing optimism around the world about their future availability and effectiveness. However, supplies are likely to be limited and restricted to certain categories of individuals, at least initially. Thus, governments have suggested prioritization schemes to allocate such limited supplies. The majority of such schemes are said to be developed to safeguard the weakest sections of society; that is, healthcare personnel and the elderly. Methods: In this work, we analyse three case studies (incarcerated people; homeless people, asylum seekers and undocumented migrants). We propose a bioethical argument that frames the discussion by describing the salient facts about each of the three populations and then argue that these characteristics entail inclusion and prioritization in the queue for vaccination in their country of residence. Results: Through an analysis informed by ethical considerations revolving around the concepts of fairness and equality, we try to raise awareness of these important issues among decision makers. Conclusion: Our goal is to advocate for the development of more inclusive policies and frameworks in SARS-CoV-2 vaccine allocation and, in general, in all scenarios in which there is a shortage of optimal care and treatments.

From strongyloidiasis to disseminated mucormycosis: the story of an HTLV-1-infected migrant

Strongyloidiasis manifestations range from asymptomatic cases to the life-threatening disseminated strongyloidiasis in case of immune deficiency: larvae migrate throughout the body, disseminating germs from the digestive flora to various organs. Here, we described a case of disseminated mucormycosis consecutive to Strongyloides stercoralis hyperinfestation in a Surinamese migrant infected with HTLV-1.

Multidrug-resistant tuberculosis imported into low-incidence countries-a GeoSentinel analysis, 2008-2020

BACKGROUND

Early detection of imported multidrug-resistant tuberculosis (MDR-TB) is crucial, but knowledge gaps remain about migration- and travel-associated MDR-TB epidemiology. The aim was to describe epidemiologic characteristics among international travellers and migrants with MDR-TB.

METHODS

Clinician-determined and microbiologically confirmed MDR-TB diagnoses deemed to be related to travel or migration were extracted from GeoSentinel, a global surveillance network of travel and tropical medicine clinics, from January 2008 through December 2020. MDR-TB was defined as resistance to both isoniazid and rifampicin. Additional resistance to either a fluoroquinolone or a second-line injectable drug was categorized as pre-extensively drug-resistant (pre-XDR) TB, and as extensively drug-resistant (XDR) TB when resistance was detected for both. Sub-analyses were performed based on degree of resistance and country of origin.

RESULTS

Of 201 patients, 136 had MDR-TB (67.7%), 25 had XDR-TB (12.4%), 23 had pre-XDR TB (11.4%) and 17 had unspecified MDR- or XDR-TB (8.5%); 196 (97.5%) were immigrants, of which 92 (45.8%) originated from the former Soviet Union. The median interval from arrival to presentation was 154 days (interquartile range [IQR]: 10-751 days); 34.3% of patients presented within 1 month after immigration, 30.9% between 1 and 12 months and 34.9% after ≥1 year. Pre-XDR- and XDR-TB patients from the former Soviet Union other than Georgia presented earlier than those with MDR-TB (26 days [IQR: 8-522] vs. 369 days [IQR: 84-827]), while patients from Georgia presented very early, irrespective of the level of resistance (8 days [IQR: 2-18] vs. 2 days [IQR: 1-17]).

CONCLUSIONS

MDR-TB is uncommon in traditional travellers. Purposeful medical migration may partly explain differences in time to presentation among different groups. Public health resources are needed to better understand factors contributing to cross-border MDR-TB spread and to develop strategies to optimize care of TB-infected patients in their home countries before migration.

Differences in Incidence of Acute Viral Hepatitis between Foreigners and Autochthonous Population in Italy

Background: In European countries, the prevalence of HBV and HCV in refugees and migrants tends to reflect the prevalence in their countries of origin. The aim of this study is to analyse acute viral hepatitis cases diagnosed in Italy among foreign citizens and to compare incidence rates in foreigners and Italians. Methods: We analysed the cases of each viral hepatitis type among foreigners. Standardised incidence rates were compared between natives and foreigners. Results: Between 2004 and 2019, 15,872 cases of acute viral hepatitis were notified by 10 Italian regions, 14.8% among foreign citizens. Until 2012, the percentage increased gradually, while a fluctuating trend set in from 2013 onwards; in 2019, 23.9% of cases were foreigners. Data from the SEIEVA surveillance show higher standardised incidence rates of hepatitis A and B among foreign citizens; no significant difference emerged between Italians and foreigners in terms of their hepatitis C incidence. Conclusions: foreign citizens have an increased incidence of hepatitis A and B. Regarding hepatitis A, vaccination is strongly recommended to foreigners travelling to their countries of origin. Screening tests for hepatitis B and C infection should be offered to newly arrived migrants from high prevalence countries, or having specific risk factors.

Seroprevalence of vaccine-preventable and non-vaccine-preventable infections in migrants in Spain

BACKGROUND

Updated seroprevalence studies of infections in migrants may aid the design of tailored vaccination and prevention programmes. The objective of this study was to describe the seroprevalence rates for potentially transmissible viral infections in migrants attended at a referral centre in a major European city.

METHODS

Descriptive analysis of seroprevalence of vaccine-preventable and non-vaccine-preventable infections in migrants attended at a centre in Madrid, Spain (2018-19). Recorded variables included age, gender, country of birth/continent of origin, time from arrival to Spain until first clinic visit, rubella, measles, mumps, varicella (VZV), hepatitis B virus (HBV), hepatitis A virus (HAV), hepatitis C virus (HCV) and HIV serology.

RESULTS

In total, 468 patients were included, 135 females (28.8%) and 333 males (71.2%), mean age 30.4 years. The majority of patients were from Africa (52.5%, of which 88.2% from sub-Saharan Africa), followed by Latin America (38.5%) and other areas (9%). Seroprevalence for tested migrants for rubella, measles and mumps was < 95% in the group overall (91% rubella, 88% measles, 83% mumps) and lower rates were observed in migrants >20 years (compared with those ≤ 20 years). Over 10% of females were potentially susceptible (negative/indeterminate serology) to rubella (11.4%), measles (12.7%) or mumps (10.3%). Lowest rates of rubella seropositivity were in Latin American migrants (over 12% potentially susceptible); measles and mumps seropositivity was lowest in migrants from areas other than Africa/Latin America (74% and 68%, respectively). Seroprevalence rates were 91% for VZV, 90% overall for HAV, ~6% for HBV chronic infection (~50% of migrants tested susceptible), 2% for HCV and 6% for HIV.

CONCLUSIONS

Differences in seroprevalence for vaccine-preventable and transmissible infections according to gender, age range and area of origin were observed. Tailored screening, vaccination and prevention strategies in potentially vulnerable migrant groups should be designed.

The impact of immigration on tuberculosis and HIV burden between Colombia and Venezuela and across frontier regions

Historically, human migrations have determined the spread of many infectious diseases by promoting the emergence of temporal outbreaks between populations. We aimed to analyze health indicators, expenditure, and disability caused by tuberculosis (TB) and HIV/AIDS burden under the Colombian-Venezuelan migration flow focusing on the Northeastern border. A retrospective study was conducted using TB and HIV/AIDS data since 2009. We consolidated a database using official reports from the Colombian Surveillance System, World Health Organization, Indexmundi, the Global Health Observatory, IHME HIV atlas, and Joint United Nations Programme on HIV/AIDS (UNAIDS). Disability metrics regarding DALYs (disability adjusted life years) and YLDs (years lived with disability), were compared between countries. Mapping was performed on ArcGIS using official migration data of Venezuelan citizens. Our results indicate that TB profiles from Colombia and Venezuela are identical in terms of disease burden, except for an increase in TB incidence in the Colombian-Venezuelan border departments in recent years, concomitantly with the massive Venezuelan immigration since 2005. We identified a four-fold underfunding for the TB program in Venezuela, which might explain the low-testing rates for cases of multidrug-resistant TB (67%) and HIV/AIDS (60%), as well as extended hospital stays (150 days). We found a significant increase in DALYs of HIV/AIDS patients in Venezuela, specifically, 362.35 compared to 265.37 observed in Colombia during 2017. This study suggests that the Venezuelan massive migration and program underfunding might exacerbate the dual burden of TB and HIV in Colombia, especially towards the Colombian-Venezuelan border.

Different Domains of Dengue Research in Malaysia: A Systematic Review and Meta-Analysis of Questionnaire-Based Studies

This review provided a systematic overview of the questionnaire-related dengue studies conducted in Malaysia and evaluated their reliability and validity used in the questionnaires. An extensive literature search was conducted using various electronic databases, including PubMed, EMBASE, Medline, and ScienceDirect. Systematic reviews and meta-analysis (PRISMA) were selected as the preferred item reporting method. Out of 88 identified dengue-related, 57 published from 2000 to April 2020 met the inclusion criteria and were included. Based on the meta-analysis, a poor mean score was obtained for knowledge (49%), attitude (44%), and preventive practice (55%). The study showed that the level of knowledge on cardinal signs and modes of transmission for dengue virus were highest among health care workers, followed by students (international and local) and lastly community residents. In treatment-seeking behaviours, only half of the respondents (50.8%) would send their child to the nearest health clinics or hospitals when a child became restless or lethargic. The acceptance rate for dengue vaccine, bacteria (Wolbachia), as a vector for dengue control and self-test diagnostic kit for dengue showed considerably high (88.4%, 70%, and 44.8%, respectively). Health belief model (HBM) constructs, such as perceived barriers, perceived severity, perceived susceptibility, self-efficacy, and perceived benefit influence prevention practices. Lastly, only 23 articles (40.3%) had piloted or pretested the questionnaire before surveying, in which three reported Cronbach's alpha coefficient (0.70-0.90). A need for active participation of communities and healthcare personnel, promotion of awareness, and safe complementary medicines, as well as assessment of psychometric properties of questionnaire use in dengue surveys in Malaysia, in order for assessing dengue reliably and valid.

COVID-19 in comparison with other emerging viral diseases: risk of geographic spread via travel

Purpose of review

The COVID-19 pandemic poses a major global health threat. The rapid spread was facilitated by air travel although rigorous travel bans and lockdowns were able to slow down the spread. How does COVID-19 compare with other emerging viral diseases of the past two decades?

Recent findings

Viral outbreaks differ in many ways, such as the individuals most at risk e.g. pregnant women for Zika and the elderly for COVID-19, their vectors of transmission, their fatality rate, and their transmissibility often measured as basic reproduction number. The risk of geographic spread via air travel differs significantly between emerging infectious diseases.

Summary

COVID-19 is not associated with the highest case fatality rate compared with other emerging viral diseases such as SARS and Ebola, but the combination of a high reproduction number, superspreading events and a globally immunologically naïve population has led to the highest global number of deaths in the past 20 decade compared to any other pandemic.

Neglected tropical diseases in non-endemic countries in the era of COVID-19 pandemic: the great forgotten

In non-endemic countries, the access to healthcare for migrants and other patients with NTDs may be hampered by new barriers linked to the COVID-19 pandemic. Low awareness of health care professionals on the opportunistic potential of some NTDs may lead to unfavorable outcome of COVID-19 patients treated with immunomodulatory drugs.

Trypanosoma cruzi infection in Latin American pregnant women living outside endemic countries and frequency of congenital transmission: a systematic review and meta-analysis

BACKGROUND

Chagas disease, as a consequence of globalization and immigration, is no more restricted to Central and Latin America. Therefore, congenital transmission represents a growing public health concern in non-endemic countries.

METHODS

The aim of this study was to assess the prevalence of Trypanosoma cruzi infection in pregnant Latin American (LA) women living outside endemic countries and the rate of congenital transmission. Data were extracted from studies indexed in PubMed, Scopus, Embase, Lilacs and SciELO databases without language restriction. Two investigators independently collected data on study characteristics, diagnosis, prevalence of infection in pregnant women and congenital infection rate. The data were pooled using a random effects model.

RESULTS

The search identified 1078 articles of which 29 were eligible regarding prevalence of T. cruzi infection among pregnant women and 1795 articles of which 32 were eligible regarding the congenital transmission rate. The estimated pooled prevalence of T. cruzi infection in LA pregnant women was 4.2% [95% confidence interval (CI): 3.0-5.5]. The prevalence of T. cruzi infection in pregnant women from Bolivia was 15.5% (95% CI: 11.7-19.7) and 0.5% (95% CI: 0.2-0.89) for those coming from all other LA countries. The estimated global rate of congenital transmission was 3.5% (95% CI: 2.5-4.5); excluding poor-quality studies, the rate of congenital transmission was 3.8% (95% CI: 2.4-5.1).

CONCLUSIONS

Prevalence of Chagas disease among LA pregnant women living outside endemic countries is high, particularly in Bolivian women. The rate of vertical transmission of T. cruzi infection is similar to the rate reported in South and Central American countries.

Public health emergencies of international concern: a historic overview

RATIONALE

The International Health Regulations (IHR) have been the governing framework for global health security since 2007. Declaring public health emergencies of international concern (PHEIC) is a cornerstone of the IHR. Here we review how PHEIC are formally declared, the diseases for which such declarations have been made from 2007 to 2020 and justifications for such declarations.

KEY FINDINGS

Six events were declared PHEIC between 2007 and 2020: the 2009 H1N1 influenza pandemic, Ebola (West African outbreak 2013-2015, outbreak in Democratic Republic of Congo 2018-2020), poliomyelitis (2014 to present), Zika (2016) and COVID-19 (2020 to present). Poliomyelitis is the longest PHEIC. Zika was the first PHEIC for an arboviral disease. For several other emerging diseases a PHEIC was not declared despite the fact that the public health impact of the event was considered serious and associated with potential for international spread.

RECOMMENDATIONS

The binary nature of a PHEIC declaration is often not helpful for events where a tiered or graded approach is needed. The strength of PHEIC declarations is the ability to rapidly mobilize international coordination, streamline funding and accelerate the advancement of the development of vaccines, therapeutics and diagnostics under emergency use authorization. The ultimate purpose of such declaration is to catalyse timely evidence-based action, to limit the public health and societal impacts of emerging and re-emerging disease risks while preventing unwarranted travel and trade restrictions.

Engaging the vulnerable: A rapid review of public health communication aimed at migrants during the COVID-19 pandemic in Europe

BACKGROUND

The World Health Organization recommends national risk communications tools targeting migrant communities to contain the spread of COVID-19. Within Europe, migrants are often left behind in healthcare due to structural barriers driven by hostile environment measures. This study aimed to assess inclusion of migrants in COVID-19 prevention measures by evaluating if governmental risk communications are available in common migrant languages across Europe.

METHODS

A rapid review was performed in June 2020 to understand the availability of government produced risk communications across Council of Europe member states, namely: COVID-19 health communications, migrant-specific guidelines and COVID-19 helplines.

RESULTS

96% (45/47) of countries sampled had online government COVID-19 advice. 30% (15/47) issued information in their official language(s), whilst 64% (30/47) of countries delivered information in additional languages. 48% (23/47) translated information into at least one migrant language. However, information on testing or healthcare entitlements in common migrant languages was only found in 6% (3/47). Half (53%; 25/47) of the countries with COVID-19 helpline offered information in at least one alternative language.No government produced risk communications on disease prevention targeting people in refugee camps or informal settlements.

CONCLUSIONS

There are clear gaps in the availability of translated COVID-19 risk communications across Europe, excluding migrants from the COVID-19 response. Governments must reflect on the inclusion of migrants within their COVID-19 response and seek to engage vulnerable communities. Governments should urgently partner with non-governmental organizations who already play a key role in addressing unmet health needs.

COVID-19: Exposing and addressing health disparities among ethnic minorities and migrants

COVID-19 disproportionately affects vulnerable and marginalized populations such as ethnic minorities and migrant groups. In this perspective we review the complex interaction of the many factors driving these inequities and suggest several possible solutions to mitigate the negative impact of COVID-19 on these populations.

Health challenges in refugee resettlement: an innovative multi-sector partnership to improve the continuum of care for resettled refugees

Refugee resettlement is a complex process relevant to migration medicine. A partnership between the International Organization for Migration, the US Centers for Disease Control and Prevention, and the University of Minnesota addresses medical needs of refugees and serves as a model for improving the continuum of care delivered to refugees.

Challenges of Managing Skin Diseases in Refugees and Migrants

"Currently, an estimated 70.8 million individuals worldwide are forcibly displaced due to war, violence, and persecution. Barriers to providing dermatologic care include the large number of affected people, their movement within and across international borders, security issues, and limited access to dermatology expertise and formularies. Screening protocols for skin diseases and sexually transmitted infections differ worldwide, raising the need for shared guidelines to assess migrants' health. This article reviews the literature of skin and sexually transmitted infections in migrants and displaced persons, highlighting the impact of social determinants on skin health and challenges faced in providing care."

Association Between Socioeconomic Factors and the COVID-19 Outbreak in the 39 Well-Developed Cities of China

Background: Socioeconomic factors play an indispensable role in the spread of emerging infectious diseases. Few studies have investigated the role of socioeconomic factors in the spread of COVID-19.

Methods: The number of COVID-19 cases in the 39 well-developed cities of China was aggregated by searching the publicly available sources. Socioeconomic indicators (e.g., population, population density, gross domestic product, rural-to-urban migrants, urbanization rate, per-person disposable income, and level of health care) in these cities were also aggregated from the Bureau of Statistics. The data referring to travelers from Wuhan were collected from the Baidu Migration database. A multiple stepwise linear regression model was performed to identify the independent risk factors of the number of cases.

Results: As of Mar 19, 2020, a total of 5,939 cases were reported in the 39 well-developed cities with almost half of total cases in China outside of Hubei. The number of cases ranged 20–576, and the median number of cases was 93 (IQR 54–180) in these cities. Nine socioeconomic variables including the number of travelers from Wuhan, population, native population, gross domestic product, Per-person GDP, the number of hospitals, the number of rural-to-urban migrants, traffic capacity, and person-disposable income were recognized as potential contributors of the number of cases. Results of multiple linear regression showed a statistically significant association between the number of cases and the number of travelers from Wuhan (t = 6.746, P = 0.000) and the number of rural-to-urban migrants (t = 3.776, P = 0.001) in these cities. However, other seven potential contributors were not associated with the number of cases. Moreover, a well-fitted multiple regression model was built in this study, and a regression equation was as follows: Y = 0.007X_t + 0.200X_m (adjusted R² = 0.833).

Conclusions: Travelers from Wuhan and rural-to-urban migrants were independently associated with the COVID-19 outbreak in the 39 well-developed cities of China. These findings suggested that travelers from an epicenter and rural-to-urban migrants should be paid more attention in the early stage of the COVID-19 outbreak in the well-developed cities.

Health conditions of migrants landed in north-eastern Sicily and perception of health risks of the resident population

OBJECTIVES

In Italy, a recent irregular movement of people raised concerns among the host population on possible introduction of diseases that have long been controlled in the host countries. This study evaluates the health conditions of illegal immigrants landed on the north-eastern Sicilian territory, to provide information on the clinical and epidemiologic burden of infectious diseases among migrants and how the local population feel about these landings.

STUDY DESIGN

The study design is a cross-sectional study.

METHODS

The study considered all migrants landed illegally in the city of Messina, Sicily, between January 2014 and July 2018. Analysing the data of hospital admissions and disease notifications, we calculated the frequency of infectious diseases among migrant population. Furthermore, through a survey conducted by a well-known online newspaper, we analysed the perception that the local population has about the health risk represented by migrants.

RESULTS

In the considered five-year period, 108 landings, for a total of 38,608 migrants occurred at the Messina port. The percentage of hospitalisation was rather low (3.5%), and it concerned mainly pregnant women. The notifications of infectious diseases were contained, with exception of scabies and tuberculosis. Finally, from the online survey, resulted that there is a large part of local population that considers migrants a potential danger to community health.

CONCLUSIONS

Our data show that the presence of migrants should not have to date any impact on the health conditions of the resident population. However, monitoring over time the health of migrants and screening for infectious diseases as soon as possible after landing are advantageous for both migrants and host country.

Immune checkpoint inhibitors and tuberculosis: an old disease in a new context

Tuberculosis, the leading cause of infection-related death in developing regions, is a leading cause of morbidity and mortality worldwide. Screening for, and treatment of, latent Mycobacterium tuberculosis infection is routine before initiation of anti-tumour necrosis factor α (anti-TNFα) agents in the management of psoriasis, Crohn's disease, and rheumatoid arthritis. By contrast, screening for latent tuberculosis before immune checkpoint inhibitor treatment in cancer is not routine, despite the increasing number of reports of primary infection with M tuberculosis or reactivation of latent M tuberculosis infection during such treatment. We present our experience with M tuberculosis screening in 70 patients who underwent immune checkpoint inhibitor therapy for metastatic skin cancer. Based on our understanding of the interaction between M tuberculosis and the immune system, we present the argument for tuberculosis screening before immune checkpoint inhibitor therapy and its use when considering anti-TNFα treatment for severe immune-related adverse events. We call for increased vigilance during immune checkpoint inhibition until its effects on tuberculosis pathophysiology are fully ascertained.

Severity of Plasmodium falciparum and Non-falciparum Malaria in Travelers and Migrants: A Nationwide Observational Study Over 2 Decades in Sweden

Background

The aim was to assess factors affecting disease severity in imported P. falciparum and non-falciparum malaria.

Methods

We reviewed medical records from 2793/3260 (85.7%) of all episodes notified in Sweden between 1995 and 2015 and performed multivariable logistic regression.

Results

Severe malaria according to WHO 2015 criteria was found in P. falciparum (9.4%), P. vivax (7.7%), P. ovale (5.3%), P. malariae (3.3%), and mixed P. falciparum episodes (21.1%). Factors associated with severe P. falciparum malaria were age <5 years and >40 years, origin in nonendemic country, pregnancy, HIV, region of diagnosis, and health care delay. Moreover, oral treatment of P. falciparum episodes with parasitemia ≥2% without severe signs at presentation was associated with progress to severe malaria with selected criteria. In non-falciparum, age >60 years, health care delay and endemic origin were identified as risk factors for severe disease. Among patients originating in endemic countries, a higher risk for severe malaria, both P. falciparum and non-falciparum, was observed among newly arrived migrants.

Conclusions

Severe malaria was observed in P. falciparum and non-falciparum episodes. Current WHO criteria for severe malaria may need optimization to better guide the management of malaria of different species in travelers and migrants in nonendemic areas.

Asylum seekers' and Refugees' Changing Health (ARCH) study protocol: an observational study in Lebanon and Denmark to assess health implications of long-distance migration on communicable and non-communicable diseases and mental health

INTRODUCTION

By end of 2018, the European Union countries hosted approximately 2.5 million refugees and Lebanon alone hosted more than 1 million. The majority of refugees worldwide came from Syria. The prevailing study design in published studies on asylum seekers' and refugees' health leaves a number of fundamental research questions unanswerable. In the Asylum seekers' and Refugees' Changing Health (ARCH) study, we examine the health of a homogeneous group of refugees and asylum seekers in two very different host countries with very different migration histories. We aim to study the health impact of the migration process, living conditions, access to healthcare, gene-environment interactions and the health transition.

METHODS AND ANALYSIS

ARCH is an international multisite study of the health of adult (>18 years old) Syrian refugees and asylum seekers in Lebanon and Denmark. Using a standardised framework, we collect information on mental and physical health using validated scales and biological samples. We aim to include 220 participants in Danish asylum centres and 1100 participants in Lebanese refugee camps and settlements. We will use propensity score weights to control for confounding and multiple imputation to handle missing data.

ETHICS AND DISSEMINATION

Ethical approval has been obtained in Lebanon and Denmark. In the short term, we will present the cross-sectional association between long-distance migration and the results of the throat and wound swab, blood and faeces samples and mental health screenings. In the longer term, we are planning to follow the refugees in Denmark with collection of dried blood spots, mental health screenings and semistructured qualitative interviews on the participant's health and access to healthcare in the time lived in Denmark. Here, we present an overview of the background for the ARCH study as well as a thorough description of the methodology.

Delay in schistosomiasis diagnosis and treatment: a multicenter cohort study in Italy

BACKGROUND

Barriers to access to care, different diagnostic strategies and low awareness remain challenging issues in the fight against schistosomiasis.Our study aims to examine management of schistosomiasis in migrants attending large tertiary hospitals in Italy, in order to call for a comprehensive approach.

METHODS

A retrospective review of schistosomiasis cases was carried out between January 1, 2016, and December 31, 2017, in five large Infectious Disease Centers in Italy. We included all patients diagnosed with schistosomiasis. We differentiated among (i) asymptomatic patients diagnosed by serology either as healthy 'migrant evaluation' or as 'late evaluation' in patients followed because of a different infection and (ii) patients tested because of a suggestive clinical presentation. Patients characteristics and clinical data were recorded.

RESULTS

One hundred forty-nine patients were included, 137 (91.9%) were male, the median age was 26 years and 70% of them came from Sub-Saharan Africa.Thirty-eight asymptomatic patients (25.5%) were diagnosed by serology [15, (10.1%) among 'migrant evaluation' and 23 (15.4%) among 'late evaluation' group], and 111 (74.5%) presented with signs/symptoms.The median diagnostic delay from arrival in Italy was 31 months: 110 for asymptomatic group and 16 months for symptomatic patients. Among the 111 symptomatic patients, 41 individuals were already followed in our clinics, and they never underwent screening before appearance of evident disease. Among patients with positive serology who were tested by microscopy, 32/86 (37.2%) had confirmed diagnosis. Forty-five (37.8%) patients presented radiologic abnormalities. Praziquantel was the treatment of choice (70.1% for 3 days and 29.9% in a single-day dose), and 77 (51.7%) were lost to follow-up.

CONCLUSIONS

In our centers, a high proportion of patients were tested late after arrival, and most of them presented with clinical apparent disease. Well-defined strategies and implementation of recent guidelines are needed to improve early diagnosis and to overcome heterogeneity of practice.

Schistosomiasis, strongyloidiasis and Chagas disease: the leading imported neglected tropical diseases in Italy

BACKGROUND

In recent years, an increasing number of individuals affected by neglected tropical diseases (NTDs) have been observed in Italy, due to migration, international travels and climate changes. Reliable data on the current NTD epidemiology in Italy and the health system preparedness on this issue are not available.

METHODS

We report the results of a survey on selected NTDs (schistosomiasis, strongyloidiasis, echinococcosis, Chagas disease, leishmaniasis, cysticercosis, filariasis and scabies) in nine Italian sentinel centres, in order to investigate their occurrence throughout the country and identify which ones are a priority for public health interventions, development of protocols for case management, and training activities. To explore the preparedness of the centres, we investigate the availability of specific diagnostic tools and drugs, needed for the management of the most common NTDs. We also reviewed and summarized the available national policies, recommendations and guidelines on NTDs in Italy.

RESULTS

Overall, 4123 NTDs cases were diagnosed in nine Italian centres within a 7-year period (2011-2017). Schistosomiasis and strongyloidiasis were the most common NTDs, accounting for about one-third each of all the diagnosed cases, followed by Chagas disease. The number of cases showed a significant trend to increase over time, mainly due to foreign-born subjects. Serology for Schistosoma spp. and Strongyloides stercoralis was available in seven and five centres, respectively. Agar plate stool culture for S. stercoralis was available in three sites. Ivermectin and praziquantel were always available in six centres. Six national policies, recommendations and guidelines documents were available, but for the most part, they are not fully implemented yet.

CONCLUSIONS

This survey showed how some NTDs, such as schistosomiasis and strongyloidiasis, are becoming more common in Italy, due to multiple components. A list of seven key actions was proposed, in order to improve diagnosis, management and control of NTDs in Italy.

Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean

Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.

Infectious Diseases among Refugee Children

In recent years, there has been a substantial increase in refugee and asylum-seeking adults, adolescents and children to high-income countries. Infectious diseases remain the most frequently identified medical diagnosis among U.S.-bound refugee children. Medical screening and immunization are key strategies to reduce the risk of infectious diseases in refugee, internationally adopted, and immigrant children. Notable infectious diseases affecting refugee and other newly arriving migrants include latent or active tuberculosis, human immunodeficiency virus type 1 (HIV), hepatitis B, hepatitis C, vaccine-preventable diseases, malaria, and other parasitic infections. The U.S. Centers for Disease Control and Prevention and the American Academy of Pediatrics have published guidelines for health assessment of newly arriving immigrant, refugee, and internationally adopted children. Although, data on the health risks and needs of refugee exists in some high-income countries, there is an urgent need to develop robust evidence-informed guidance on screening for infectious diseases and vaccination strategies on a broader scale to inform national policies. Innovative approaches to reach migrant communities in the host nations, address health and other complex barriers to improve access to high-quality integrated health services, and strong advocacy to mobilize resources to improve health, safety, and wellbeing for refugee children and their families are urgent priorities.

Migration Health: Highlights from Inaugural International Society of Travel Medicine (ISTM) Conference on Migration Health

PURPOSE OF REVIEW

International migration is a global phenomenon that is growing in scope, complexity and impact. The inaugural International Society of Travel Medicine (ISTM) International Conference on Migration Health provided a forum to discuss scientific evidence on the broad issues relevant to migration health. This review summarises the key health issues, with a focus on infectious diseases, current effective strategies and future considerations presented at this forum and in the recent literature.

RECENT FINDINGS

Migrants face health disparities for both communicable and non-communicable diseases. Their heightened infectious disease risks, compared to host populations, are related to pre-migration exposures, the circumstances of the migration journey and the receptivity and access to health services in their receiving countries. While the prevalence of infectious diseases identified through screening programmes are generally low, delays in diagnosis and treatment for a range of treatable infectious diseases result in higher morbidity and mortality among migrants. Barriers to care in host countries occur at the patient, provider and health systems levels. Coordinated and inclusive health services, healthcare systems and health policies, responsive to patient diversity reduce these barriers. Structural barriers to healthcare provision impede equitable care to migrants and refugees. Public health and medical professionals have a role in advocating for policy reforms.

Chagas disease: comments on the 2018 PAHO Guidelines for diagnosis and management

BACKGROUND

Chagas disease, or American trypanosomiasis, is a protozoan infectious disease endemic throughout most of the Americas, caused by the trypanosome, Trypanosoma cruzi, and mainly transmitted to humans by reduviid or kissing bugs. Some progress has been achieved in control of the disease mainly in endemic areas, but migration flows have acted as drivers for the emergence of the disease mainly in non-endemic areas of Europe and North America. Most imported cases of Chagas disease in Europe are reported in migrants from highly endemic areas of countries such as Bolivia and Paraguay, and reports of Chagas disease in travellers are extremely rare.

METHODS

Pan American Health Organization (PAHO) recently updated their guidelines on the diagnosis and management of Chagas. These guidelines and their applicability to migrants and travellers are reviewed.

RESULTS

PAHO recommends the use of two serological tests for diagnosis of chronic infection (allowing for the use of a single sensitive test followed by confirmation in special settings such as the screening of potential blood donors). The indication for specific trypanocidal treatment of acute infections, children and women of child-bearing age remains as before, with either benznidazole or nifurtimox being the treatment of choice. For chronic infection with/without organ damage, treatment recommendations are less well defined. Although treatment is generally not recommended in patients with visceral involvement, decisions regarding treatment need to be tailored to the individual. Either benznidazole or nifurtimox may be used for initial treatment.

CONCLUSIONS

The recent PAHO Guidelines provide a framework to aid the diagnosis and management of this infection, but several aspects such as the underdiagnosis of infections, the multidisciplinary approach to patient management, the investigation of novel biomarkers of disease progression/response to treatment and the development of new treatment strategies are areas which should be further strengthened.

Severe dengue in travellers: pathogenesis, risk and clinical management

RATIONALE FOR REVIEW

Dengue is a frequent cause of febrile illness among travellers and has overtaken malaria as the leading cause of febrile illness for those traveling to Southeast Asia. The purpose is to review the risk of dengue and severe dengue in travellers with a particular focus on the pathogenesis and clinical management of severe dengue.

RISK, PATHOGENESIS AND CLINICAL MANAGEMENT

The risk of travel-acquired dengue depends on destination, season and duration of travel and activities during travel. Seroconversion rates reported in travellers, therefore, vary between <1% and >20%. The most common life-threatening clinical response to dengue infection is the dengue vascular permeability syndrome, epidemiologically linked to secondary infection, but can also occur in primary infection. Tertiary and quaternary infections are usually associated with mild or no disease. Antibody-dependent enhancement, viral factors, age, host factors and clinical experience of the managing physician modulate the risk of progressing to severe dengue. The relative risk of severe dengue in secondary versus primary infection ranges from 2 to 7. The absolute risk of severe dengue in children in highly endemic areas is ~0.1% per year for primary infections and 0.4% for secondary infections. About 2-4% of secondary infections lead to severe dengue. Severe dengue and death are both relatively rare in general travellers but more frequently in those visiting friends and relatives. Clinical management of severe dengue depends on judicious use of fluid rehydration.

CONCLUSIONS

Although dengue is a frequent cause of travel illness, severe dengue and deaths are rare. Nevertheless, dengue infections can interrupt travel and lead to evacuation and major out-of-pocket costs. Dengue is more frequent than many other travel-related vaccine preventable diseases, such as hepatitis A, hepatitis B, rabies, Japanese encephalitis and yellow fever, indicating a need for a dengue vaccine for travellers.