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Kumar GS, Pezzi C, Wien S, Mamo B, Scott K, Payton C, Urban K, Hughes S, Kennedy L, Cabanting N, Montour J, Titus M, Aguirre J, Kawasaki B, Ford R, Jentes ES. Health of Special Immigrant Visa holders from Iraq and Afghanistan after arrival into the United States using Domestic Medical Examination data, 2014-2016: A cross-sectional analysis. PLoS Med 2020; 17:e1003083. [PMID: 32231361 PMCID: PMC7108690 DOI: 10.1371/journal.pmed.1003083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Since 2008, the United States has issued between 2,000 and 19,000 Special Immigrant Visas (SIV) annually, with the majority issued to applicants from Iraq and Afghanistan. SIV holders (SIVH) are applicants who were employed by, or on behalf of, the US government or the US military. There is limited information about health conditions in SIV populations to help guide US clinicians caring for SIVH. Thus, we sought to describe health characteristics of recently arrived SIVH from Iraq and Afghanistan who were seen for domestic medical examinations. METHODS AND FINDINGS This cross-sectional analysis included data from Iraqi and Afghan SIVH who received a domestic medical examination from January 2014 to December 2016. Data were gathered from state refugee health programs in seven states (California, Colorado, Illinois, Kentucky, Minnesota, New York, and Texas), one county, and one academic medical center and included 6,124 adults and 4,814 children. Data were collected for communicable diseases commonly screened for during the exam, including tuberculosis (TB), hepatitis B, hepatitis C, malaria, strongyloidiasis, schistosomiasis, other intestinal parasites, syphilis, gonorrhea, chlamydia, and human immunodeficiency virus, as well as elevated blood lead levels (EBLL). We investigated the frequency and proportion of diseases and whether there were any differences in selected disease prevalence in SIVH from Iraq compared to SIVH from Afghanistan. A majority of SIV adults were male (Iraqi 54.0%, Afghan 58.6%) and aged 18-44 (Iraqi 86.0%, Afghan 97.7%). More SIV children were male (Iraqi 56.2%, Afghan 52.2%) and aged 6-17 (Iraqi 50.2%, Afghan 40.7%). The average age of adults was 29.7 years, and the average age for children was 5.6 years. Among SIV adults, 14.4% were diagnosed with latent tuberculosis infection (LTBI), 63.5% were susceptible to hepatitis B virus (HBV) infection, and 31.0% had at least one intestinal parasite. Afghan adults were more likely to have LTBI (prevalence ratio [PR]: 2.0; 95% confidence interval [CI] 1.5-2.7) and to be infected with HBV (PR: 4.6; 95% CI 3.6-6.0) than Iraqi adults. Among SIV children, 26.7% were susceptible to HBV infection, 22.1% had at least one intestinal parasite, and 50.1% had EBLL (≥5 mcg/dL). Afghan children were more likely to have a pathogenic intestinal parasite (PR: 2.7; 95% CI 2.4-3.2) and EBLL (PR: 2.0; 95% CI 1.5-2.5) than Iraqi children. Limitations of the analysis included lack of uniform health screening data collection across all nine sites and possible misclassification by clinicians of Iraqi and Afghan SIVH as Iraqi and Afghan refugees, respectively. CONCLUSION In this analysis, we observed that 14% of SIV adults had LTBI, 27% of SIVH had at least one intestinal parasite, and about half of SIV children had EBLL. Most adults were susceptible to HBV. In general, prevalence of infection was higher for most conditions among Afghan SIVH compared to Iraqi SIVH. The Centers for Disease Control and Prevention (CDC) Guidelines for the US Domestic Medical Examination for Newly Arriving Refugees can assist state public health departments and clinicians in the care of SIVH during the domestic medical examination. Future analyses can explore other aspects of health among resettled SIV populations, including noncommunicable diseases and vaccination coverage.
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Affiliation(s)
- Gayathri S. Kumar
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Immigrant, Refugee, and Migrant Health Branch, Atlanta, Georgia, United States of America
- * E-mail:
| | - Clelia Pezzi
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Immigrant, Refugee, and Migrant Health Branch, Atlanta, Georgia, United States of America
| | - Simone Wien
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Immigrant, Refugee, and Migrant Health Branch, Atlanta, Georgia, United States of America
| | - Blain Mamo
- Minnesota Department of Health, Saint Paul, Minnesota, United States of America
| | - Kevin Scott
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Colleen Payton
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Kailey Urban
- Minnesota Department of Health, Saint Paul, Minnesota, United States of America
| | - Stephen Hughes
- Bureau of Tuberculosis Control, New York State Department of Health, Albany, New York, United States of America
| | - Lori Kennedy
- Colorado Department of Public Health and Environment, Disease Control and Environmental Epidemiology Division, Refugee Health Program, Denver, Colorado, United States of America
| | - Nuny Cabanting
- Office of Refugee Health, Center for Infectious Diseases, California Department of Public Health, Sacramento, California, United States of America
| | - Jessica Montour
- Texas Department of State Health Services, Austin, Texas, United States of America
| | - Melissa Titus
- Marion County Public Health Department, Indianapolis, Indiana, United States of America
| | - Jenny Aguirre
- Illinois Department of Public Health, Refugee Health Program, Chicago, Illinois, United States of America
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Disease Control and Environmental Epidemiology Division, Refugee Health Program, Denver, Colorado, United States of America
| | - Rebecca Ford
- University of Louisville Division of Infectious Diseases, Louisville, Kentucky, United States of America
| | - Emily S. Jentes
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Immigrant, Refugee, and Migrant Health Branch, Atlanta, Georgia, United States of America
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Safi N, Warusavithana S, Shah Alawi SA, Atta H, Montresor A, Gabrielli AF. Elimination of morbidity due to soil-transmitted helminthiases among Afghan schoolchildren. Acta Trop 2019; 197:105035. [PMID: 31128094 DOI: 10.1016/j.actatropica.2019.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 01/17/2023]
Abstract
Large sectors of the Afghan population have limited access to safe water and sanitation, which increases the risk of transmission of water- and food- borne diseases, including Soil-Transmitted Helminth (STH) infections. STHs interfere with the human host's health status, and their burden of disease is highest among children of school age. Based on the results of a nationwide survey conducted in 2003, which showed an STH prevalence of 47.2%, and with the aim of reducing morbidity among school children, Afghanistan has been conducting nationwide deworming for preschool-age and school-age children since 2004. In 2017, 14 years after the first baseline assessment, a follow-up survey was carried out among schoolchildren aged 8-10 years to provide an update on STH epidemiology and facilitate evidence-informed planning of future deworming campaigns. Stool samples were collected from 2263 pupils aged 8-10 years in five provinces representing the different ecological zones of the country - Kabul, Balkh, Herat, Nangarhar and Kandahar. Microscopic examination was carried out by the Kato-Katz thick smear technique, to assess the presence and the number of parasites and/or their eggs. The survey revealed that 26.6% of the sample was infected with at least one of the STH, a marked decrease from the level registered in 2003. The most prevalent infection was the one with A. lumbricoides (25.7%), followed by T. trichiura (1.0%) and hookworms (0.1%). All positive children were noted to have light-intensity infections, compared to the previous survey where 9.7% of the sample had moderate-to-heavy intensity infections. Only 0.2% of the children had co-infection with two or more parasites. Meanwhile, 6.8% of the students were found infected with the dwarf tapeworm, Hymenolepis nana. The absence of infections of moderate-to-heavy intensity after several yearly rounds of deworming and overall improvements in provision of safe water and sanitation, indicates successful control of morbidity due to STH and, overall, their elimination as a public-health problem from Afghanistan. Nevertheless, current levels of prevalence of infection still show persistence of active transmission of STHs, thus justifying the continued implementation of mass deworming interventions among children. The permanent elimination of STH transmission, however, will be possible only when the country reaches a sanitation level sufficient to impede fecal contamination of the environment with human excreta.
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Affiliation(s)
- Naimullah Safi
- World Health Organization Country Office, Kabul, Afghanistan.
| | | | - Sayed Ali Shah Alawi
- Child and Adolescent Health Department, General Directorate of Preventive Medicine, Ministry of Public Health, Kabul, Afghanistan
| | - Hoda Atta
- Division of Communicable Diseases, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Albis Francesco Gabrielli
- Division of Communicable Diseases, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Abstract
PURPOSE OF REVIEW Cestodes infections in humans are among the most prevalent parasitosis worldwide. Although tapeworm infection is often asymptomatic, they can be associated with a range of symptoms. The landscape of cestode infections is changing with rapid diagnosis techniques and advanced molecular diagnosis aiding in identification of species specific epidemiology. RECENT FINDINGS Traditional descriptions of species by location have been challenged with molecular diagnostic techniques, which show variation in distribution of species, thought to be because of globalization and importation of disease. MAIN THEMES IN LITERATURE Epidemiology, molecular diagnostic techniques. SUMMARY Infection by tapeworms is often asymptomatic or accompanied by mild symptoms though can occasionally cause severe disease and contribute to anemia and malnutrition. Tapeworm infection is most prevalent in resource-poor countries but the distribution is worldwide. Epidemiology of infection is changing because of molecular diagnostics, which allow more accurate tracking of species.
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Affiliation(s)
- Camille Webb
- Division of Infectious Disease Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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Lass A, Karanis P, Korzeniewski K. First detection and genotyping of Giardia intestinalis in stool samples collected from children in Ghazni Province, eastern Afghanistan and evaluation of the PCR assay in formalin-fixed specimens. Parasitol Res 2017; 116:2255-2264. [PMID: 28612148 PMCID: PMC5529491 DOI: 10.1007/s00436-017-5529-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/01/2017] [Indexed: 02/07/2023]
Abstract
It is estimated that faecal-orally transmitted diseases are common in Afghanistan, as a consequence of poor hygienic standards of life and widespread contamination of water and food with both human and animal faeces. However, there is little information in the literature concerning infections caused by intestinal parasites in the Afghan population. In this study, we report the occurrence of Giardia intestinalis assemblages (A and B) in formalin-fixed stool samples collected from 245 Afghan schoolchildren living in Ghazni Province in eastern Afghanistan. Detection of the parasite’s DNA and genotyping was performed using real-time PCR, specific to the β-giardin gene of G. intestinalis. Positive results were recorded in 52 (21.2%) samples. Genotyping was successful in 39 faecal samples and showed the predominance of assemblage B of G. intestinalis in this population (15 assemblage A and 24 assemblage B). Co-infection with both genotypes A and B was detected in four samples. Additionally, we evaluated the effect of 10% buffered formalin fixative on the detection of G. intestinalis DNA using real-time PCR and nested PCR characterised by different lengths of PCR products (74 and 479 bp, respectively). The human faeces containing the Giardia cysts were tested for 16 weeks. Amplification of G. intestinalis DNA with real-time PCR was possible up to 6 weeks of preservation of stool sample in formalin, compared to only 2 weeks with nested PCR. This suggests that real-time PCR is a more suitable tool in cases where stool samples have to be kept in formalin for longer periods of time.
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Affiliation(s)
- Anna Lass
- Department of Tropical Parasitology, Institute of Maritime and Tropical Medicine in Gdynia, Medical University of Gdansk, 9b Powstania Styczniowego Str, 81-519, Gdynia, Poland.
| | - Panagiotis Karanis
- State Key Laboratory of Plateau Ecology and Agriculture, Center for Biomedicine and Infectious Disease, Qinghai Academy of Animal Sciences and Veterinary Medicine, Qinghai University, Xining, 1#Wei'er Road, Qinghai Biological Scientific Estate Garden, Xining, 810016, People's Republic of China
| | - Krzysztof Korzeniewski
- Epidemiology and Tropical Medicine Department in Gdynia, Military Institute of Medicine in Warsaw, Grudzinskiego St. 4, 81-103, Gdynia, Poland
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