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García-Marín NM, Marrero GA, Guerra-Neira A, Rivera-Deán A. Profiles of travelers to intermediate-high health risk areas following the reopening of borders in the COVID-19 crisis: A clustering approach. Travel Med Infect Dis 2023; 54:102607. [PMID: 37353065 PMCID: PMC10284617 DOI: 10.1016/j.tmaid.2023.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/15/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND The reactivation of international travel in 2021 has created a new scenario in which the profile of the traveler to medium-high health risk areas may well have changed. However, few studies have analyzed this new profile since the reopening of borders in that year. METHODS We designed an ad hoc questionnaire that was administered face-to-face by our medical team during appointments with 330 travelers in the second half of 2021. Information was collected on the following topics: sociodemographic and socioeconomic status; type of travel and previous travel experience; health status and risk perception (of COVID-19 and tropical infectious diseases). Using all features simultaneously, an unsupervised machine learning approach (k-means) is implemented to characterize groups of travelers. Pairwise chi-squared tests were performed to identify key features that showed statistically significant differences between clusters. RESULTS The travelers were clustered into seven groups. We associated the clusters with different intensities of perceived risk of acquiring COVID-19 and tropical infectious diseases on the trip. The perceived risk of both diseases was low in the group "middle or lower middle class young inexperienced male tourist" but high in the group "middle or lower middle-class young with children inexperienced business traveler". CONCLUSIONS Broadening our knowledge of the profiles of travelers to intermediate-high health risk areas would help to tailor the health advice provided by practitioners to their characteristics and type of travel. In a changing health context, the k-means approach supposes a flexible statistical method that calculates travelers' profiles and can be easily adapted to process new information.
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Affiliation(s)
- Nidia M García-Marín
- International Vaccination Center at Santa Cruz de Tenerife, Spanish Ministry of Health, Spain; University of La Laguna, Research Center of Social Inequality and Governance (CEDESOG), Spain
| | - Gustavo A Marrero
- University of La Laguna, Department of Economics, Spain; University of La Laguna, Research Center of Social Inequality and Governance (CEDESOG), Spain; University of La Laguna, IUDR, Spain.
| | - Ana Guerra-Neira
- International Vaccination Center at Santa Cruz de Tenerife, Spanish Ministry of Health, Spain; University of La Laguna, Research Center of Social Inequality and Governance (CEDESOG), Spain
| | - Almudena Rivera-Deán
- International Vaccination Center at Santa Cruz de Tenerife, Spanish Ministry of Health, Spain; University of La Laguna, Research Center of Social Inequality and Governance (CEDESOG), Spain
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López-Gigosos RM, Segura M, Díez-Díaz RM, Ureña I, Urzay D, Guillot P, Guerra-Neira A, Rivera A, Pérez-Cobaleda Á, Martín A, Nuñez-Torrón M, Alvarez B, Faraco M, Barrera JM, Calvo MJ, Gallegos J, Bermejo A, Aramburu C, Dávila M, Carreras F, Neipp R, Mariscal A. The Maritime Declaration of Health (MDH) as a tool to detect maritime traffic-related health risks: analysis of MDH forms submitted to Spanish ports, October 2014 to March 2015. Euro Surveill 2017; 22:30551. [PMID: 28661394 PMCID: PMC5479973 DOI: 10.2807/1560-7917.es.2017.22.24.30551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 12/15/2016] [Indexed: 12/02/2022]
Abstract
The international maritime traffic of people and goods has often contributed to the spread of pathogens affecting public health. The Maritime Declaration of Health (MDH), according to the International Health Regulations (IHR) (2005), is a document containing data related to the state of health on board a ship during passage and on arrival at port. It is a useful tool for early detection of public health risks. The main objective of our study was to evaluate compliance with the model provided in the IHR, focusing on the format and degree of completion of MDH forms received at Spanish ports. We reviewed the content of 802 MDH forms submitted to nine Spanish ports between October 2014 and March 2015. Study results show that 22% of MDH forms presented did not comply with the recommended model and 39% were incomplete. The proportion of cargo ships with correct and complete MDH forms was lower than passenger ships; thus, the nine health questions were answered less frequently by cargo ships than passenger ships (63% vs 90%, p value < 0.001). The appropriate demand and usage of MDH forms by competent authorities should improve the quality of the document as a tool and improve risk assessment.
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Affiliation(s)
| | - Marina Segura
- Medical service, Port Health Authority of Málaga, Málaga, Spain
| | | | - Isabel Ureña
- Medical service, Port Health Authority of Málaga, Málaga, Spain
| | - David Urzay
- Medical service, Port Health Authority of Tarragona, Tarragona, Spain
| | - Patricia Guillot
- Medical service, Port Health Authority of Tarragona, Tarragona, Spain
| | - Ana Guerra-Neira
- Medical service, Port Health Authority of Tenerife, Santa Cruz de Tenerife, Spain
| | - Almudena Rivera
- Medical service, Port Health Authority of Tenerife, Santa Cruz de Tenerife, Spain
| | | | - Ascensión Martín
- Medical service, Port Health Authority of A Coruña, A Coruña, Spain
| | | | - Begoña Alvarez
- Medical service, Port Health Authority of Vigo, Vigo, Spain
| | - Mar Faraco
- Medical service, Port Health Authority of Huelva, Huelva, Spain
| | - José M Barrera
- Medical service, Port Health Authority of Huelva, Huelva, Spain
| | - María J Calvo
- Medical service, Port Health Authority of Santander, Santander, Spain
| | - José Gallegos
- Medical service, Port Health Authority of Algeciras, Algeciras, Spain
| | - Antonio Bermejo
- Medical service, Port Health Authority of Algeciras, Algeciras, Spain
| | - Carmen Aramburu
- Medical service, Port Health Authority of Barcelona, Barcelona, Spain
| | - Miguel Dávila
- Subdirección General de Sanidad Exterior, Ministry of Health, Madrid, Spain
| | - Fernando Carreras
- Subdirección General de Sanidad Exterior, Ministry of Health, Madrid, Spain
| | - Rosemarie Neipp
- Subdirección General de Sanidad Exterior, Ministry of Health, Madrid, Spain
| | - Alberto Mariscal
- Department of Public Health, University of Málaga, Málaga, Spain
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Guerra-Neira A, Rubio JM, Royo JR, Ortega JC, Auñón AS, Diaz PB, LLanes AB. Plasmodium diversity in non-malaria individuals from the Bioko Island in Equatorial Guinea (West Central-Africa). Int J Health Geogr 2006; 5:27. [PMID: 16784527 PMCID: PMC1550388 DOI: 10.1186/1476-072x-5-27] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 06/19/2006] [Indexed: 11/10/2022] Open
Abstract
Background In this paper we analyse the Plasmodium sp. prevalence in three villages with different isolation status on the island of Bioko (Equatorial Guinea) where malaria is a hyper-endemic disease. We also describe the genetic diversity of P. falciparum, using several plasmodia proteins as markers which show a high degree of polymorphism (MSP-1 and MSP-2). The results obtained from three different populations are compared in order to establish the impact of human movements and interventions. Methods Plasmodium sp. were analysed in three villages on Bioko Island (Equatorial Guinea), one of which (Southern) is isolated by geographical barriers. The semi-nested multiplex polymerase chain reaction (PCR) technique was used to determine the prevalence of the four human plasmodia species. The genotyping and frequency of P. falciparum populations were determined by PCR assay target polymorphism regions of the merozoite surface proteins 1 and 2 genes (MSP-1 and MSP-2). Results The data obtained show that there are no differences in plasmodia population flow between the Northwest and Eastern regions as regards the prevalence of the different Plasmodium species. The Southern population, on the other hand, shows a minor presence of P. malariae and a higher prevalence of P. ovale, suggesting some kind of transmission isolated from the other two. The P. falciparum genotyping in the different regions points to a considerable allelic diversity in the parasite population on Bioko Island, although this is somewhat higher in the Southern region than the others. There was a correlation between parasitaemia levels and the age of the individual with the multiplicity of infection (MOI). Conclusion Results could be explained by the selection of particular MSP alleles. This would tend to limit diversity in the parasite population and leading up to the extinction of rare alleles. On the other hand, the parasite population in the isolated village has less outside influence and the diversity of P. falciparum is maintained higher. The knowledge of parasite populations and their relationships is necessary to study their implications for control intervention.
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Affiliation(s)
- Ana Guerra-Neira
- Centro de Referencia para el Control de Endemias, Centro Nacional de Medicina Tropical. Instituto de Salud Carlos III, Malabo, Bioko, Equatorial Guinea
| | - José M Rubio
- Servicio de Medicina Tropical. Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Sinesio Delgado 6, Pabellón 13, 28220, Madrid, Spain
| | - Jesús Roche Royo
- Centro de Referencia para el Control de Endemias, Centro Nacional de Medicina Tropical. Instituto de Salud Carlos III, Malabo, Bioko, Equatorial Guinea
| | - Jorge Cano Ortega
- Centro de Referencia para el Control de Endemias, Centro Nacional de Medicina Tropical. Instituto de Salud Carlos III, Malabo, Bioko, Equatorial Guinea
| | - Antonio Sarrión Auñón
- Centro de Referencia para el Control de Endemias, Centro Nacional de Medicina Tropical. Instituto de Salud Carlos III, Malabo, Bioko, Equatorial Guinea
| | - Pedro Berzosa Diaz
- Servicio de Medicina Tropical. Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Sinesio Delgado 6, Pabellón 13, 28220, Madrid, Spain
| | - Agustín Benito LLanes
- Servicio de Medicina Tropical. Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Sinesio Delgado 6, Pabellón 13, 28220, Madrid, Spain
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Cano J, Berzosa PJ, Roche J, Rubio JM, Moyano E, Guerra-Neira A, Brochero H, Mico M, Edú M, Benito A. Malaria vectors in the Bioko Island (Equatorial Guinea): estimation of vector dynamics and transmission intensities. J Med Entomol 2004; 41:158-161. [PMID: 15061273 DOI: 10.1603/0022-2585-41.2.158] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The current study was performed on the Bioko Island (Equatorial Guinea) with the aim of establishing a rapid assessment technique for mapping malaria risk and measuring vector densities. Human bait collection, tent traps, light traps, indoor resting collection, and window exit traps were used to collect Anopheles gambiae s.s. and Anopheles funestus, the two anopheline species involved in malaria transmission in this island. Capture data were used to compare differences in the behavior and vectorial capacity of An. gambiae s.s. and An. funestus. Differences in the two species of mosquitoes were found in relation to the season and trapping methods used. Entomological inoculation rates (EIR) for Plasmodium falciparum were calculated using a polymerase chain reaction (PCR) test with individual anopheline mosquitoes from human bait collections in two villages during the dry and rainy seasons. P. falciparum sporozoites were detected from both dissected heads/thorax and abdomens of both species.
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Affiliation(s)
- J Cano
- Laboratorio de Salud Pública para el Control de Endemias, Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Equatorial Guinea
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Roche J, Guerra-Neira A, Raso J, Benito A. Surveillance of in vivo resistance of Plasmodium falciparum to antimalarial drugs from 1992 to 1999 in Malabo (Equatorial Guinea). Am J Trop Med Hyg 2003; 68:598-601. [PMID: 12812353 DOI: 10.4269/ajtmh.2003.68.598] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
From 1992-1999, we have assessed the therapeutic efficacy of three malaria treatment regimens (chloroquine 25 mg/kg over three days, pyrimethamine/sulfadoxine 1.25/25 mg/kg in one dose, and quinine 25-30 mg/kg daily in three oral doses over a four-, five-, or seven-day period) in 1,189 children under age 10 at Malabo Regional Hospital in Equatorial Guinea. Of those children, 958 were followed up clinically and parasitologically for 14 days. With chloroquine, the failure rate varied from 55% in 1996 to 40% in 1999; the early treatment failure rate increased progressively over the years, from 6% in 1992 to 30% in 1999. With pyrimethamine/sulfadoxine, the failure rate varied from 0% in 1996 to 16% in 1995. The short quinine treatment regimens used in 1992 and 1993 (4 and 5 days, respectively) resulted in significantly higher failure rates (19% and 22%, respectively) than the 7d regimen (3-5.5%). We conclude that: a) failure rates for chloroquine are in the change period (> 25%), and urgent action is needed; b) pyrimethamine/ sulfadoxine failure rates are in the alert period (6-15%), and surveillance must be continued; and c) quinine failure rates are in the grace period (< 6%), so quinine can be recommended.
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Affiliation(s)
- Jesús Roche
- Proyecto Control del Paludismo, Hospital Regional de Malabo, Equatorial Guinea
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Campo P, Guerra-Neira A, Cruchaga S, Ladrón De Guevara C. Is routinely searching for halophilic vibrios useful in non-coastal areas? Clin Microbiol Infect 1999; 5:506-507. [PMID: 11856296 DOI: 10.1111/j.1469-0691.1999.tb00182.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Pilar Campo
- Department of Microbiology, 'La Paz' Hospital, Ppo de la Castellana, 261, 28046 Madrid, Spain
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