Epidemiology of Leprosy in Spain: The Role of the International Migration

Abstract

BackgroundAlthough incidence of leprosy in Spain has declined steadily over the years, the fivefold increase in immigration since the turn of the century—much of it from countries where leprosy is still prevalent—has been linked to an uptick in registered cases.ObjectiveTo describe the epidemiologic trends of incident leprosy cases detected in Spain among Spanish- and foreign-born population groups.MethodsObservational, retrospective study of suspected leprosy cases in Spain, as reported through the System of Compulsory Notification of Diseases from 2003 to 2013, with results disaggregated by country of birth. We collected statistical data on leprosy burden for other countries from WHO to estimate the expected number of imported cases.ResultsOf the 168 leprosy cases registered during the study period, 40 (24.6%) were in Spanish patients, while 128 (76.2%) were detected in legally resident immigrants. We identified a significantly higher number of imported leprosy cases during the 2008–2010 and 2011–2013 trienniums compared to the reference biennium 2003–2004 (OR 5.38, 95% CI 1.83–14.88 and OR 4.80, 95% CI 1.41–16.33, respectively). Most imported cases were diagnosed in Latin American immigrants (71.9%), especially Brazilians, but also Paraguayans, Bolivians and other nationalities from South and Central America. However, registered incidence was lower than expected for each year. For example, in 2003, the expected new cases in immigrants was 47.12, compared to only four cases that were actually detected (a 91% difference). Likewise, we expected to find 49.6 incident cases among immigrants in 2009, but only 15 new cases were reported (60% fewer than expected).ConclusionImported cases of leprosy are responsible for most leprosy incidence in Spain, and we cannot rule out some under-diagnosis. Clinicians should be made more aware of the potential for leprosy incidence among patients from countries where the disease is endemic.

Climatic changes and their role in emergence and re-emergence of diseases

“…In Spain, between 2003 and 2013, a sum of 168 leprosy cases was registered. Out of them, 40 people were Spanish patients, while the remaining were illegal immigrants (Ramos et al 2016).…”

Vipers, mambas and taipans: the escalating health crisis over snakebites

“…in the venom of the coral snake (Micrurus corallinus), a member of the elapid family 4 . Mice were injected with the DNA using a technique that enabled some to generate antibodies against coral-snake venom, and the group enhanced the mice's immune responses by injecting them with synthetic antibodies manufactured in bacterial cells.…”

Autochthonous leprosy in the eastern United States is from international migration, not from armadillos

“…They concluded that the registered incidence of leprosy was lower than expected every year, often more than 50% and as high as 90% per year. 2 We reported autochthonous leprosy cases in New York City, 3 including proof with molecular techniques. 4 In our original epidemiologic evaluation of leprosy in New York City, we found an average lag from onset of symptoms to diagnosis of leprosy of 4.8 years with some cases going undiagnosed for more than 30 years, 5 findings that tend to confirm the lower incidence than expected in the Ramos study.…”

“…The foreign-born population in Orlando is at 14.2% (408,137 immigrants) of a total population of 2,875,341 in 2013 ( http://immigrationforum.org ). In a recent report, Ramos et al 2 emphasized the role of international migration on leprosy in Spain, a country of low prevalence similar to the that of United States, by analyzing Spanish immigration statistics and World Health Organization leprosy statistics on the countries of origin. They concluded that the registered incidence of leprosy was lower than expected every year, often more than 50% and as high as 90% per year.…”