Screening for Imported Diseases in an Immigrant Population: Experience from a Teaching Hospital in Barcelona, Spain

Abstract

Abstract. The objective of this study was to describe the screening for imported diseases among an immigrant population. This retrospective observational study was of all adult immigrants attended at the Tropical Medicine Unit of the Vall d'Hebron Teaching Hospital from September of 2007 to March of 2010. The screening strategy was adjusted by symptoms, country of origin, and length of residence in Europe. Overall, 927 patients were included. The median age was 34.5 years, and 42.1% of patients were male. A diagnosis was made in 419 (45.2%) patients. The most frequent diagnoses were Chagas disease, anemia, latent tuberculosis infection, intestinal parasitosis, hepatitis B virus (HBV) infection, and human immunodeficiency virus (HIV) infection. After screening, more diseases were identified in immigrants from sub-Saharan Africa (new diagnoses in 56.6% of patients) than patients from other geographic areas. The geographic origin and length of residence in a developed country determine the prevalence of diseases; hence, screening protocols must be based on this information.

Infectious Diseases in Sub-Saharan Immigrants to Spain

“…10,11,18,32 Similar to previous studies, no relationship was found between having symptoms and the presence of imported infectious diseases, suggesting that screening protocols should be carried out regardless of clinical status. 9,33 The prevalence of pathogenic infectious disease was high (73%).…”

“…The prevalence of LTBI (61%) in this study was similar to that of other studies (46-71%), being higher than the general prevalence in the world (onethird of the world's population is estimated to be infected) and in that of other immigrant groups. [7][8][9][10]12,34 Nonetheless, the prevalence of LTBI in this study may be overestimated, since false-positive TST result may be observed in subjects who have received the Bacillus Calmette-Guérin vaccine or are infected with other mycobacterias. 12 This is important to take into account because the side effects of chemoprophylaxis for LTBI are not negligible.…”

“…This prevalence was reportedly lower (45%) in studies including other areas of origin. 10 The prevalence of either infections or noninfectious diseases was 84% in previous studies. 7 According to our data, subSaharan immigrants coming through a land-maritime routes are more vulnerable to infectious diseases.…”

“…In this study, the prevalence of HBsAg in sub-Saharan immigrants (15%) was similar to that described in other studies (10-19%), being higher compared with other immigrant groups. [7][8][9][10]38 International guidelines recommend screening in populations in which the prevalence is estimated to be greater than 2%. 39 On the other hand, although the prevalence of HbsAg in sub-Saharan immigrants remains as high as 10% in some areas in Africa, it has decreased in recent years probably due to expanded immunization programs in these countries.…”

“…4,7,8 Several studies have described a higher prevalence of latent tuberculosis infection (LTBI) (46-71%) and positive hepatitis B surface antigen (HBsAg; 10-14%) in sub-Saharan immigrants than in Latin American (LTBI, 19-47%; HBsAg, 0-7%) or Asian immigrants (LTBI, 30-51%; HBsAg, 0-3%). [7][8][9][10][11] Coinfections should also be taken into account as some of these infections have a similar geographical distribution. Prompt diagnosis and treatment of these infections are important, since, for example, in the case of LTBI, 5-10% of cases may develop active tuberculosis (TB), and a quarter of the cases with HBsAg may develop cirrhosis and/or liver cancer.…”