Volume 92, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Migrants from developing countries are usually young and healthy but several studies report they may harbor asymptomatic infections for prolonged periods. Prevalence of infections were determined for asymptomatic immigrants from Latin America and sub-Saharan Africa who ettended to a European Tropical Medicine Referral Center from 2000 to 2009. A systematic screening protocol for selected infections was used. Data from 317 sub-Saharan Africans and 383 Latin Americans were analyzed. Patients were mostly young (mean age 29 years); there were significantly more males among sub-Saharan Africans (83% versus 31.6%) and pre-consultation period was longer for Latin Americans (5 versus 42 months). Diagnoses of human immunodeficiency virus (HIV), chronic hepatitis B and C virus infection, and latent tuberculosis were significantly more frequent in sub-Saharan Africans (2.3% versus 0.3%; 14% versus 1.6%; 1.3 versus 0%; 71% versus 32.1%). There were no significant differences in prevalence for syphilis and intestinal parasites. Malaria and schistosomiasis prevalence in sub-Saharan Africans was 4.6% and 5.9%, respectively, and prevalence of Chagas disease in Latin Americans was 48.5%. Identifying and treating asymptomatic imported infectious diseases may have an impact both for the individual concerned and for public health. Based on these results, a systematic screening protocol for asymptomatic immigrants is proposed.


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  1. International Organization for Migration, 2013. World Migration Report: Migrant Well-Being and Development. Available at: https://www.iom.int/cms/es/sites/iom/home.html. Accessed June 9, 2014. [Google Scholar]
  2. Migration Policy Institute (MPI), 2013. MPI Data Hub: Migration, Facts, Stats and Maps. Available at: http://www.migrationinformation.org/datahub/charts/5.1.shtml. Accessed June 18, 2013. [Google Scholar]
  3. National Institute for Statistics, 2014. Municipal Register of Inhabitants (January 1, 2014). Available at: http://www.ine.es/prensa/np776.pdf. Accessed May 15, 2013. [Google Scholar]
  4. Lifson AR, Thai D, O'Fallon A, Mills WA, Hang K, , 2002. Prevalence of tuberculosis, hepatitis B virus, and intestinal parasitic infections among refugees to Minnesota. Public Health Rep 117: 6977.[Crossref] [Google Scholar]
  5. Monge-Maillo B, Jimenez BC, Perez-Molina JA, Norman F, Navarro M, Pérez-Ayala A, Herrero JM, Zamarrón P, López-Vélez R, , 2009. Imported infectious diseases in mobile populations, Spain. Emerg Infect Dis 15: 17451752.[Crossref] [Google Scholar]
  6. Norredam M, Olsbjerg M, Petersen JH, Bygbjerg I, Krasnik A, , 2011. Mortality from infectious diseases among refugees and immigrants compared to native Danes: a historical prospective cohort study. Trop Med Int Health 17: 223230.[Crossref] [Google Scholar]
  7. O'Brien DP, Leder K, Matchett E, Brown GV, Torresi J, , 2006. Illness in returned travelers and immigrants/refugees: the 6-year experience of two Australian infectious diseases units. J Travel Med 13: 145152.[Crossref] [Google Scholar]
  8. Angelini R, Finarelli AC, Angelini P, Po C, Petropulacos K, Macini P, Fiorentini C, Fortuna C, Venturi G, Romi R, Majori G, Nicoletti L, Rezza G, Cassone A, , 2007. An outbreak of chikungunya fever in the province of Ravenna, Italy. Euro Surveill 12: E070906.1. [Google Scholar]
  9. Sudre B, Rossi M, Van Bortel W, Danis K, Baka A, Vakalis N, Semenza JC, , 2013. Mapping environmental suitability for malaria transmission, Greece. Emerg Infect Dis 19: 784786.[Crossref] [Google Scholar]
  10. Fortun J, Martin-Davila P, Navas E, López-Vélez R, Pintado V, Cobo J, González A, Bonilla M, Aneiros V, Gómez-Mampaso E, Moreno S, , 2011. Changes in the epidemiology of tuberculosis: the influence of international migration flows. Enferm Infecc Microbiol Clin 29: 654659.[Crossref] [Google Scholar]
  11. Stauffer WM, Kamat D, Walker PF, , 2002. Screening of international immigrants, refugees, and adoptees. Prim Care 29: 879905.[Crossref] [Google Scholar]
  12. Manzardo C, Trevino B, Gomez i Prat J, Cabezos J, Monguí E, Clavería I, Luis Del Val J, Zabaleta E, Zarzuela F, Navarro R, , 2008. Communicable diseases in the immigrant population attended to in a tropical medicine unit: epidemiological aspects and public health issues. Travel Med Infect Dis 6: 411.[Crossref] [Google Scholar]
  13. Gonzalez-Tome MI, Rivera M, Camaño Gutierrez I, Norman F, Flores-Chávez MD, Rodríguez-Gómez L, Fumadó V, García-López Hortelano M, López-Vélez R, González-Granado LI, García-Burguillo A, Santos Sebastian M del M, Avila Arzanegui O, Sociedad Española de Infectología Pediátrica Sociedad de Enfermedades Infecciosas y Microbiología Clínica Sociedad Española de Ginecología y Obstetricia; ; ; , 2013. Recommendations for the diagnosis, treatment and follow-up of the pregnant woman and child with chagas disease. Enferm Infecc Microbiol Clin 31: 535542.[Crossref] [Google Scholar]
  14. de Sanidad M, Social e Igualdad P, , 2013. Sistemas autonómicos de vigilancia epidemiológica. Centro Nacional de Epidemiología. Vigilancia epidemiológica del VIH/SIDA en España junio. Available at: http://www.msssi.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/vigilancia/InformeVIHSida_Junio2013.pdf. Accessed February 6, 2014.
  15. Jefatura de estado. Real Decreto -Ley 16/2012, 20 de abril, de medidas urgentes para garantizar la sostenibilidad del sistema nacional de salud y mejorar la calidad y seguridad de sus prestaciones. Available at: http://www.boe.es/boe/dias/2012/04/24/pdfs/BOE-A-2012-5403.pdf. Accessed July 8, 2013.
  16. Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, Clark JE, , 2006. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 55: 117. [Google Scholar]
  17. Perez-Molina JA, Diaz-Menendez M, Plana MN, Zamora J, Lopez-Velez R, Moreno S, , 2012. Very late initiation of HAART impairs treatment response at 48 and 96 weeks: results from a meta-analysis of randomized clinical trials. J Antimicrob Chemother 67: 312321.[Crossref] [Google Scholar]
  18. American Association for the Study of Liver Disease (AASLD), 2009. AASLD Practice Guidelines Update. Chronic Hepatitis B: Update. Available at: https://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Chronic_Hep_B_Update_2009%208_24_2009.pdf. Accessed July 2, 2013. [Google Scholar]
  19. Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, Narasiah L, Kirmayer LJ, Ueffing E, MacDonald NE, Hassan G, McNally M, Khan K, Buhrmann R, Dunn S, Dominic A, McCarthy AE, Gagnon AJ, Rousseau C, Tugwell P, , 2011. Evidence-based clinical guidelines for immigrants and refugees. CMAJ 183: E824E925.[Crossref] [Google Scholar]
  20. Eckman MH, Kaiser TE, Sherman KE, , 2011. The cost-effectiveness of screening for chronic hepatitis B infection in the United States. Clin Infect Dis 52: 12941306.[Crossref] [Google Scholar]
  21. Salas J, Vazquez J, Cabezas T, Lozano AB, Cabeza I, , 2011. Hepatitis B virus (HBV) infection in sub-Saharan immigrants in Almeria (Spain). Enferm Infecc Microbiol Clin 29: 121123.[Crossref] [Google Scholar]
  22. Perez-Molina JA, Herrero-Martinez JM, Norman F, Pérez-Ayala A, Monge-Mahillo B, Navarro-Beltrá M, López-Vélez R, , 2011. Clinical, epidemiological characteristics and indications for liver biopsy and treatment in immigrants with chronic hepatitis B at a referral hospital in Madrid. J Viral Hepat 18: 294299.[Crossref] [Google Scholar]
  23. Gibney KB, Torresi J, Lemoh C, Biggs BA, , 2008. Isolated core antibody hepatitis B in sub-Saharan African immigrants. J Med Virol 80: 15651569.[Crossref] [Google Scholar]
  24. Ghany MG, Strader DB, Thomas DL, Seeff LB, American Association for the Study of Liver Diseases; . 2009. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology 49: 13351374.[Crossref] [Google Scholar]
  25. Almasio PL, Babudieri S, Barbarini G, Brunetto M, Conte D, Dentico P, Gaeta GB, Leonardi C, Levrero M, Mazzotta F, Morrone A, Nosotti L, Prati D, Rapicetta M, Sagnelli E, Scotto G, Starnini G, , 2011. Recommendations for the prevention, diagnosis, and treatment of chronic hepatitis B and C in special population groups (migrants, intravenous drug users and prison inmates). Dig Liver Dis 43: 589595.[Crossref] [Google Scholar]
  26. Masvidal Aliberch RM, Estabanell Buxo A, Miguel Gil B, Cruz Rodríguez C, de Frutos Gallego E, Guzmán Molina C, Riera Vidal D, , 2010. Indication of determination of antibodies against hepatitis C and A viruses in the protocol for the care of young immigrants. Gac Sanit 24: 288292.[Crossref] [Google Scholar]
  27. Golden MR, Marra CM, Holmes KK, , 2003. Update on syphilis: resurgence of an old problem. JAMA 290: 15101514.[Crossref] [Google Scholar]
  28. Hawkes S, Matin N, Broutet N, Low N, , 2011. Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect Dis 11: 684691.[Crossref] [Google Scholar]
  29. Soler-Gonzalez J, Real J, Farre J, Serna C, Cruz I, Ruiz C, Bosch A, , 2013. Comparative analysis of serological tests performed in immigrants in the Lleida health area. Aten Primaria 45: 8491.[Crossref] [Google Scholar]
  30. Center for Disease Control and Prevention (CDC), 1990. Screening for tuberculosis in high-risk populations: recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR Recomm Rep 39: 17. [Google Scholar]
  31. Dasgupta K, Menzies D, , 2005. Cost-effectiveness of tuberculosis control strategies among immigrants and refugees. Eur Respir J 25: 11071116.[Crossref] [Google Scholar]
  32. Khan K, Muennig P, Behta M, Zivin JG, , 2002. Global drug-resistance patterns and the management of latent tuberculosis infection in immigrants to the United States. N Engl J Med 347: 18501859.[Crossref] [Google Scholar]
  33. Cain KP, Benoit SR, Winston CA, Mac Kenzie WR, , 2008. Tuberculosis among foreign-born persons in the United States. JAMA 300: 405412.[Crossref] [Google Scholar]
  34. Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS board of directors, July 1999. This is a joint statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med 161: S221S247.[Crossref] [Google Scholar]
  35. Gilbert RL, Antoine D, French CE, Abubakar I, Watson JM, Jones JA, , 2009. The impact of immigration on tuberculosis rates in the United Kingdom compared with other European countries. Int J Tuberc Lung Dis 13: 645651. [Google Scholar]
  36. Horsburgh CR, Jr, 2004. Priorities for the treatment of latent tuberculosis infection in the united states. N Engl J Med 350: 20602067.[Crossref] [Google Scholar]
  37. Gilroy SA, Rogers MA, Blair DC, , 2000. Treatment of latent tuberculosis infection in patients aged > or = 35 years. Clin Infect Dis 31: 826829.[Crossref] [Google Scholar]
  38. Pareek M, Watson JP, Ormerod LP, Kon OM, Woltmann G, White PJ, Abubakar I, Lalvani A, , 2011. Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis. Lancet Infect Dis 11: 435444.[Crossref] [Google Scholar]
  39. Machado A, Jr Emodi K, Takenami I, Finkmoore BC, Barbosa T, Carvalho J, Cavalcanti L, Santos G, Tavares M, Mota M, Barreto F, Reis MG, Arruda S, Riley LW, , 2009. Analysis of discordance between the tuberculin skin test and the interferon-gamma release assay. Int J Tuberc Lung Dis 13: 446453. [Google Scholar]
  40. Muennig P, Pallin D, Sell RL, Chan MS, , 1999. The cost effectiveness of strategies for the treatment of intestinal parasites in immigrants. N Engl J Med 340: 773779.[Crossref] [Google Scholar]
  41. Muennig P, Pallin D, Challah C, Khan K, , 2004. The cost-effectiveness of ivermectin vs. albendazole in the presumptive treatment of strongyloidiasis in immigrants to the United States. Epidemiol Infect 132: 10551063.[Crossref] [Google Scholar]
  42. Weissman AM, , 1994. Preventive health care and screening of Latin American immigrants in the United States. J Am Board Fam Pract 7: 310323. [Google Scholar]
  43. Garg PK, Perry S, Dorn M, Hardcastle L, Parsonnet J, , 2005. Risk of intestinal helminth and protozoan infection in a refugee population. Am J Trop Med Hyg 73: 386391. [Google Scholar]
  44. Navarro M, Perez-Ayala A, Guionnet A, Perez-Molina JA, Navaza B, Estevez L, Norman F, Flores-Chavez M, Lopez-Velez R, , 2011. Targeted screening and health education for Chagas disease tailored to at-risk migrants in Spain, 2007 to 2010. Euro Surveill 16: 19973. [Google Scholar]
  45. Perez-Ayala A, Perez-Molina JA, Norman F, Navarro M, Monge-Maillo B, Díaz-Menéndez M, Peris-García J, Flores M, Cañavate C, López-Vélez R, , 2010. Chagas disease in Latin American migrants: a Spanish challenge. Clin Microbiol Infect 13: 11081113. [Google Scholar]
  46. Chih DT, Heath CH, Murray RJ, , 2006. Outpatient treatment of malaria in recently arrived African migrants. Med J Aust 185: 598601. [Google Scholar]
  47. Sheikh M, Pal A, Wang S, MacIntyre CR, Wood NJ, Isaacs D, Gunasekera H, Raman S, Hale K, Howell A, , 2009. The epidemiology of health conditions of newly arrived refugee children: a review of patients attending a specialist health clinic in Sydney. J Paediatr Child Health 45: 509513.[Crossref] [Google Scholar]
  48. D'Ortenzio E, Godineau N, Fontanet A, Houze S, Bouchaud O, Matheron S, Le Bras J, , 2008. Prolonged Plasmodium falciparum infection in immigrants, Paris. Emerg Infect Dis 14: 323326.[Crossref] [Google Scholar]
  49. Collinet-Adler S, Stauffer WM, Boulware DR, Larsen KL, Rogers TB, Williams DN, , 2007. Financial implications of refugee malaria: the impact of pre-departure presumptive treatment with anti-malarial drugs. Am J Trop Med Hyg 77: 458463. [Google Scholar]
  50. Ohrt CF, O'Meara WF, Remich SF, McEvoy P, Ogutu B, Mtalib R, Odera JS, , 2008. Pilot assessment of the sensitivity of the malaria thin film. Malar J 7: 22.[Crossref] [Google Scholar]
  51. Stauffer WM, Newberry AM, Cartwright CP, Rosenblatt JE, Hanson KL, Sloan L, Tsukayama DT, Taylor C, Juni BA, , 2006. Evaluation of malaria screening in newly arrived refugees to the United States by microscopy and rapid antigen capture enzyme assay. Pediatr Infect Dis J 25: 948950.[Crossref] [Google Scholar]
  52. Ndao MF, Bandyayera EF, Kokoskin E, Gyorkos TW, MaLean JD, Ward BJ, , 2004. Comparison of blood smear, antigen detection, and nested-PCR methods for screening refugees from regions where malaria is endemic after a malaria outbreak in Quebec, Canada. J Clin Microbiol 42: 26942700.[Crossref] [Google Scholar]
  53. Danis K, Baka A, Lenglet A, Van Bortel W, Terzaki I, Tseroni M, Detsis M, Papanikolaou E, Balaska A, Gewehr S, Dougas G, Sideroglou T, Economopoulou A, Vakalis N, Tsiodras S, Bonovas S, Kremastinou J, , 2011. Autochthonous Plasmodium vivax malaria in Greece, 2011. Euro Surveill 16: 19993. [Google Scholar]
  54. Santa-Olalla Peralta P, Vazquez-Torres MC, Latorre-Fandos E, Mairal-Claver P, Cortina-Solano P, Puy-Azón A, Adiego Sancho B, Leitmeyer K, Lucientes-Curdi J, Sierra-Moros MJ, , 2010. First autochthonous malaria case due to Plasmodium vivax since eradication, Spain, October 2010. Euro Surveill 15: 19684. [Google Scholar]
  55. Hagmann S, Khanna K, Niazi M, Purswani M, Robins EB, , 2007. Congenital malaria, an important differential diagnosis to consider when evaluating febrile infants of immigrant mothers. Pediatr Emerg Care 23: 326329.[Crossref] [Google Scholar]
  56. Kitchen AD, Barbara JA, Hewitt PE, , 2005. Documented cases of post-transfusion malaria occurring in England: a review in relation to current and proposed donor-selection guidelines. Vox Sang 89: 7780.[Crossref] [Google Scholar]
  57. Scuracchio P, Vieira SD, Dourado DA, Bueno LM, Colella R, Ramos-Sanchez EM, Lima GF, Inoue J, Sanchez MC, Di Santi SM, , 2011. Transfusion-transmitted malaria: case report of asymptomatic donor harboring Plasmodium malariae . Rev Inst Med Trop Sao Paulo 53: 5559.[Crossref] [Google Scholar]
  58. Hung CC, Chang SC, Chen YC, Yen TS, Hsieh WC, , 1994. Plasmodium vivax infection in a renal transplant recipient: report of a case. J Formos Med Assoc 93: 888889. [Google Scholar]
  59. Chiche L, Lesage A, Duhamel C, Salame E, Malet M, Samba D, Segol P, Treilhaud M, , 2003. Posttransplant malaria: first case of transmission of Plasmodium falciparum from a white multiorgan donor to four recipients. Transplantation 75: 166168.[Crossref] [Google Scholar]
  60. Monge-Maillo B, Norman F, Perez-Molina JA, Diaz-Menendez M, Rubio JM, Lopez-Velez R, , 2012. Plasmodium falciparum in asymptomatic immigrants from sub-Saharan Africa, Spain. Emerg Infect Dis 18: 356357.[Crossref] [Google Scholar]
  61. López-Vélez R, Huerga H, , 2002. Esquistosomiosis. Inmigración y salud. Madrid: PBM, SL, 5051. [Google Scholar]
  62. Doehring-Schwerdtfeger E, Abdel-Rahim IM, Kardorff R, Kaiser C, Franke D, Schlake J, Richter J, Elsheikh M, Mohamed-Ali Q, Ehrich JH, , 1992. Ultrasonographical investigation of periportal fibrosis in children with Schistosoma mansoni infection: reversibility of morbidity twenty-three months after treatment with praziquantel. Am J Trop Med Hyg 46: 409415. [Google Scholar]
  63. Posey DL, Blackburn BG, Weinberg M, Flagg EW, Ortega L, Wilson M, Secor WE, Sanders-Lewis K, Won K, Maguire JH, , 2007. High prevalence and presumptive treatment of schistosomiasis and strongyloidiasis among African refugees. Clin Infect Dis 45: 13101315.[Crossref] [Google Scholar]
  64. McCarthy AE, Weld LH, Barnett ED, So H, Coyle C, Greenaway C, Stauffer W, Leder K, Lopez-Velez R, Gautret P, Castelli F, Jenks N, Walker PF, Loutan L, Cetron M, GeoSentinel Surveillance Network; , 2013. Spectrum of illness in international migrants seen at GeoSentinel clinics in 1997–2009, part 2: migrants resettled internationally and evaluated for specific health concerns. Clin Infect Dis 56: 925933.[Crossref] [Google Scholar]
  65. Lengeler C, Utzinger J, Tanner M, , 2002. Questionnaires for rapid screening of schistosomiasis in sub-Saharan Africa. Bull World Health Organ 80: 235242. [Google Scholar]
  66. Saconato H, Atallah A, , 2000. Interventions for treating Schistosomiasis mansoni . Cochrane Database Syst Rev CD000528. [Google Scholar]

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  • Received : 18 Aug 2014
  • Accepted : 16 Dec 2014
  • Published online : 01 Apr 2015

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