Newly Arrived African Migrants to Spain: Epidemiology and Burden of Disease

Joaquín Salas-Coronas Tropical Medicine Unit, Hospital de Poniente, El Ejido, Almería, Spain;
RICET (Red de Investigación Cooperativa en Enfermedades Tropicales);
CEMyRI (Center for the Study of Migration and Intercultural Relations) of the University of Almería, Almería, Spain;

Search for other papers by Joaquín Salas-Coronas in
Current site
Google Scholar
PubMed
Close
,
María Teresa Cabezas-Fernández Tropical Medicine Unit, Hospital de Poniente, El Ejido, Almería, Spain;
RICET (Red de Investigación Cooperativa en Enfermedades Tropicales);
CEMyRI (Center for the Study of Migration and Intercultural Relations) of the University of Almería, Almería, Spain;
Biotechnology Service, Hospital de Poniente, El Ejido, Almería, Spain;

Search for other papers by María Teresa Cabezas-Fernández in
Current site
Google Scholar
PubMed
Close
,
Ana Belén Lozano-Serrano Tropical Medicine Unit, Hospital de Poniente, El Ejido, Almería, Spain;
RICET (Red de Investigación Cooperativa en Enfermedades Tropicales);

Search for other papers by Ana Belén Lozano-Serrano in
Current site
Google Scholar
PubMed
Close
,
Manuel Jesús Soriano-Pérez Tropical Medicine Unit, Hospital de Poniente, El Ejido, Almería, Spain;
RICET (Red de Investigación Cooperativa en Enfermedades Tropicales);

Search for other papers by Manuel Jesús Soriano-Pérez in
Current site
Google Scholar
PubMed
Close
,
José Vázquez-Villegas RICET (Red de Investigación Cooperativa en Enfermedades Tropicales);
Tropical Medicine Unit, Distrito Poniente, Almería, Spain

Search for other papers by José Vázquez-Villegas in
Current site
Google Scholar
PubMed
Close
, and
José Ángel Cuenca-Gómez Tropical Medicine Unit, Hospital de Poniente, El Ejido, Almería, Spain;
RICET (Red de Investigación Cooperativa en Enfermedades Tropicales);

Search for other papers by José Ángel Cuenca-Gómez in
Current site
Google Scholar
PubMed
Close
Restricted access

The aim of this study is to describe the epidemiological profile, clinical characteristics, and microbiological findings in African immigrants newly arrived to Spain attended at a specialized reference unit from October 2004 to February 2017. A common protocol for the screening of imported and cosmopolitan diseases was designed to evaluate patients with ≤ 12 months of stay in Spain. A total of 523 patients were included in the study, 488 (93.3%) of sub-Saharan origin. A high number of helminthic infections were diagnosed in sub-Saharan patients, including geohelminthiasis (hookworms 14.3%; Trichuris trichiura 4.1%; Ascaris lumbricoides 3.1%), schistosomiasis (12.3%), strongyloidiasis (17.2%), and filariasis (8.4%). Thirty-five patients (7.2%) had malaria, most by Plasmodium falciparum. Among communicable diseases, 33.6% of sub-Saharans presented HBsAg positivity compared with 5.7% of North African patients (P = 0.001). Thirteen patients were diagnosed with active tuberculosis. Seventy percent of the sub-Saharans and 40% of the North Africans who were tested had a latent tuberculosis infection (LTI). Treatment of LTI was administered in selected cases (14%), achieving end of treatment in 80% of them. In light of these results, effective screening strategies, particularly within the sub-Saharan immigrant population, including potentially communicable diseases and certain potentially serious parasitic diseases (Strongyloides, Schistosoma), should be implemented. It is necessary to facilitate fully and free of charge access to the public health system to newly arrived immigrants, as well as to implement programs and actions aimed at favoring care and follow-up, especially for communicable diseases. Empirical treatment of some parasitic diseases could be a cost-effective action.

Author Notes

Address correspondence to Joaquín Salas-Coronas, Tropical Medicine Unit, Hospital de Poniente, Ctra. Almerimar sn, El Ejido 4700, Almería, Spain. E-mail: joaquin.salas@ephpo.es

Financial support: This study has been conducted within the activities developed by the research group PAIDI CTS 582 of the regional Ministry of Gender, Health and Social Policy of the Government of Andalusia, RICET (Red de Investigación Cooperativa en Enfermedades Tropicales) and the CEMyRI (Center for the Study of Migration and Intercultural Relations) of the University of Almeria (Spain).

Authors’ addresses: Joaquín Salas-Coronas, María Teresa Cabezas-Fernández, Ana Belén Lozano-Serrano, Manuel Jesús Soriano-Pérez, and José Ángel Cuenca-Gómez, Tropical Medicine Unit, Hospital de Poniente, Almería, Spain, E-mails: joaquin.salas@ephpo.es, tcabezasf@yahoo.es, anbelose@gmail.com, manueljsoriano@hotmail.com, and jacuencag@gmail.com. José Vázquez-Villegas, Tropical Medicine Unit, Distrito Poniente de Almería, Almería, Spain, E-mail: pepevazquezv@gmail.com.

  • 1.

    Manzardo C, Treviño B, Gómez 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Díaz-Menéndez M et al. 2012. Imported diseases by immigrants and travellers: results from the cooperative network for the study of imported diseases by immigrants and Travellers +Redivi. Enferm Infecc Microbiol Clin 30: 528534.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Pardo J, Carranza C, Muro A, Ángel-Moreno A, Martín AM, Martín T, Hernández-Cabrera M, Pérez-Arellano JL, 2006. Helminth-related eosinophilia in African immigrants, Gran Canaria. Emerg Infect Dis 12: 15871589.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    López-Vélez R, Huerga H, Turrientes MC, 2003. Infectious diseases in immigrants from the perspective of a tropical medicine referral unit. Am J Trop Med Hyg 69: 115121.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Molina-Arrebola MA, Avivar-Oyonarte C, Salas-Coronas J, Pérez-Moyano R, Giménez-López MJ, García-Bautista JA, Jiménez-Gila AM, Porrino-Herrera C, 2012. Practical diagnosis of red cell disorders in southern Spain. Acta Haematol 127: 5055.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Davies A, Basten A, Frattini C, 2006. Migration: A Social Determinant of Health of Migrants. In: Background Paper. International Organization for Migration (IOM); Available at: http://www.migrant-health-europe.org/files/FINAL%20DRAFT%20-%20IOM%20SDH.pdf. Accessed May 23, 2017.

    • PubMed
    • Export Citation
  • 7.

    Cimas M, Gullon P, Aguilera E, Meyer S, Freire JM, Perez-Gomez B, 2016. Healthcare coverage for undocumented migrants in Spain: regional differences after Royal Decree Law 16/2012. Health Policy 120: 384395.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Stasi C, Silvestri C, Voller F, Cipriani F, 2016. The epidemiological changes of HCV and HBV infections in the era of new antiviral therapies and the anti-HBV vaccine. J Infect Public Health 9: 389395.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Daw MA, Sifennasr NEM, El-Bouzedi A, Daeke AO, Dau AA, Drah AM, Ahmed MO, Agnan MM, 2017. Epidemiology of hepatitis B virus in immigrants crossing to Europe from North and Sub-Saharan Africa. Travel Med Infect Dis 16: 5961.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Coppola N et al. 2017. Hepatitis B virus infection in undocumented immigrants and refugees in southern Italy: demographic, virological, and clinical features. Infect Dis Poverty 6: 33.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ, 2015. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet 386: 15461555.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Caminero JA, Caylà JA, Lara N, 2003. Evaluation of tuberculosis trends in Spain, 1991–1999. Int J Tuberc Lung Dis 7: 236242.

  • 13.

    Fortún J et al. 2011. Changes in the epidemiology of tuberculosis: the influence of international migration flows. Enferm Infecc Microbiol Clin 29: 654659.

  • 14.

    Sandgren A, Hollo V, van der Werf MJ, 2013. Extrapulmonary tuberculosis in the European Union and European Economic Area, 2002 to 2011. Euro Surveill 18: 20431.

  • 15.

    Grupo de Trabajo de los Talleres de 2001 y 2002 de la Unidad de Investigación en Tuberculosis de Barcelona, 2003. Prevención y control de las tuberculosis importadas [in Spanish]. Med Clin (Barc) 121: 549557.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Greenaway C, Sandoe A, Vissandjee B, Kitai I, Gruner D, Wobeser W, Pottie K, Ueffing E, Menzies D, Schwartzman K, 2011. Tuberculosis: evidence review for newly arriving immigrants and refugees. CMAJ 183: E939E951.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Hladun O, Grau A, Esteban E, Jansà JM, 2014. Results from screening immigrants of low-income countries: data from a public primary health care. J Travel Med 21: 9298.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Salinas C, Ballaz A, Díez R, Aguirre U, Antón A, Altube L, 2015. Tuberculosis screening program for undocumented immigrant teenagers using the QuantiFERON(®)-TB gold in-tube test [in Spanish]. Med Clin (Barc) 145: 713.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    1998. Recommendations for prevention and control of tuberculosis among foreign-born persons. Report of the working group on tuberculosis among foreign-born persons. Centers for Disease Control and Prevention. MMWR 47: 129.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Meltzer E, Percik R, Shatzkes J, Sidi Y, Schwartz E, 2008. Eosinophilia among returning travelers: a practical approach. Am J Trop Med Hyg 78: 702709.

  • 21.

    Buonfrate D, Requena-Mendez A, Angheben A, Muñoz J, Gobbi F, Van Den Ende J, Bisoffi Z, 2013. Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis 13: 78.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Colley DG, Bustinduy AL, Secor WE, King CH, 2014. Human schistosomiasis. Lancet 383: 22532264.

  • 23.

    Holtfreter MC, Moné H, Müller-Stöver I, Mouahid G, Richter J, 2014. Schistosoma haematobium infections acquired in Corsica, France, August 2013. Euro Surveill 19: 20821.

  • 24.

    Martínez-Ortí A, Bargues MD, Mas-Coma S, 2015. Dos nuevas localizaciones para España de Bulinus trucatus (Audouin, 1827) (Gastropoda, Planorbidae), hospedador intermediario de Schistosomiasis urinaria. Arxious de Miscel-lània Zoològica. 13: 2531.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Ramírez-Olivencia G, Rubio JM, Rivas P, Subirats M, Herrero MD, Lago M, Puente S, 2012. Imported submicroscopic malaria in Madrid. Malar J 11: 324.

  • 26.

    Ashley EA, White NJ, 2014. The duration of Plasmodium falciparum infections. Malar J 13: 500.

  • 27.

    Ramsdale CD, Coluzzi M, 1975. Studies on the infectivity of tropical African strains of Plasmodium falciparum to some southern European vectors of malaria. Parassitologia 17: 3948.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Dayan AD, 2003. Albendazole, mebendazole and praziquantel. Review of non-clinical toxicity and pharmacokinetics. Acta Trop 86: 141159.

  • 29.

    Salas-Coronas J, Cabezas-Fernández MT, Vázquez-Villegas J, Soriano-Pérez MJ, Lozano-Serrano AB, Pérez-Camacho I, Cabeza-Barrera MI, Cobo F, 2015. Evaluation of eosinophilia in immigrants in southern Spain using tailored screening and treatment protocols: a prospective study. Travel Med Infect Dis 13: 315321.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 283 283 24
Full Text Views 884 31 1
PDF Downloads 370 21 1
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save