Community strategies to tackle tuberculosis according to the WHO region of origin of immigrant communities.

Setting: Tuberculosis (TB) control requires the proper identification and treatment of affected patients and investigation of their contacts. In certain vulnerable immigrant groups, however, these tasks may be hindered due to their ethnic and sociocultural characteristics. Objective: To analyse the results of a community programme designed to locate hard-to-reach immigrants with TB. Design: Descriptive study of all cases diagnosed with confirmed TB referred to the Public and Community Health team of the Drassanes International Health Unit in Barcelona during 2012-2014 due to difficulties in tracing these patients. Both cases and contacts were categorised based on their World Health Organization region of origin. The sociodemographic characteristics of each group and the community interventions carried out during the tracing period are described. Results: A total of 122 cases and 316 contacts were detected. As a result of community-based strategies, 73% of the initial cases completed treatment; 3.8% of the contacts were diagnosed with TB, 91.7% of whom were treated appropriately; 17.1% contacts had latent infection, 79.3% of whom completed chemoprophylaxis. Conclusions: Intervention strategies with a community approach for follow-up and control of TB in certain immigrant communities seem to be effective.

Contexte : La lutte contre la tuberculose (TB) requiert l'identification et le traitement appropriés des patients affectés et l'examen de leurs contacts. Ces tâches peuvent néanmoins être entravées dans certains groupes vulnérables d'immigrants en raison de leurs spécificités ethniques et socioculturelles.Objectif : Analyser les résultats d'un programme communautaire conçu pour localiser les immigrants atteints de TB dont le suivi s'avère difficile.Schéma : Etude descriptive de tous les cas ayant un diagnostic de TB confirmé référés à l'équipe de santé publique et communautaire dans l'unité de santé internationale Drassanes de Barcelone en 2012­2014 en raison des difficultés à les localiser. A la fois les cas et les contacts ont été classés en se basant sur leur région Organisation Mondiale de la Santé d'origine. Les caractéristiques sociodémographiques de chaque groupe et les interventions communautaires réalisées pendant leur recherche sont décrites.Résultats : Ont été détectés 122 cas et 316 contacts. Grâce aux stratégies communautaires, 73% des cas initiaux ont achevé leur traitement, 3,8% des contacts ont eu un diagnostic de TB, dont 91,7% ont été traités correctement ; 17,1% des contacts avaient une infection latente, dont 79,3% ont achevé la chimioprophylaxie.Conclusions: Les stratégies d'intervention par approche communautaire du suivi et de la lutte contre la TB dans certaines communautés d'immigrants semblent efficaces.

Marco de Referencia: El control de la tuberculosis (TB) requiere identificar y tratar adecuadamente a los pacientes afectados y realizar el seguimiento de sus contactos. Sin embargo, la realización de estas tareas puede ser complicada de llevar a cabo en ciertos colectivos de inmigrantes vulnerables debido a sus peculiaridades étnicas y socioculturales.Objetivo: Analizar los resultados de un programa comunitario diseñado para realizar el seguimiento de inmigrantes afectados de TB.Diseño: Estudio descriptivo de todos los casos con diagnóstico confirmado de TB remitidos al equipo de Salud Pública y Salud Comunitaria de la Unidad de Salud Internacional de Drassanes de Barcelona debido a las dificultades para realizar su seguimiento, durante el período 2012­2014. Se describen las características sociodemográficas tanto de los casos como de los contactos categorizados según su región de origen como intervenciones comunitarias llevadas a cabo durante su seguimiento.Resultados: Se detectaron 122 casos y 316 contactos. Como resultado de las estrategias comunitarias el 73% de los casos iniciales completaron el tratamiento. Un 3,8% de los contactos fueron diagnosticados de TB, de los cuales el 91,7% fueron tratados correctamente. El 17,1% de los contactos tenían una infección tuberculosa latente, de los cuales el 79,3% completaron la quimioprofilaxis.Conclusiones: Las estrategias de intervención comunitarias para el seguimiento y control de la TB en ciertos colectivos inmigrantes parecen ser efectivas.

Trypanosoma cruzi infection in a non-endemic country: epidemiological and clinical profile.

Chagas disease has been increasingly diagnosed in non-endemic countries. This is a prospective observational study performed at the Tropical Medicine Units of the International Health Program of the Catalan Health Institute, Barcelona (PROgrama de Salud Internacional del Instituto Catalán de la Salud, PROSICS Barcelona, Spain), that includes all patients with Chagas disease who attended from June 2007 to May 2012. Clinical and epidemiological data were collected. Overall, 1274 patients were included, the mean age of the patients was 37.7 years, 67.5% were women and 97% came from Bolivia. Thirteen patients had immunosuppressive conditions. The prevalence of cardiac involvement was 16.9%, lower than in previous studies performed in endemic areas (20-60%). Cardiac alterations were found in 33.8% of symptomatic and 14.1% of asymptomatic patients. The prevalence of digestive involvement was 14.8%. The rate of digestive involvement is very different among previous studies because of different diagnostic tools and strategies used. Barium enema alterations were found in 21.4% of symptomatic and 10.3% of asymptomatic patients, and oesophageal alterations were found in 3.7% of symptomatic and in 2.3% of asymptomatic patients. As shown in previous studies, Chagas disease in non-endemic countries affects younger patients and has lower morbidity.

Epidemiology and clinical features of vivax malaria imported to Europe: sentinel surveillance data from TropNetEurop.

BACKGROUND: Plasmodium vivax is the second most common species among malaria patients diagnosed in Europe, but epidemiological and clinical data on imported P. vivax malaria are limited. The TropNetEurop surveillance network has monitored the importation of vivax malaria into Europe since 1999. OBJECTIVES: To present epidemiological and clinical data on imported P. vivax malaria collected at European level. MATERIAL AND METHODS: Data of primary cases of P. vivax malaria reported between January 1999 and September 2003 were analysed, focusing on disease frequency, patient characteristics, place of infection, course of disease, treatment and differences between network-member countries. RESULTS: Within the surveillance period 4,801 cases of imported malaria were reported. 618 (12.9%) were attributed to P. vivax. European travellers and immigrants were the largest patient groups, but their proportion varied among the reporting countries. The main regions of infection in descending order were the Indian subcontinent, Indonesia, South America and Western and Eastern Africa, as a group accounting for more than 60% of the cases. Regular use of malaria chemoprophylaxis was reported by 118 patients. With 86 (inter-quartile range 41-158) versus 31 days (inter-quartile range 4-133) the median symptom onset was significantly delayed in patients with chemoprophylaxis (p < 0.0001). Common complaints were fever, headache, fatigue, and musculo-skeletal symptoms. All patients survived and severe clinical complications were rare. Hospitalization was provided for 60% and primaquine treatment administered to 83.8% of the patients, but frequencies varied strongly among reporting countries. CONCLUSIONS: TropNetEurop data can contribute to the harmonization of European treatment policies.

Tuberculosis screening among immigrants holding a hunger strike in churches.

SETTING: In January 2001, approximately 600 immigrants held a sit-down and hunger strike in several churches in Barcelona to force the Spanish government to comply with demands to regulate their immigration status. Following the diagnosis of a case of smear-positive pulmonary tuberculosis (TB) in one of the immigrants, we performed a large contact investigation. OBJECTIVES: To describe contact investigation procedures used in this setting and to evaluate contact investigation results. METHODS: Demographic variables were collected, and tuberculin skin tests (TST) and chest radiograph examinations were performed. Odds ratios (OR) with 95% confidence intervals (CI) were calculated and logistic regression was used for multivariate analyses. RESULTS: A total of 541 TSTs were performed. Of these, 86% were read and 40.5% yielded a positive reaction with an induration >14 mm. In a multivariate analysis, the risk of presenting a TST induration >14 mm was found to be three times higher among those aged >35 years compared to those <24 years (OR 3.40; 95%CI 1.76-6.59), and for immigrants from Bangladesh (OR 3.14; 95%CI 1.16-6.10) and Pakistan (OR 2.04; 95%CI 1.11-3.73) compared to those from India. A total of 314 chest radiographs examinations were performed and three additional cases of TB were identified, yielding a TB prevalence of 0.7%. CONCLUSIONS: By focusing efforts and conducting targeted TB screening in this high-risk population, it was possible to complete the intervention in only 3 days. A high prevalence of TB infection and TB disease was found.