The sero-prevalence of antibodies to trypanosoma cruzi in Latin American refugees and immigrants to Canada.

BACKGROUND: Chagas' disease is caused by infection with the protozoan agent Trypanosoma cruzi. An estimated sixteen to eighteen million people are infected in Latin America. Outside of endemic regions, Chagas' disease may be transmitted through the transfusion of infected blood components, congenital infection and organ transplantation. We sought to determine the sero-prevalence of antibodies to T. cruzi in a community sample of Latin American refugees and immigrants to Canada. METHODS: This was a sero-prevalence study in Latin American refugees and immigrants living in Canada. Eligible subjects were born in South America, Central America or in Mexico. Participants were recruited from a variety of community settings, as well as from medical clinics. Serum was tested by enzyme-linked immunoassay for antibodies to T. cruzi. RESULTS: A total of 102 participants were enrolled. One sample tested positive for antibodies for T. cruzi. The seroprevalence in our sample was 1.0% (95% CI: 0.2%- 5.3%). INTERPRETATION: We found a low sero-prevalence of Chagas' disease in a community sample of Latin American immigrants and refugees. Physicians who treat Latin American immigrants should consider the risk profile and clinical status of the individual in their decision to screen for Chagas' disease.

Balancing prevention and screening among international migrants with tuberculosis: population mobility as the major epidemiological influence in low-incidence nations.

BACKGROUND: Tuberculosis infection and disease remain a significant cause of global morbidity and mortality. The burden of tuberculosis disease is greatest in the developing nations of the world, although the effect of imported disease is observed in low-incidence tuberculosis regions, represented predominantly by high-income countries. In these regions, national tuberculosis control and elimination programmes are increasingly challenged to address disease in foreign-born residents. Immigration policies and shifting migration patterns over the past 5 decades have brought larger numbers of permanent and temporary residency migrants from high-prevalence regions of the world into low tuberculosis incidence environments. As a consequence, both national immigration policies and global health strategies for the control of tuberculosis share common interest in mobile populations moving from high-to-low prevalence regions. Existing immigration medical screening practices in major immigrant-receiving nations were often designed to prevent and manage the importation of contagious, active pulmonary tuberculosis disease. Such programmes may be limited in addressing the long-term consequences of latent tuberculosis infection in foreign-born residents. In nations with a low incidence of tuberculosis, a direct link can be found between the globalization of health factors related to international population movements, as observed with tuberculosis and immigration policies and practices. Continued migration from high-endemic tuberculosis regions will increasingly influence the disease burden in low-endemic areas, and challenge local tuberculosis control and elimination programmes. Evidence-based approaches to meeting those challenges will allow for the effective use of resources and support ongoing programme evaluation.

Immigration medical screening and HIV infection in Canada.

HIV infection, particularly associated with AIDS, is often used by migrant screening nations to exclude entry into the country. The unique feature of the Canadian immigration HIV screening programme is that it was not primarily for determining inadmissibility of HIV-positive applicants, but for health promotion and disease prevention purposes. All applicants over 15 years of age for permanent residency or temporary residency from designated countries are HIV antibody tested. This includes persons seeking asylum from within Canada. The highest rates of HIV infection were found in migrant applicants from high prevalence areas of the world and reflected the demographic profile of the source region (predominately women). The majorities of HIV-positive persons are exempt from exclusion from Canada due to class of application (refugee, family) or are already in Canada (refugee claimant). Significant issues in notification, reporting and programme management have been identified as a consequence of this programme.

Tuberculosis rates among migrants in Australia and Canada.

Multiple linear regression analysis was used to compare the regression coefficients for Australia and Canada on the association between tuberculosis (TB) rates among migrants and the estimated incidence in the country of birth. Regression coefficients predicting the rate of TB among migrants based on the incidence of TB in the country of birth are not significantly different between populations of migrants in Australia and Canada. Our findings support the ability of the incidence of TB in the country of birth to predict variation in the incidence of TB in migrants groups in two migration receiving countries. This information can be used to focus TB treatment and prevention efforts towards high-risk groups.

Human mobility and population health. New approaches in a globalizing world.

The globalization of economies in the last 25 years has greatly increased both the number of people on the move and the rapidity of their movement, and has brought attention to global disparities in health determinants and to the health of migrant populations themselves. Differences in epidemiological disease risk (prevalence gaps) may have negative, neutral, or positive health consequences for the migrant or receiving population. Population mobility represents a growing challenge to the development of public health programs and legislative policies to prevent the importation of disease, and to promote and protect the health of migrants and the local, receiving population. The inability to detect and contain imported disease threats at national borders requires a shift in immigration, quarantine, and public health approaches to health and mobile populations. A new paradigm is needed to facilitate the development of policies and programs to address the health consequences of population mobility.

Population mobility and infectious diseases: the diminishing impact of classical infectious diseases and new approaches for the 21st century.

In an increasingly globalized world, rapid population mobility and migration is reducing the differences in infectious disease epidemiology between regions of the world. The movement and relocation of populations between locations where the prevalence and incidence of infections are markedly different poses current and future challenges to those involved in clinical infectious diseases and public health program management. Historically, international attention has focused on the screening and treatment of acute infections of epidemic potential, but, as immigration significantly changes the demography of many nations, chronic infections will require increased attention. In countries with large mobile populations, the population-based burden of infections with long latency periods or significant noninfectious sequelae will make up an increasing amount of the infectious disease caseload and will require more-modern approaches than the traditional screening of arrivals. The globalization of chronic infectious disease epidemiology will require corresponding development of integrated programs to anticipate and manage these diseases in response to an increasingly mobile patient population.

Arrest and detention in international travelers.

BACKGROUND: Our objective was to examine the characteristics of international travelers from Canada who have been arrested or detained while abroad, and to review the health implications of incarceration. METHOD: An EpiInfo 6 program was created to analyse all of the Consular reports received in 1995 via the Secure Integrated Global Network (SIGNET) which provides communications and computerization services to the Department of Foreign Affairs and International Trade, Canada. The Consular Management and Operations System was designed to support the delivery of consular services by the Department, and to link Headquarters in Ottawa with missions in other countries through case management files, including a "Prisoners" file. Information obtained included personal demographics (age, gender), date, country, and reason for arrest or detention, and outcome of judicial process. RESULTS: There were 1, 086 arrest or detention reports received from Consular services via SIGNET in 1995. Males outnumbered females 5.6:1. Most individuals arrested were young: 57.5% were less than 40 years, and 79% were less than 50 years. Drug related charges were cited in 33.1% of all cases, with 52.8% of arrested females charged with drug related offenses. The documented conviction rate was 96%. The majority of detained Canadian travelers were held in countries within the Americas (791 cases - 69.2%), with 642 (59.1%) being detained in the USA. CONCLUSIONS: Arrest and detention is an unusual occurrence for international travelers but relative youth, male gender, and female drug couriers were identifiable risk characteristics. Public awareness campaigns can be targeted to specific population demographics, but all international travelers need to be counseled on the consequences of transgressing laws in foreign countries.

Malaria, intestinal parasites, and schistosomiasis among Barawan Somali refugees resettling to the United States: a strategy to reduce morbidity and decrease the risk of imported infections.

In 1997, enhanced health assessments were performed for 390 (10%) of approximately 4,000 Barawan refugees resettling to the United States. Of the refugees who received enhanced assessments, 26 (7%) had malaria parasitemia and 128 (38%) had intestinal parasites, while only 2 (2%) had Schistosoma haematobium eggs in the urine. Mass therapy for malaria (a single oral dose of 25 mg/kg of sulfadoxine-pyrimethamine) was given to all Barawan refugees 1-2 days before resettlement. Refugees >2 years of age and nonpregnant women received a single oral dose of 600 mg albendazole for intestinal parasite therapy. If mass therapy had not been provided, upon arrival in the United States an estimated 280 (7%) refugees would have had malaria infections and 1,500 (38%) would have had intestinal parasites. We conclude that enhanced health assessments provided rapid on-site assessment of parasite prevalence and helped decrease morbidity among Barawan refugees, as well as, the risk of imported infections.

Death and dying abroad: the Canadian experience.

BACKGROUND: The objective was to examine the characteristics of international travelers from Canada, who have died while abroad, and to review the health protection and promotion strategies for prevention of adverse health outcomes associated with travel, which may have prevented these deaths. METHOD: An EpiInfo 6 program was created to analyse all of the Consular reports received in 1995 via the Secure Integrated Global Network, which provides communications and computerization services to the Department of Foreign Affairs and International Trade, Canada. The Consular Management and Operations System was designed to support the delivery of consular services by the Department, and to link Headquarters in Ottawa with missions in other countries, through case management files, including a "Death Abroad" file. The type of data collected included personal demographics (age, gender), date, country, and cause of death. RESULTS: In 1995, consular services received 309 reports of Canadians dying abroad. Two hundred and twenty deaths were males (71.2%), and 69 were females (22.3%). The average age (56 years) and median age (43 years) were similar for males and females (age range 0.3-86 years). Recorded causes of death were: natural (62.1%), accidents (24.9%), murder (7.8%), and suicide (5.2%). Cardiovascular disease and trauma were the two most commonly specified causes of death. CONCLUSIONS: At least 36% of the deaths occurring in Canadian travelers would be considered preventable. Pretravel medical interventions for travelers with known preexisting medical problems, may have prevented many more deaths. International travelers need to be aware of the health risks associated with travel. Access to appropriate health risk assessment, prior to exposure, in many cases, would have prevented death abroad.

Health issues associated with the smuggling and trafficking of migrants.

Approximately 4 million persons annually may be smuggled illegally across international borders. In 1997 it was estimated that 700,000 women or children were smuggled across international borders, of whom 175,000 were estimated to come from the former Soviet bloc; approximately 45,000-50,000 smuggled women and children arrived in the United States in that year. This article develops a framework to consider the impact of human trafficking on health within the context of migrant health and the destination population's health. Health risks are assumed by the individual being smuggled during the pre-journey, migratory, and arrival phases. In addition, the recipient country's population may also incur additional health burdens related to illegal arrivals from higher disease prevalence areas of the world. Some of this disease risk potential may be from transmissible agents, but there is increasing concern, and some evidence, that noncontagious diseases may be a significant problem associated with human trafficking. The global consideration of human smuggling and the individual and social impact on health are the focus of this paper.

Human plague in India, August-October, 1994.

As of 9 October, the total number of fatalities in India due to plague was 55 (52 from Surat city and 3 from New Delhi). Reasons for the low case-fatality ratio remain to be determined and will require more detailed and reliable clinical and laboratory information. Additional studies into the patterns of transmission in the infected areas are underway or anticipated. By 14 October reports of both suspect and confirmed cases had decreased. The area around the Beed district in the state of Maharashtra was also declared as "infected" under the definition of the International Health Regulations. A WHO expert committee has been in the affected areas and detailed reports are anticipated.