目的:我们旨在评估七种感染的流行病学(查加斯病,圆线虫病,血吸虫病,人类免疫缺陷病毒,乙型肝炎和丙型肝炎病毒,和活动性结核病)在加泰罗尼亚初级保健设施就读的移民人口中,西班牙。
方法:这是一项横断面研究,于2018年3月至12月在加泰罗尼亚的八个初级保健中心进行。在西班牙,考虑到病原体在其出生国的地方性,建议卫生专业人员系统地筛查移民中的多种感染。常规健康数据是从初级保健中心的电子健康记录中回顾性提取的。每种感染测试的个体中的病例比例以其95%的置信区间(CI)估计。进行混合效应物流回归模型以评估暴露变量与主要结果之间的任何可能关联。
结果:在参加初级保健中心的15780名移民中,对2410个人进行了至少一种感染测试。在508名(21.1%)被诊断患有至少一种疾病的移民中,来自撒哈拉以南非洲的比例更高(207,40.7%),其次是东南欧(117,23.0%)和拉丁美洲(88,17.3%;p值<0.001)。确诊为查加斯病的移民比例为5/122(4.1%,95CI0.5-7.7),对于圆线虫病56/409(13.7%,95CI10.3-17.0)和血吸虫病2/101(2.0%,95CI0.0-4.7),测试案例很少。人类免疫缺陷病毒的估计比例为67/1176(5.7%,95CI4.4-7.0);377/1478(25.5%,95CI23.3-27.7)用于乙型肝炎病毒,108/1478(7.3%,95CI6.0-8.6)中出现活动性感染,而31/1433(2.2%,95CI1.4-2.9)被诊断为丙型肝炎病毒。在对172名移民患者进行检测后诊断出1例活动性肺结核(0.6%,95CI0.0-1.7)。
结论:我们估计来自流行地区的移民所研究的感染比例很高。对移民感染负担的具体国家估计是实施预防性干预措施的基础。
OBJECTIVE: We aimed to evaluate the epidemiology of seven infections (Chagas disease,
strongyloidiasis, schistosomiasis, human immunodeficiency virus, hepatitis B and C virus, and active tuberculosis) in migrant populations attended at primary care facilities in Catalonia, Spain.
METHODS: This is a cross sectional study conducted from March to December 2018 at eight primary care centres in Catalonia, Spain where health professionals were recommended to systematically screen multiple infections in migrants considering the endemicity of the pathogens in their country of birth. Routine health data were retrospectively extracted from electronic health records of the primary care centres. The proportion of cases among individuals tested for each infection was estimated with its 95% confident interval (CI). Mixed-effects logistics regression models were conducted to assess any possible association between the exposure variables and the primary outcome.
RESULTS: Out of the 15,780 migrants that attended primary care centres, 2410 individuals were tested for at least one infection. Of the 508 (21.1%) migrants diagnosed with at least one condition, a higher proportion originated from Sub-Saharan Africa (207, 40.7%), followed by South-East Europe (117, 23.0%) and Latin-America (88, 17.3%; p value <0.001). The proportion of migrants diagnosed with Chagas disease was 5/122 (4.1%, 95%CI 0.5-7.7), for
strongyloidiasis 56/409 (13.7%, 95%CI 10.3-17.0) and for schistosomiasis 2/101 (2.0%, 95%CI 0.0-4.7) with very few cases tested. The estimated proportion for human immunodeficiency virus was 67/1176 (5.7%, 95%CI 4.4-7.0); 377/1478 (25.5%, 95%CI 23.3-27.7) for hepatitis B virus, with 108/1478 (7.3%, 95%CI 6.0-8.6) of them presenting an active infection, while 31/1433 (2.2%, 95%CI 1.4-2.9) were diagnosed with hepatitis C virus. One case of active tuberculosis was diagnosed after testing 172 migrant patients (0.6%, 95%CI 0.0-1.7).
CONCLUSIONS: We estimated a high proportion of the studied infections in migrants from endemic areas. Country-specific estimations of the burden of infections in migrants are fundamental for the implementation of preventive interventions.