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Imported Infectious Diseases: The Impact in Developed Countries
Azioni libro
Inizia a leggereLunghezza: 472 pagine4 ore
- Editore:
- Elsevier Science
- Pubblicato:
- Oct 7, 2014
- ISBN:
- 9781908818737
- Formato:
- Libro
Descrizione
The increase of immigrant population in developed countries (mainly in Europe and North America) together with an important increase of international travel worldwide are the two most important causes that have contributed to the introduction and diagnosis of imported/tropical infectious diseases in these countries. These factors have had an important impact in developed countries in both social and economic aspects. Imported Infectious Diseases focuses not only on describing the infections, but also in evaluating the current epidemiology, the economic and social impact and the possibility to apply immunization measures and vaccines. The main purpose of this book is to give an overview of the current most important and frequent imported infectious diseases in developed countries. The first chapter informs about the medical services that are being offered to the immigrants in the main developed countries depending on the legal situation. Following chapters describe the main surveillance systems for these kinds of diseases, mainly in Europe and North America. Finally, remaining chapters contain sections on epidemiology, pathogenesis, clinical features, diagnosis, treatment and prevention.
Informazioni sul libro
Imported Infectious Diseases: The Impact in Developed Countries
Lunghezza: 472 pagine4 ore
Descrizione
The increase of immigrant population in developed countries (mainly in Europe and North America) together with an important increase of international travel worldwide are the two most important causes that have contributed to the introduction and diagnosis of imported/tropical infectious diseases in these countries. These factors have had an important impact in developed countries in both social and economic aspects. Imported Infectious Diseases focuses not only on describing the infections, but also in evaluating the current epidemiology, the economic and social impact and the possibility to apply immunization measures and vaccines. The main purpose of this book is to give an overview of the current most important and frequent imported infectious diseases in developed countries. The first chapter informs about the medical services that are being offered to the immigrants in the main developed countries depending on the legal situation. Following chapters describe the main surveillance systems for these kinds of diseases, mainly in Europe and North America. Finally, remaining chapters contain sections on epidemiology, pathogenesis, clinical features, diagnosis, treatment and prevention.
- Editore:
- Elsevier Science
- Pubblicato:
- Oct 7, 2014
- ISBN:
- 9781908818737
- Formato:
- Libro
Informazioni sull'autore
Dr Fernando Cobo is a specialist in microbiology working in the Microbiology Department of the Hospital de Poniente, Spain, and has previously worked at the University Hospital Virgen de las Nievas and the Stem Cell Bank of Andalucía. He is a member of several professional societies including the Spanish Society of Infectious Diseases and Clinical Microbiology, and has published over 50 peer-reviewed journal articles, 10 books, 90 book chapters, and 120 national and international conference papers.
Correlati a Imported Infectious Diseases
Anteprima del libro
Imported Infectious Diseases - Fernando Cobo
Imported Infectious Diseases
The impact in developed countries
First Edition
Fernando Cobo
Woodhead Publishing Series in Biomedicine: Number 66
Table of Contents
Cover image
Title page
Copyright page
List of figures
List of tables
Acknowledgements
Preface
About the author
1: Introduction
Abstract
1.1 The real problem of the immigration phenomenon
1.2 Immigration health costs in developed countries
1.3 Health assistance in immigrants: comparison of several countries
1.4 Impact of immigration on infectious diseases in developed countries
2: Epidemiology of infectious diseases in immigrants
Abstract
2.1 Importance of immigration in the epidemiology of infectious diseases
2.2 Immigration patterns and infectious diseases
2.3 Current epidemiological data of the main imported infectious diseases in immigrants
2.4 Implications for public health research and intervention policies
3: Surveillance systems for tropical infectious diseases in developed countries
Abstract
3.1 Definition of surveillance
3.2 Local and regional surveillance systems
3.3 National Public Health Institutes
3.4 International public health surveillance systems
3.5 Information for disease prevention and control
4: Febrile syndrome in immigrants and travellers
Abstract
4.1 Introduction
4.2 Assessment of febrile syndrome in immigrants and returned travellers
4.3 Standardised diagnosis protocols
5: Diarrhoea syndrome
Abstract
5.1 Approach to acute diarrhoea in developing countries
5.2 Traveller’s diarrhoea
6: Current status of malaria
Abstract
6.1 Disease and pathophysiology
6.2 Epidemiology of imported malaria
6.3 Biology and ecology of malaria
6.4 Clinical features of malaria
6.5 Diagnostic procedures
6.6 Prevention and prophylaxis: development of a malaria vaccine
6.7 Treatment of malaria
7: Filariasis
Abstract
7.1 Definition
7.2 Life cycle
7.3 Lymphatic filariasis
7.4 Onchocerciasis (river blindness)
7.5 Loiasis
7.6 Mansonellosis
8: Schistosomiasis (bilharziasis)
Abstract
8.1 The parasite and the disease
8.2 Epidemiology
8.3 Pathogenesis
8.4 Clinical features
8.5 Diagnosis
8.6 Treatment
9: Strongyloidiasis
Abstract
9.1 Definition
9.2 Epidemiology
9.3 Clinical features
9.4 Risk factors for hyperinfection and severe disease
9.5 Diagnosis
9.6 Treatment and monitoring
9.7 Prevention
10: Trypanosomiasis
Abstract
10.1 General description
10.2 African trypanosomiasis
10.3 American trypanosomiasis
11: Taeniasis and neurocysticercosis
Abstract
11.1 Taeniasis
11.2 Neurocysticercosis
12: HIV infection
Abstract
12.1 Initial outbreak
12.2 Current epidemiological status and mode of transmission
12.3 Viral structure and pathogenesis
12.4 Clinical manifestations
12.5 Diagnosis
12.6 Drug treatment
12.7 Prevention of HIV transmission
13: Syphilis
Abstract
13.1 Aetiology
13.2 Epidemiology
13.3 Natural history and clinical manifestations
13.4 Laboratory diagnosis
13.5 Treatment of syphilis
13.6 Follow-up examinations
14: Tuberculosis: the problem of multiresistance
Abstract
14.1 Definition and microbiology
14.2 Current epidemiology
14.3 Pathogenesis
14.4 Clinical manifestations
14.5 Diagnosis
14.6 Prevention and control
14.7 Treatment
15: Viral hepatitis
Abstract
15.1 Introduction: the global problem of infectious hepatitis
15.2 Hepatitis A virus (HAV)
15.3 Hepatitis B virus (HBV)
15.4 Hepatitis C virus (HCV)
16: Leishmaniasis
Abstract
16.1 Definition
16.2 Visceral leishmaniasis
16.3 Cutaneous leishmaniasis
17: Viral haemorrhagic fevers
Abstract
17.1 Definition and overall epidemiology
17.2 Yellow fever
17.3 Lassa fever
17.4 Marburg haemorrhagic fever
17.5 Ebola haemorrhagic fever
17.6 Crimean–Congo haemorrhagic fever
17.7 Dengue
17.8 Rift Valley fever
17.9 Laboratory diagnosis
17.10 Prevention measures and control
17.11 Antiviral treatment
18: Arthropod-borne viruses affecting the central nervous system
Abstract
18.1 Definition and epidemiology
18.2 General diagnosis
18.3 Clinically relevant arthropod-borne viruses
19: Prophylaxis, immunisation and vaccination
Abstract
19.1 General considerations
19.2 Current status of selective vaccines
Index
Copyright
Woodhead Publishing is an imprint of Elsevier
80 High Street, Sawston, Cambridge, CB22 3HJ, UK
225 Wyman Street, Waltham, MA 02451, USA
Langford Lane, Kidlington, OX5 1GB, UK
Copyright © 2014 F. Cobo. All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher.
Permissions may be sought directly from Elsevier’s Science & Technology Rights Department in Oxford, UK: phone (+44) (0) 1865 843830; fax (+44) (0) 1865 853333; email: permissions@elsevier.com. Alternatively you can submit your request online by visiting the Elsevier website at http://elsevier.com/locate/permissions, and selecting Obtaining permission to use Elsevier material.
Notice
No responsibility is assumed by the publisher for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Control Number: 2014938532
ISBN 978-1-907568-57-2 (print)
ISBN 978-1-908818-73-7 (online)
For information on all Woodhead Publishing publications
visit our website at http://store.elsevier.com/
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Printed and bound in the United Kingdom
List of figures
3.1 Example of organisation of a Tropical Medicine Unit 20
4.1 Summary of differential diagnosis of fever in immigrants and travellers to the tropics 36
5.1 Algorithm for fluid management in patients with hypovolaemia 48
6.1 Malaria endemic countries 63
6.2 Life cycle of the malaria parasite 65
6.3 Plasmodium falciparum 73
7.1 Life cycle of the filariasis parasite 93
7.2 Distribution of lymphatic filariasis worldwide 95
7.3 Distribution of onchocerciasis worldwide 101
7.4 Distribution of Loiasis in African countries 105
7.5 Loa loa 107
7.6 Mansonella perstans 109
8.1 Worldwide prevalence of schistosomiasis 117
8.2 Schistosoma haematobium 122
8.3 Schistosoma mansoni 123
9.1 Strongyloides stercoralis larvae 132
10.1 Distribution of African trypanosomiasis 138
10.2 Life cycle of Trypanosoma brucei 141
10.3 Trypanosoma brucei 144
10.4 Distribution of American trypanosomiasis 147
10.5 Life cycle of Trypanosoma cruzi 148
10.6 Trypanosoma cruzi 151
11.1 Worldwide distribution of neurocysticercosis 159
12.1 Prevalence of human immunodeficiency virus (HIV) 169
13.1 Recommended laboratory testing algorithm and results interpretation 192
14.1 Global estimated tuberculosis (TB) incidence worldwide 202
15.1 Prevalence of hepatitis A worldwide 215
15.2 Prevalence of HBV infection 218
15.3 Prevalence of hepatitis C virus infection 222
16.1 Leishmania tropica 229
16.2 Leishmania major 230
17.1 Areas at risk of dengue 250
List of tables
4.1 Main causes of fever in immigrants and travellers depending on geographic area 29
4.2 Main causes of infections in immigrants and travellers according to incubation period 30
4.3 Associated infections depending on clinical findings 31
4.4 Correlation between several physical findings and infectious diseases in the tropics 34
4.5 Recommendations for the diagnosis of main infections in travellers and immigrants 35
5.1 Main pathogens causing diarrhoea in developing countries 44
5.2 Clinical manifestations of and comparison between acute watery diarrhoea and dysentery 45
5.3 Antimicrobial therapy for microorganisms causing diarrhoea 49
5.4 Main pathogens causing traveller’s diarrhoea 52
6.1 Laboratory parameters of severe malaria 72
6.2 Factors for choosing drugs for malaria prophylaxis 76
6.3 Resistance of Plasmodium falciparum to main drugs worldwide 77
6.4 Treatment of uncomplicated falciparum malaria in adults 83
6.5 Clinical characteristics and laboratory findings of severe malaria in adults 84
6.6 Treatment of pregnant women for different types of Plasmodium malaria 85
7.1 Main characteristics of filariasis 94
9.1 Main drug for the treatment of uncomplicated strongyloidiasis 134
10.1 Comparison of Rhodesian and Gambian sleeping sickness 142
11.1 Current diagnostic criteria for neurocysticercosis 162
11.2 Summary of the treatment for neurocysticercosis 164
12.1 AIDS-defining conditions 174
12.2 People who should receive testing for HIV-2 virus 176
12.3 Antiretroviral drugs currently approved by US Food and Drug Administration 178
13.1 Staging, clinical manifestations and incubation period in patients with syphilis infection 189
13.2 Treatment for syphilis infection 195
16.1 Species of Leishmania that cause human disease 228
18.1 Summary of main arthropod-borne viruses associated with human encephalitis 258
19.1. Selective use of vaccines or prophylaxis for travellers 264
Acknowledgements
I would like to acknowledge to the Tropical Medicine Unit of the Hospital of Poniente for the support. Some photographs of parasites have been taken from its collection.
Preface
Fernando Cobo, MD, PhD
Migration has historically played a major role in shaping societies and influencing demographic changes. The current trend towards globalisation involves movements of people and may have implications for the appearance, presentation and evolution of public health challenges. The increase of immigrant populations in developed regions, mainly in North America and European countries, together with the growth of international travel are the two most important factors contributing to the introduction of imported/tropical infectious diseases in these areas. Their impact on social, economic and health aspects is significant.
The emergence and re-emergence of many tropical pathologies, as well as increases in drug resistance in some diseases, have recently aroused the interest of many healthcare professionals, epidemiologists and health authorities. An evidence-based update of tropical diseases is necessary.
Imported Infectious Diseases focuses not only on describing the main imported infections in developed countries, but also in evaluating the current epidemiology, the economic and social impacts of these diseases in the countries and in the population, and the possibility of carrying out immunisation measures. The main purpose of this book is to give an overview of the most important and frequently imported infectious diseases in developed regions. It will also cover aspects of the medical services that are offered to immigrants, the main surveillance systems for these diseases, and the epidemiology of the main tropical diseases. The data on epidemiology, pathogenesis, clinical manifestations, diagnosis and treatment of these main imported diseases has also been updated.
About the author
Dr Fernando Cobo, MD, PhDfernando.cobo.sspa@juntadeandalucia.es, Section of Microbiology (Biotechnology Area), Tropical Medicine Unit, Hospital de Poniente, Almería, Spain
Dr Fernando Cobo is a medical doctor and a specialist in microbiology and parasitology. He received his MD from the University of Valencia and his PhD from the University of Granada. After specialising in microbiology and parasitology, he spent four years at the University Hospital Carlos Haya in Málaga, until 2009. He then worked for five years as a doctor in medicine and a researcher and microbiologist in the Infectious Pathology Unit of the University Hospital Virgen de las Nieves in Granada. He was also a microbiology advisor at the Stem Cell Bank of Andalucía in Granada. During this time, he implemented several laboratory detection techniques for human papilloma virus (HPV) such as InnoLipa, microarrays and real-time PCR using different samples (mainly female cervical specimens embedded paraffin tissue).
Currently Dr Cobo works in the Microbiology Section (Biotechnology Area) at the Tropical Medicine Unit of the Hospital de Poniente in Almería, Spain – one of the five tropical medicine units in Spain. The health area covered by the hospital has an immigration rate of approximately 30%, mostly from Africa and Latin America.
Dr Cobo is a member of several professional societies, including the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Andalusian Society of Microbiology and Parasitology (SAMPAC). He has published over 60 peer-reviewed journal articles (some related to tropical medicine and parasitology), ten complete books, a hundred book chapters and has given 130 national and international meeting and congress presentations. He has collaborated as a referee on several journals such as Clinical Transplantation, Biomaterials and Journal of Immunological Methods, and is Associate Editor of The Open Virology Journal. He also belongs to the editorial boards of The Open Biotechnology Journal, Experimental Medicine and Microbiology Insights.
1
Introduction
Abstract
It is difficult to determine the true impact of unauthorised immigration on uncompensated healthcare costs. This impact is not uniformly distributed between different countries, or even within countries among regions and individual healthcare providers and hospitals. The rate of uninsurance is higher among immigrants than the native-born population, but usage of healthcare services by immigrants is significantly lower than that of native-born people. However, uncompensated care costs are a serious problem for the healthcare system in certain countries, such as the US and several European countries, particularly in those with large numbers of un-insured or illegal immigrants.
Key words
Immigration
healthcare costs
health insurance
illegal immigration
immigration policies
uninsurance
1.1 The real problem of the immigration phenomenon
Current policy discussion about immigration generally focuses on two key issues: the true impact of immigration on the economy, including health insurance costs; and its social and cultural importance. The social and cultural impact of immigration, in general, has usually been seen as a negative factor because immigrant populations may disrupt coherence to communities and undermine the sense of national identity. On the other hand, the economic impact is a strong positive factor in most of countries, especially in countries with older populations that can benefit from migrant workers.
There are also economic arguments against immigration. Policy makers must balance the economic need for immigrants against the social problems that a massive wave of immigration might create in some communities. Developed countries that require workers have always been the primary driver of immigration. Both legal and illegal immigration levels are closely related to changes in the global economy, increasing during economic booms and decreasing during time of recession.
Illegal immigration into the US and several countries on Europe is a current phenomenon. More than ten million undocumented people reside in the US, and there are similar numbers in Western Europe.
Typically, illegal immigrants enter developed countries for better jobs; sometimes they are refugees from wars in their home country (especially those from Africa). However, illegal immigration can cause serious security problems in these countries. Even although they are not directly involved in such problems, the presence of millions of undocumented immigrants without resources may lead to alterations in the law, distraction of resources, and create a background for criminals and delinquency. For these reasons, many experts in the field believe that the real problem presented by illegal immigration relates to security rather than the economy. Furthermore, illegal immigration undoubtedly has a ‘called effect’ for other illegal immigrants, and encourages the culture of illegality.
1.2 Immigration health costs in developed countries
Besides the problem of security in countries with massive illegal immigrants, there are economic costs. One of the most important of these is the healthcare cost, which is frequently cited as a reason for limiting immigration.
Uncompensated care costs result when patients are provided with healthcare services for which no insurance or other payment is made. These costs are then taken on by healthcare providers, health public system and some hospitals. No comprehensive and accurate data is available yet about the impact of authorised immigrant on uncompensated care costs in developed countries. The link between illegal immigrants and uncompensated care costs is based on the assumptions that the majority of unauthorised immigrants are not insured and that unauthorised immigrants receive critical care in hospitals and thus contribute significantly to uncompensated care costs.
These increased healthcare costs are not uniformly distributed among countries, or even among regions or hospitals within countries. Some unauthorised immigrants obtain insurance through an employer, and the majority of uncompensated hospital care costs are not clearly attributable to unauthorised immigrants.
Immigrants use significantly less healthcare services than native-born citizens. Among immigrants with public insurance, the value of healthcare services was 45% lower than that of native-born citizens. Also, the value of healthcare services used by uninsured immigrants was 60% less than that of uninsured native-born people.
In the US, more than 40% of non-US citizens are without insurance. Each immigrant’s access to health insurance depends on their legal status, education and the length of time they have spent in the US
With regard to healthcare costs, uncompensated health costs were estimated at 38–40 million dollars in the US in 2001. Public funds cover up to 85% of these costs, decreasing investments in other public services.
1.3 Health assistance in immigrants: comparison of several countries
Healthcare utilisation varies among developed countries. Some differences might reflect lower take-up of new medical technologies, as well as the policies through which access to medical services is controlled. Many developed countries, mainly in the US and Western Europe, have recently taken in numerous immigrants. Currently, there are close to 30 million immigrants in the US and constitute 10–15% of the total population, thus the fight against illegal immigration is at the moment a priority for all developed countries. The last decades have seen tightening of national legislations, with increases in border control, identity checks, workplace inspections and return of illegal immigrants to their original countries. According to the International Labour Organization, in 2010 there were four and a half to five million illegal immigrants living in Western Europe. However, European countries have contributed equally to this phenomenon, and certain countries are the preferred destinations for many immigrants, such as Germany and the UK.
Immigrants may use different healthcare services depending on which country they are in, because each has different policies with regard to attending to immigrant people. Countries also vary in their acceptance of immigrants, and cultural difference between immigrants and natives are greater in some. The importance of determinants of healthcare use may differ according to type of medical care, and the country. For example, it is well known that the use of emergency services can be a consequence of barriers in primary healthcare, or of level of satisfaction with primary care providers.
1.3.1 Health coverage in the United States
All legal permanent residents and other legal immigrants had the same access to public benefits, including medications. After some legal reforms in 1996, states had many health policy options related to immigrants. Of the six states with the largest immigrant populations, only California decided to include immigrants in all its health programs, including medication, even although this state receives no Federal funds to do so.
Immigrants account for approximately 20% of the 44 million uninsured people in the US. Of the nine million low-income non-citizens, over 58% have no health insurance and only 15% received medication. In contrast, about 30% of low-income citizens are uninsured and almost 30% have received medication.
Health coverage for immigrants also varies depending on where the immigrants come from. Half of immigrants from Mexico are uninsured compared with 20% of those from Cuba, Russia and the Philippines. Only 15% of immigrants from Mexico have coverage, whereas almost 40% of Cuban and Russian immigrants are covered. Barriers to coverage and health services for immigrants include issues related to language, discrimination and misinformation.
In summary, immigrants in the US have low health coverage and fewer health services than native-born US citizens, and low-income immigrants are the most uninsured population in the country. Children born in the US in immigrant families are more likely to be uninsured.
1.3.2 Health coverage in European countries
In Western Europe, almost half the countries require a fee for medical services as part of their national health system, and this might reduce use of healthcare services among all people, especially the immigrant population.
There are some differences with regard to access to publicly funded healthcare services for immigrants in countries of the European Union (EU). Countries such as Belgium, Germany and the Netherlands have Social Health Insurance (SHI) systems, whereas Spain, Italy and the UK have tax-financed National Health Services (NHS). In general, healthcare providers in SHI systems belong to private organisations; physicians are paid a fee for their services. In contrast, NHS systems belong to the public sector and doctors are paid by means of a monthly salary.
In Belgium, the fees for physicians and specialists are usually paid in advance, in full, by patients, thus immigrants are always required to pay. However, the costs of providing urgent medical care to an immigrant are paid by the providers and then reimbursed by the Social Welfare Centre.
In Germany, the fees for medical care are paid by health providers, but in the case of communicable diseases such as tuberculosis or sexual transmitted diseases, which are an immediate risk to public health, public health offices and publicly subsidised private medical centres will treat uninsured people free of charge (but this does not apply to AIDS treatment). All public employees are obliged to denounce any illegal immigrant to the authorities.
In the Netherlands, any illegal immigrant who is not a lawful citizen cannot claim any benefit in social security, such as healthcare assistance. However, there are two situations in which illegal immigrants can reclaim these services, namely the provision of care in emergencies, and for diseases of public health importance.
In the UK, people who are ordinarily resident in the country, including legal immigrants, are completely covered with regard to medical services, while non-citizens, including illegal immigrants, who require medical treatment are subject to the provisions of the NHS. These patients are not charged for the treatments they receive, but further treatments might be chargeable, other than in the case of certain communicable diseases (excluding AIDS, or HIV infection).
The healthcare system in Italy is based on a NHS that provides universal coverage free of charge at the point of service. Immigrants in Italy have the right to receive urgent and essential primary and hospital care due to any disease or accident.
Finally, in Spain all healthcare services are free of charge, but since 1991 all patients have been required to have an individual health card. Immigrants must be registered in their local census, as well local citizens, in order to have the same rights. Complete coverage of medical services is provided for unregistered immigrants if they are below the age of 18 years and for women who are pregnant, in labour and during the post-partum period. Care is provided for people with severe diseases and after accidents. No reference is made to unregistered immigrants with communicable diseases.
Immigrants represent around 1% of the people residing in the EU. Measuring rates of public healthcare resources by immigrants is not easy but immigrants appear, on average, to be using health services at a lower rate than the rest of the population. A major problem in many developed countries is that healthcare managers and providers are unaware of the legislative developments concerning access to healthcare for immigrants.
1.4 Impact of immigration on infectious diseases in developed countries
The movement of people and the increased mobility of disease vectors are major consequences of globalisation, which both exacerbate the risk of infectious disease spread. According to several studies, three million people every day travel across borders, with one million of them crossing from developing countries to developed countries. It is estimated that half a million people cross EU borders each year without permission or travel documents; this is especially true of immigrants from Africa.
A recent report from the UK Health Protection Agency, in 2006, showed that the majority of immigrants are healthy young adults, but they carry a disproportionate burden of infectious diseases. Approximately 70% of newly diagnosed cases of tuberculosis (TB), HIV infection and malaria were in patients born outside the EU. The last published data about infectious diseases demonstrate that there is an emerging epidemic of tuberculosis in many European countries such as Greece and Spain, and this is strongly related to increasing levels of immigration from Latin America, Africa and Asia. The majority of immigrants develop the infection due to their socioeconomic status in the host countries. European countries are, therefore, at risk of re-introducing diseases like malaria because of re-colonisation by Anopheles mosquitoes, and the health threat related to immigration from Latin America.
The main health problem for immigrants is their increased vulnerability to communicable diseases, especially HIV infection or AIDS. In 2005, 25% of new patients diagnosed with HIV infection in the EU were non-EU citizens who were probably infected in their countries of origin.
It is obvious that additional pathogens may be emerging related to human immigration, for example there is increasing incidence of neurocysticercosis in the US and other countries, amoebiasis caused by Entamoeba histolytica in some European countries, and leishmaniasis in the Northern regions of Europe. Antimicrobial resistance may also spread quickly worldwide, in particular the multidrug-resistance of tuberculosis bacteria.
For these reasons, there is a need to share information on current epidemiology, and to identify good practice. It will be very important to coordinate screening measures and follow-up practices for high-risk groups and to introduce a database of the most relevant infections related to immigration and travel.
1.5 References
Anon. Migration and health: a complex relation. Lancet. 2006;368:1039.
Carrasco-Garrido P, Gil A, Hernández V, Jiménez-García R. Health profiles, lifestyles and use of health resources by the immigrant population resident in Spain. Eur J Public Health. 2007;17:503–507.
Carrasquillo O, Carrasquillo AI, Shea S. Health insurance coverage of immigrants living in the United States: differences by citizenship status and country of origin. Am J Public Health. 2000;90:917–923.
Gibbons KH. Access to health insurance. Issue Brief Health Policy Track Serv. 2012;31:1–59.
Glen P. Health care and the illegal immigrant. Health Matrix Clevel. 2013;23:197–236.
National Intelligence Council
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