移民中的疟疾

Malaria in migrants.

作者信息

Castelli F, Matteelli A, Caligaris S, Gulletta M, el-Hamad I, Scolari C, Chatel G, Carosi G

机构信息

Clinic of Infectious and Tropical Diseases, University of Brescia, Italy.

出版信息

Parassitologia. 1999 Sep;41(1-3):261-5.

PMID:10697866

Abstract

An increasing proportion of malaria cases in Italy is observed in immigrants revisiting their country of origin, but little specific research work has been carried out in this field. All malaria cases occurring from 1990 to 1998 at the Reference Clinic for Infectious and Tropical Diseases in Brescia were prospectically evaluated to compare clinical outcome in migrant and non-immune cases. No difference was observed between parasitaemia at diagnosis and time to clearance of peripheral parasitaemia. Clinical presentation was milder in migrants than in non-immunes, with an OR for severe malaria of 0.27 (c.i. = 0.09-0.84) (p = 0.01). Fever clearance time was significantly shorter in migrants (3.0 days, SD = 1.2) than in non-immunes (4.3 days, SD = 1.7) (p < 0.001). Among immigrants, the proportion of severe cases was higher in residents since 2 years or less (12.5%) compared to residents since 2 to 5 years (3.3%) and residents since more than 5 years (0.9%) (p = 0.02). The proportion of malaria cases who had used chemoprophylaxis was significantly lower among immigrants (30/272, 11.0%) compared to non-immunes (41/74, 55.4%) (p < 0.001). In a population based malaria KAP analysis among 504 migrants from malaria endemic countries, correct knowledge of malaria risk was reported by 351 (69.5%). Of 170 subjects who reported at least one visit back to the home country, 30 (17.6%) had sought pre-travel advice, 24 (14.1%) had started chemoprophylaxis and 7 (4.1%) had completed it during the last visit. Of 140 migrants who failed to seek pre-travel advice, 73 (52%) were unaware of malaria risk, 56 (40%) did not know how to protect themselves, and 11 (8%) refused to use protective measures. Migrants account for a significant proportion of imported malaria cases in industrialised countries. Clinical presentation is milder compared to non-immune subjects. The proportion of migrants who adopt malaria protective measure while returning home is very low, due to both unawareness of risk and inappropriateness of medical advice.

摘要

在意大利，越来越多的疟疾病例出现在返回原籍国的移民中，但该领域的具体研究工作开展较少。对1990年至1998年期间布雷西亚传染病和热带病参考诊所发生的所有疟疾病例进行前瞻性评估，以比较移民和非免疫病例的临床结局。诊断时的寄生虫血症与外周血寄生虫清除时间之间未观察到差异。移民的临床表现比非免疫者更为轻微，严重疟疾的比值比为0.27（置信区间=0.09 - 0.84）（p = 0.01）。移民的发热清除时间（3.0天，标准差=1.2）显著短于非免疫者（4.3天，标准差=1.7）（p < 0.001）。在移民中，居住时间不到2年的居民中重症病例的比例（12.5%）高于居住2至5年的居民（3.3%）和居住超过5年的居民（0.9%）（p = 0.02）。与非免疫者（41/74，55.4%）相比，移民中使用化学预防的疟疾病例比例显著更低（30/272，11.0%）（p < 0.001）。在对504名来自疟疾流行国家的移民进行的基于人群的疟疾知识、态度和行为分析中，351人（69.5%）报告对疟疾风险有正确认识。在报告至少回过一次祖国的170名受试者中，30人（17.6%）寻求过旅行前建议，24人（14.1%）开始进行化学预防，7人（4.1%）在上次旅行期间完成了预防。在140名未寻求旅行前建议的移民中，73人（52%）未意识到疟疾风险，56人（40%）不知道如何保护自己，11人（8%）拒绝采取保护措施。在工业化国家，移民占输入性疟疾病例的很大比例。与非免疫者相比，临床表现更为轻微。由于对风险缺乏认识以及医疗建议不合适，移民回国时采取疟疾保护措施的比例非常低。