Department of Medicine, University of Ottawa, Ottawa, Canada.
Clin Infect Dis. 2013 Apr;56(7):925-33. doi: 10.1093/cid/cis1016. Epub 2012 Dec 7.
Increasing international migration may challenge healthcare providers unfamiliar with acute and long latency infections and diseases common in this population. This study defines health conditions encountered in a large heterogenous group of migrants.
Migrants seen at GeoSentinel clinics for any reason, other than those seen at clinics only providing comprehensive protocol-based health screening soon after arrival, were included. Proportionate morbidity for syndromes and diagnoses by country or region of origin were determined and compared.
A total of 7629 migrants from 153 countries were seen at 41 GeoSentinel clinics in 19 countries. Most (59%) were adults aged 19-39 years; 11% were children. Most (58%) were seen >1 year after arrival; 27% were seen after >5 years. The most common diagnoses were latent tuberculosis (22%), viral hepatitis (17%), active tuberculosis (10%), human immunodeficiency virus (HIV)/AIDS (7%), malaria (7%), schistosomiasis (6%), and strongyloidiasis (5%); 5% were reported healthy. Twenty percent were hospitalized (24% for active tuberculosis and 21% for febrile illness [83% due to malaria]), and 13 died. Tuberculosis diagnoses and HIV/AIDS were reported from all regions, strongyloidiasis from most regions, and chronic hepatitis B virus (HBV) particularly in Asian immigrants. Regional diagnoses included schistosomiasis (Africa) and Chagas disease (Americas).
Eliciting a migration history is important at every encounter; migrant patients may have acute illness or chronic conditions related to exposure in their country of origin. Early detection and treatment, particularly for diagnoses related to tuberculosis, HBV, Strongyloides, and schistosomiasis, may improve outcomes. Policy makers should consider expansion of refugee screening programs to include all migrants.
国际移民的增加可能会给不熟悉移民中常见的急性和潜伏期感染及疾病的医疗保健提供者带来挑战。本研究定义了在一大群异质移民中遇到的健康状况。
我们纳入了在 GeoSentinel 诊所因任何原因就诊的移民，不包括仅在抵达后提供全面基于协议的健康筛查的诊所就诊的移民。按原籍国或地区确定并比较了综合征和诊断的发病率。
来自 153 个国家的 7629 名移民在 19 个国家的 41 个 GeoSentinel 诊所就诊。大多数（59%）为 19-39 岁的成年人；11%为儿童。大多数（58%）在抵达后 1 年以上就诊；27%在 5 年以上就诊。最常见的诊断为潜伏性结核（22%）、病毒性肝炎（17%）、活动性结核（10%）、人类免疫缺陷病毒（HIV）/艾滋病（7%）、疟疾（7%）、血吸虫病（6%）和旋毛虫病（5%）；5%报告为健康。20%住院（24%为活动性结核，21%为发热性疾病[83%为疟疾]），13 人死亡。所有地区均报告了结核病诊断和艾滋病，大多数地区报告了旋毛虫病，亚洲移民中慢性乙型肝炎病毒（HBV）尤其常见。区域诊断包括血吸虫病（非洲）和恰加斯病（美洲）。
在每次就诊时询问移民史都很重要；移民患者可能患有与原籍国暴露相关的急性疾病或慢性疾病。早期发现和治疗，特别是与结核病、HBV、旋毛虫和血吸虫病相关的诊断，可能会改善预后。政策制定者应考虑扩大难民筛查计划，将所有移民包括在内。
