Mellado-Sola Isabel, Rodríguez-Molino Paula, Armas Elisa-Andrea, Nogueira López Javier, Falces-Romero Iker, Rey Cristina Calvo, Grasa Lozano Carlos, Mellado María José, López-Hortelano Milagros García, Sainz Talía
General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, 28046 Madrid, Spain.
La Paz Research Institute (IdiPAZ), 28029 Madrid, Spain.
Trop Med Infect Dis. 2022 Dec 29;8(1):28. doi: 10.3390/tropicalmed8010028.
In recent decades, the increase in population movements has turned the focus to imported diseases. The COVID-19 pandemic has negatively impacted the access to health care systems, especially in highly vulnerable populations. We address the effects of the pandemic on the health screening of migrant unaccompanied minors (UM) in Spain.
Retrospective cross-sectional study including UM screened for imported diseases with a unified protocol at a pediatric reference unit for tropical and infectious diseases in Madrid, Spain. We compared the pre-pandemic (2018-2019) and post-pandemic periods (2020-2021).
A total of 192 minors were screened during the study period, with a drop in UM's referral to our center in the post-pandemic years (140 in 2018-2019 vs. 52 in 2020-2021). Out of 192, 161 (83.9%) were diagnosed with at least one medical condition. The mean age was 16.8 years (SD 0.8) and 96.9% were males. Most cases were referred for a health exam; only 38% of children were symptomatic. Eosinophilia was present in 20.8%. The most common diagnosis were latent tuberculosis infection (LTBI) (72.9%), schistosomiasis (15.1%), toxocariasis (4.9%) and strongyloidiasis (4.9%). The prevalence of LTBI did not vary significantly (69.3% vs. 82.7%, = 0.087). A total of 38% of the patients diagnosed with LTBI never started treatment or were lost to follow-up, as were two out of three patients with active pulmonary tuberculosis.
In this series, the number of UM referred for health screening has dropped dramatically after the COVID pandemic, and two years after the beginning of the pandemic, access to care is still limited. Lost to follow-up rates are extremely high despite institutionalization. Specific resources, including multidisciplinary teams and accessible units are needed to improve diagnoses and linkage to care in this vulnerable population.
近几十年来，人口流动的增加使人们将焦点转向了输入性疾病。新冠疫情对医疗保健系统的可及性产生了负面影响，尤其是在高度脆弱的人群中。我们探讨了疫情对西班牙无人陪伴未成年移民（UM）健康筛查的影响。
回顾性横断面研究，纳入在西班牙马德里一家热带病和传染病儿科参考单位按照统一方案接受输入性疾病筛查的无人陪伴未成年移民。我们比较了疫情前（2018 - 2019年）和疫情后时期（2020 - 2021年）。
在研究期间共筛查了192名未成年人，疫情后几年转介至我们中心的无人陪伴未成年移民数量有所下降（2018 - 2019年为140例，2020 - 2021年为52例）。在192名中，161名（83.9%）被诊断患有至少一种疾病。平均年龄为16.8岁（标准差0.8），96.9%为男性。大多数病例是因健康检查被转介；只有38%的儿童有症状。嗜酸性粒细胞增多症的比例为20.8%。最常见的诊断是潜伏性结核感染（LTBI）（72.9%）、血吸虫病（15.1%）、弓蛔虫病（4.9%）和类圆线虫病（4.9%）。潜伏性结核感染的患病率没有显著变化（69.3%对82.7%，P = 0.087）。总共38%被诊断为潜伏性结核感染的患者从未开始治疗或失访，三分之二的活动性肺结核患者也是如此。
在本系列研究中，新冠疫情后被转介进行健康筛查的无人陪伴未成年移民数量大幅下降，疫情开始两年后，医疗服务的可及性仍然有限。尽管实行了机构化管理，但失访率极高。需要包括多学科团队和可及单位在内的特定资源，以改善对这一脆弱人群的诊断和医疗服务衔接。
