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Objectives Given the scarcity of data regarding prevalence of various infectious diseases in Latin-American countries, our study aims to assess the burden of T. cruzi, S. stercoralis, HIV and viral hepatitis in Latin-American migrants, with a focus on Bolivian migrants. Methods We performed a retrospective observational study of 565 screening evaluations in adults (≥18 years) carried out at our International Healthcare referral service in Barcelona. We reviewed structured clinical records and microbiological results of patients attended between February 2012 and April 2015. Results The median age was 35 years and 74% were women. Of the population screened, 87% were of Bolivian origin. We found a 48% prevalence of T. cruzi, 16% of S. stercoralis, 0.2% of HIV, 0.2% HBV and 0.2% HCV. Conclusions These results support the relevance of screening for T. cruzi and S. stercoralis in Bolivian migrants but challenge the pertinence of systematic screening for HBV in this population.

Immigrant health status may be improved if certain health conditions are identified early through the implementation of a screening program. This document presents the recommendations resulting from the Screening in immigrant population project (CRIBMI) aimed at implementing a screening program for infectious diseases (HIV, HBV, HCV, tuberculosis, strongyloidiasis, schistosomiasis and Chagas disease), as well as female genital mutilation and mental health (MH) in migrant population at Primary Care level. Screening recommendations were based on: coming from an endemic country for strongyloidiasis, schistosomiasis, and Chagas diseases; on a threshold level of prevalence for HIV (> 1%), HBV (> 2%), and HCV (> 2%), and on incidence (> 50 cases/100,000-inhabitants) for active tuberculosis in immigrants with < 5 years in Europe. Exploring the risk of FGM is recommended in women from countries where this practice is prevalent. Evaluation of MH status is recommended for people from areas of conflict and violence.

Different diagnostic tests were evaluated in a cluster of six European travellers with acute schistosomiasis (AS) acquired in Mozambique. Adult worm and soluble egg antibodies, circulating anodic antigen (CAA) and DNA detection allowed early confirmation of AS. CAA permitted monitoring treatment response and Sm1-7 polymerase chain reaction allowed identification of Schistosoma mansoni complex.

Background Although tick-borne pathogens have been reported as an important cause of imported fever, the incidence of Anaplasma phagocytophilum, the causative agent of human granulocytic anaplasmosis (HGA), in travellers is unknown. Methods We conducted a prospective cohort study to investigate the aetiologies of fever in returning travellers (November 2017—July 2019). Polymerase chain reaction for msp2 gene amplification and indirect immunofluorescence assay for A. phagocitophilum were performed in all returning travellers with undifferentiated non-malarial fever. Results Among 141 travellers included, 8 patients were diagnosed with probable or confirmed HGA. The overall incidence rate of HGA was 19.9 cases/1000 person—week of travel. The main destination of travel was Asia, accounting for 62.5% patients with HGA. Co-infections were found in 37.5% of patients with HGA. Conclusions Diagnosis of HGA and empirical treatment with doxycycline should be considered in travellers with fever.

Introduction: Spain is the non-endemic country with the highest burden of Chagas disease outside the Americas, and it represents a model for non-endemic countries concerning health policies to control the disease. This study generates high-resolution estimates of the burden of undetected and untreated T.cruzi infection cases in Spain and compare them with the actual number of cases reported by official sources. Methods: A study using aggregate data collected from the literature and official sources (Spanish National Statistics Institute; Spanish Agency of Medicines and Medical Devices) was undertaken, from 2010 to 2018, to estimate the number of Chagas disease cases and the underdiagnosis and undertreatment rates. Results: We estimated a total of 55,367 migrants living with Chagas disease in Spain in 2018, out of them 613 (1%) were children under 15 years of age. Bolivian migrants represented 54% of the total estimated cases. Underdiagnosis and undertreatment rates were heterogeneous among the different Spanish autonomous regions, being the estimated global underdiagnosis rate of around 71%. The global rate of undertreatment in Spain was estimated to be 82·5% among patients older than 14 years. Conclusion: The burden of Chagas disease in Spain remains high, with both considerable underdiagnosis and undertreatment rates, particularly notorious in childbearing age women despite being a priority group; but much improved in children, suggesting the efficacy of antenatal screening programmes implemented in the country. Funding: None to declare Declaration of Interest: All authors declare not competing interest

Introduction: Strongyloidiasis is a prevailing helminth infection ubiquitous in tropical and subtropical areas, however, seroprevalence data are scarce in migrant populations, particularly for those coming for Asia. Methods: This study aims at evaluating the prevalence of S. stercoralis at the hospital level in migrant populations or long term travellers being attended in out-patient and in-patient units as part of a systematic screening implemented in six Spanish hospitals. A cross-sectional study was conducted and systematic screening for S. stercoralis infection using serological tests was offered to all eligible participants. Results: The overall seroprevalence of S. stercoralis was 9.04% (95%CI 7.76&ndash, 10.31). The seroprevalence of people with a risk of infection acquired in Africa and Latin America was 9.35% (95%CI 7.01&ndash, 11.69), 9.22% (7.5&ndash, 10.93), respectively. The number of individuals coming from Asian countries was significantly smaller and the overall prevalence in these countries was 2.9% (95%CI &minus, 0.3&ndash, 6.2). The seroprevalence in units attending potentially immunosuppressed patients was significantly lower (5.64%) compared with other units of the hospital (10.20%) or Tropical diseases units (13.33%) (p &lt, 0.001). Conclusions: We report a hospital-based strongyloidiasis seroprevalence of almost 10% in a mobile population coming from endemic areas suggesting the need of implementing strongyloidiasis screening in hospitalized patients coming from endemic areas, particularly if they are at risk of immunosuppression.

Chagas disease is an emerging but still largely unrecognised infectious parasitic disease in European countries.1 It has important public health implications because, although the classic vector-borne route of transmission only occurs in endemic areas of Latin America, the less common transmission routes—blood transfusion, transplantation, and vertical transmission from mother to child—have been shown in Europe.2 Therefore, providing policy makers with accurate estimates of country-specific prevalence of Chagas disease should inform the design and implementation of the most cost-effective health interventions.

Background Water, sanitation and hygiene (WASH) are major health determinants, responsible for an estimated world-wide disease burden of 5.7%. However, the debate about the effect of water quality, hygiene and sanitation in preventing diarrhoea is still ongoing. The aim of this study is to describe access to improved water supply and sanitation infrastructure, as defined by the Joint Monitoring Programme, in the Manhica Health Research Centre (CISM) study area and evaluate its association with morbidity and mortality indicators. Methods We conducted a retrospective cohort study. All children under 15 living in the study area during the period 2012–2015 were included (N=61900). Children were followed up until they moved from the study area, turned 15 or until 2015. Water and sanitation household data were obtained from the CISM demographic surveillance system (DSS) in the Manhica district, an area of around 2380 km2. Clinical data were obtained from CISM9s round-the-clock morbidity surveillance system covering outpatient and hospital admissions at the Manhica District Hospital (MDH) and rural health posts. A negative binomial regression model using Wald test was performed to assess the minimum community-based incidence rates (MCBIR) for every morbidity-mortality indicator. Results Preliminary data showed that 86% of the children lived at least once in a household with unimproved sanitation facilities, 27% with an unimproved water source. Spatial distribution of unimproved water and sanitation facilities showed to be clustered. Access to unimproved sanitation and water facilities was associated to higher rates of diarrhoea, a significant 30% of diarrhoea rate increase was observed for rivers, lakes and ponds as water sources. Other morbidity indicators (malnutrition, parasitaemia, anaemia) also showed a rate increase with the use of unimproved water and sanitation facilities. Conclusions Obtained results are useful to inform sector-related decision-making processes and ultimately improve access to safe drinking water and sanitation in rural southern Mozambique.