Academic journal article Bulletin of the World Health Organization

Economic Crisis and Increased Immigrant Mobility: New Challenges in Managing Chagas Disease in Europe

Academic journal article Bulletin of the World Health Organization

Economic Crisis and Increased Immigrant Mobility: New Challenges in Managing Chagas Disease in Europe

Article excerpt

In Europe, there is evidence of the effect of the global financial crisis and austerity measures on vulnerable peoples health: increasing risky health behaviours, difficulties accessing health care and poorer mental, maternal and child health. (1) There are little data on the extent to which communicable diseases are affected by the economic crisis in developed countries. However, a meta-analysis suggests worse health outcomes affecting the whole population, with infants, elderly, poor and/or homeless people, prisoners and immigrants carrying the main burden. (2)

Europe has a substantial burden of infectious diseases in vulnerable groups with social and economic disadvantages. In the past two decades this region has received more than 3.5 million Latin American immigrants, with a predominance of young-to-middle aged women, many of whom are undocumented. (3) Chagas disease, a potential life-threating parasitic infection endemic in Latin America, has recently emerged in Europe, affecting an estimated 80 000 to 120 000 Latin American immigrants. In European countries, Chagas disease costs 16 million United States dollars (US$) for health care and US$ 137 million as a result of lost productivity annually. (4)

Chagas disease transmission through congenital and unscreened blood and organ donations has been identified in several European countries. Italy and Spain, two countries severely hit by the economic crisis, host the largest Latin American communities at risk and have reported the highest number of Chagas cases. (5) Undetected and untreated, 20-40% of infected people develop severe cardiac, digestive or neurologic complications requiring complex, costly and long-term medical attention.

Despite evidence of the economic and health benefits of introducing targeted screening and treatment strategies among risk groups, Chagas disease-related health needs remain largely unmet in Europe. It is estimated that 90% of infected persons living in Europe have yet to be identified. ' The recommended transmission-control strategies include screening pregnant women, their babies and other family members, and testing blood and organ donors at risk. But the identification of infected individuals is particularly hindered by the long clinically-silent phase, the poor specificity and high diversity of possible symptoms, the need for specific diagnostic procedures and the lack of awareness among health professionals. Moreover, infected immigrants at risk in Europe often face administrative and economic barriers preventing them from obtaining access to care.

Europe's current economic crisis and subsequent austerity measures have been significantly affecting the management of Chagas disease. Since 2008, several European countries have been cutting health and social services for vulnerable immigrants. Spain, for example, issued a Royal Decree in 2012 severely restricting access to preventive and primary health care for undocumented immigrants.

As a result of the decreasing economic opportunities in the countries most affected--notably Italy, Portugal and Spain--immigrants have been moving to other European countries or going back to their countries of origin. (3) Immigrant families have in some instances been forced to split, with male and female members targeting specific job opportunities in different places. This jeopardizes continuity of care and challenges the recommended screening of the whole family after a case of infection has been identified.

While most infected immigrants initially lived in Spain--where effective responses to Chagas disease have been developed over the last decade--some immigrants have recently moved to other European countries, with few or no Chagas-disease programmes, thus raising the likelihood of further transmission.

Therefore, there is a need for European countries to implement evidence-based public health and clinical interventions to optimize Chagas-disease management and control in Europe in the context of current migration patterns. …

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