Spectrum of illness in migrants to Canada: sentinel surveillance through CanTravNet

• Published in: Journal of travel medicine 2019-02, Vol.26 (2)
• Main Authors: Boggild, Andrea K, Geduld, Jennifer, Libman, Michael, Yansouni, Cedric P, McCarthy, Anne E, Hajek, Jan, Ghesquiere, Wayne, Mirzanejad, Yazdan, Vincelette, Jean, Kuhn, Susan, Plourde, Pierre J, Chakrabarti, Sumontra, Greenaway, Christina, Hamer, Davidson H, Kain, Kevin C
• Format: Article
• Language: English
• Subjects: Diabetes mellitus; Epidemiology; Hepatitis; Hepatitis B; HIV; Human immunodeficiency virus; Illnesses; Infectious diseases; Migrants; Migration; Political factors; Population; Surveillance; Travellers; Tuberculosis
• ISSN: 1708-8305; 1195-1982; 1708-8305
• DOI: 10.1093/jtm/tay117

Abstract Background Due to ongoing political instability and conflict in many parts of the world, migrants are increasingly seeking asylum and refuge in Canada. Methods We examined demographic and travel correlates of illnesses among migrants to Canada to establish a detailed epidemiologic framework of this population for Canadian practitioners. Data on ill-returned Canadian travellers presenting to a CanTravNet site between 1 January 2015 and 31 December 2015 were analyzed. Results During the study period, 2415 ill travellers and migrants presented to a CanTravNet site, and of those, 519 (21.5%) travelled for the purpose of migration. Sub-Saharan Africa (n = 160, 30.8%), southeast Asia (n = 84, 16.2%) and south central Asia (n = 75, 14.5%) were the most common source regions for migrants, while the top specific source countries, of 98 represented, were the Philippines (n = 45, 8.7%), China (n = 36, 6.9%) and Vietnam (n = 31, 6.0%). Compared with non-migrant travellers, migrants were more likely to have a pre-existing immunocompromising medical condition, such as HIV or diabetes mellitus (P < 0.0001), and to require inpatient management of their illness (P < 0.0001). Diagnoses such as tuberculosis (n = 263, 50.7%), hepatitis B and C (n = 78, 15%) and HIV (n = 11, 2.1%) were over-represented in the migrant population compared with non-migrant travellers (P < 0.0001). Most cases of tuberculosis in the migrant population (n = 263) were latent (82% [n = 216]); only 18% (n = 47) were active. Conclusions Compared with non-migrant travellers, migrants were more likely to present with a communicable infectious disease, such as tuberculosis, potentially complicated by an underlying immunosuppressing condition such as HIV. These differences highlight the divergent healthcare needs in the migrant population, and underscore the importance of surveillance programmes to understand their burden of illness. Intake programming should be adequately resourced to accommodate the medical needs of this vulnerable population of new Canadians.