Immigration, European Union and health issues: A commentary

Abstract

In 2010, 47,348,000 foreign-born immigrants lived in European Union (EU) countries, composing almost 10% of its population. Italy ranked 5th after Germany, France, United Kingdom, and Spain, with a total of 4,798,000 registered foreign-born persons living there and currently representing 8.3% of the Italian population [ [1] Immigration to Europe. Wikipedia the Free Encyclopedia. Statistical data on immigrant populations. 2010 data for European Union. http://en.wikipedia.org/wiki/Immigration_to_Europe#2010_data_for_European_Union [accessed 12.09.13]. Google Scholar ]. Europe is familiar with immigration. During its long history, several waves of migrating people have crossed its soil. Starting with barbaric tribal movements crossing and destroying everything on their way from North and East to South and West of Europe and finally mixing with, or being expelled by the local populations. In the beginning of the 20th century, Europe was the starting point for emigration to North America and Australia and after World War II, the target of immigration from Turkey, Greece and Italy to Central Europe. Apart from the two Great Wars, which brought a toll of more than 100 million dead, destruction and even larger numbers of people dislocated from their homes, the pattern of immigration to Europe was, with infrequent exceptions, an internal affair. The last three decades however, have witnessed a quite different pattern of immigration to Europe and especially to European Union (EU) countries. Millions of people from Africa, Asia and Eastern Europe, wanting to escape war, oppression, natural disasters or poverty, try by any means to find refuge in this continent as, legal or mostly illegal, immigrants. They carry along with them to the host countries, not only their meagre belongings, but also diseases prevalent in their home nations. Besides tuberculosis, well-known health problems include hepatitis B (HBV), C (HCV), human immunodeficiency (HIV) viral infections [ [2] McCarthy A.E. Weld L.H. Barnett E.D. et al. Spectrum of illness in international migrants seen at GeoSentinel clinics in 1997–2009, part 2: Migrants resettled internationally and evaluated for specific health concerns. Clinical Infectious Diseases. 2013; 56: 925-933 Crossref PubMed Scopus (70) Google Scholar ] and occasionally co-infections, including hepatitis delta virus (HDV) as well [ [3] Manesis E.K. Vourli G. Dalekos G. et al. Prevalence and clinical course of hepatitis delta infection in Greece: a 13-year prospective study. Journal of Hepatology. 2013; 59: 949-956 Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar ]. Immigrants crossing the borders of Greece originate mostly from Balkan countries, Central Asia, Middle East and Africa; those immigrating to Central Europe come mostly from Eastern Europe and Turkey and those entering Italy and Spain, from neighbouring European countries, North Africa and Latin America. Northern Balkan countries and in particular Albania, Romania and Moldova, have high prevalence of HBV and HDV infection [ [4] Chironna M. Germinario C. Lopalco P.L. et al. HBV, HCV and HDV infections in Albanian refugees in Southern Italy (Apulia region). Epidemiology and Infection. 2000; 125: 163-167 Crossref PubMed Scopus (34) Google Scholar ]; the Middle East and especially Egypt, are areas of high HCV endemicity [ [5] Hatzakis A. Van Damme P. Alcorn K. et al. The state of hepatitis B and C in the Mediterranean and Balkan countries: report from a summit conference. Journal of Viral Hepatitis. 2013; 20: 1-20 Crossref PubMed Scopus (56) Google Scholar ]; Afghan and Pakistani immigrants have also increased carriership of HBV and HCV. Sub-Saharan Africa continues to have high prevalence of HIV infection, especially among adolescent females and the incidence of new HIV infections is reportedly increasing in Eastern European, Central Asian and North African countries [ [6] UNAIDS Report on the global AIDS epidemic-2012. Accessed from: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/20121120_UNAIDS_Global_Report_2012_with_annexes_en.pdf [accessed 15.09.13]. Google Scholar ]. In host countries, the health problem related to immigration is not negligible. In Northern European countries, the excess burden of HBV infection attributed to immigration has been estimated between 80 and 94% and the prevalence of HIV1 non-B subtype, considered to have been introduced to Europe by immigration, varies to up to 33% of all HIV cases today [ [7] Yebra G. Holguín A. Pillay D. et al. Phylogenetic and demographic characterization of HIV-1 transmission in Madrid, Spain. Infection, Genetics and Evolution. 2013; 14: 232-239 Crossref PubMed Scopus (24) Google Scholar ].