Social determinants of health and primary immunodeficiency.

Abstract Objective: Inborn errors of immunity (IEI) are rare genetic conditions affecting the immune system. The rate of IEI's, their presentation, course and treatment, are all affected by a multitude of social determinants, eventually affecting prognosis. This review summarizes the current knowledge of the social determinants affecting infectious susceptibility, genetic predisposition, diagnosis and treatment of IEI. Data Sources: Pubmed. Study Selections: search terms included “consanguinity” “social determinants” and “founder effect”. Further studies were selected based on relevant citations. Results: Changes in climate and human behavior have modulated the spread of disease vectors and infectious organisms. Consanguinity increases the rate of autosomal recessive conditions, changes the distribution and affects the severity of IEI. Access to sophisticated genetic and immunologic diagnostic modalities affects genetic counseling and timely diagnosis. Effective genetic counselling should address to the patient's genetic background and ethical code. Access to appropriate and timely treatment of immunodeficiencies is scarce in some regions of the world. Conclusion: High consanguinity rate and reduced access to prophylactic measures increase the burden of immunodeficiencies in many low- and medium-income countries. Poor access to diagnostic and treatment modalities in these regions further adversely affect patients’ prognosis. Increased awareness among healthcare professionals and the public, and increased collaboration with Western countries aid in diagnosis of these conditions. Further advancements require improved public funding to the prevention, diagnosis and treatment of IEI.