Chagas disease screening in pregnant Latin American women: Adherence to a systematic screening protocol in a non-endemic country

Background Chagas disease (CD) is a chronic parasitic disease caused by Trypanosoma cruzi and is endemic to continental Latin America. In Spain, the main transmission route is congenital. We aimed to assess adherence to regional recommendations of universal screening for CD during pregnancy in Latin American women in the province of Alicante from 2014 to 2018. Methodology/Principal findings Retrospective quality study using two availa sources: 1) delivery records of Latin American women that gave birth in the 10 public hospitals of Alicante between January 2014 and December 2018; and 2) records of Chagas serologies carried out in those centers between May 2013 and December 2018. There were 3026 deliveries in Latin American women during the study period; 1178 (38.9%) underwent CD serology. Screening adherence ranged from 17.2% to 59.3% in the different health departments and was higher in Bolivian women (48.3%). Twenty-six deliveries (2.2%) had a positive screening; CD was confirmed in 23 (2%) deliveries of 21 women. Bolivians had the highest seroprevalence (21/112; 18.7%), followed by Colombians (1/333; 0.3%) and Ecuadorians (1/348; 0.3%). Of 21 CD-positive women (19 Bolivians, 1 Colombian, 1 Ecuadorian), infection was already known in 12 (57.1%), and 9 (42.9%) had already been treated. Only 1 of the 12 untreated women (8.3%) was treated postpartum. Follow-up started in 20 of the 23 (87.0%) neonates but was completed only in 11 (47.8%); no cases of congenital transmission were detected. Among the 1848 unscreened deliveries, we estimate 43 undiagnosed cases of CD and 1 to 2 undetected cases of congenital transmission. Conclusions/Significance Adherence to recommendations of systematic screening for CD in Latin American pregnant women in Alicante can be improved. Strategies to strengthen treatment of postpartum women and monitoring of exposed newborns are needed. Currently, there may be undetected cases of congenital transmission in our province.

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Economic evaluation of Chagas disease screening of pregnant Latin American women and of their infants in a non endemic area

Acta Tropica ◽

10.1016/j.actatropica.2011.02.012 ◽

2011 ◽

Vol 118 (2) ◽

pp. 110-117 ◽

Cited By ~ 69

Author(s):

Elisa Sicuri ◽

José Muñoz ◽

Maria Jesús Pinazo ◽

Elizabeth Posada ◽

Joan Sanchez ◽

...

Keyword(s):

Economic Evaluation ◽

Chagas Disease ◽

Latin American ◽

Endemic Area ◽

Disease Screening ◽

American Women

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Chagas disease in Switzerland: history and challenges

Eurosurveillance ◽

10.2807/ese.16.37.19963-en ◽

2011 ◽

Vol 16 (37) ◽

Cited By ~ 14

Author(s):

Y Jackson ◽

F Chappuis

Keyword(s):

At Risk ◽

Chagas Disease ◽

Latin American ◽

Risk Groups ◽

Cultural Groups ◽

Systematic Screening ◽

Raising Awareness ◽

Screening Strategies ◽

The Social ◽

Health Programmes

Chagas disease, endemic in Latin America, is an emerging health problem in Europe affecting an estimated 80,000 persons. Around 60,000 Latin American migrants live in Switzerland, and cases of Chagas disease have been reported since 1979. As of June 2011, 258 cases have been diagnosed, mostly adults in the indeterminate phase of the chronic stage of the disease. Vertical transmission has been identified and there is a high potential for blood- and organ-borne transmission in the absence of systematic screening. Major challenges include (i) raising awareness among migrants and healthcare professionals, (ii) developing national protocols for screening and treatment targeting high-risk groups such as pregnant woman, newborns, migrants from highly endemic areas (e.g. Bolivia), and immunocompromised migrants, (iii) preventing blood- and organ-borne transmission by appropriate screening strategies, (iv) taking into account the social vulnerability of individuals at risk in the design and implementation of public health programmes, and (v) facilitating contacts with the communities at risk through outreach programmes, for example in churches and cultural groups.

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Chemiluminescent Microparticle Immunoassay for the Diagnosis of Congenital Chagas Disease: A Prospective Study in Spain

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0332 ◽

2021 ◽

Author(s):

Luis Gil-Gallardo ◽

Marina Simón ◽

María Iborra ◽

Bartolomé Carrilero ◽

Manuel Segovia

Keyword(s):

Prospective Study ◽

Chagas Disease ◽

Latin American ◽

Serological Test ◽

Serological Tests ◽

Chemiluminescent Microparticle Immunoassay ◽

A Prospective Study ◽

Global Health Problem ◽

Rule Out

Congenital Chagas disease (CCD) has become a global health problem. Historically, the diagnosis of CCD has been carried out using parasitological methods and traditional serological techniques, however, new serological techniques such as chemiluminescent microparticle immunoassays (CMIA) have been developed in the last few years with many advantages compared with traditional serological tests. A total of 75 children born to 72 Latin American Chagas-infected mothers were consecutively enrolled and studied by CMIA and indirect immunofluorescence (IIF) at 0–2, 6, 9, and 12 months of age. At the end of the follow-up, 74 out of 75 children were considered uninfected and one child was diagnosed with CCD. Our study emphasizes the need to carry out serological follow-up on every newborn from a mother with Chagas disease and shows that CMIA assay is a great diagnostic tool as a single serological test at 9 months of age to rule out CCD or to identify possible transmission.

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Chagas disease among pregnant Latin American women in the United Kingdom: time for action

BMJ Global Health ◽

10.1136/bmjgh-2017-000478 ◽

2017 ◽

Vol 2 (4) ◽

pp. e000478 ◽

Cited By ~ 2

Author(s):

Cristina Fernandez Turienzo ◽

Carmen Cabeza Brasa ◽

William Newsholme ◽

Jane Sandall ◽

Peter L Chiodini ◽

...

Keyword(s):

United Kingdom ◽

Chagas Disease ◽

Latin American ◽

American Women ◽

The United Kingdom

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Chagas disease prevalence in pregnant women: migration and risk of congenital transmission

The Journal of Infection in Developing Countries ◽

10.3855/jidc.7118 ◽

2016 ◽

Vol 10 (09) ◽

pp. 895-901 ◽

Cited By ~ 3

Author(s):

Rodolfo A Kolliker-Frers ◽

Ivan Insua ◽

Gabriela Razzitte ◽

Francisco Capani

Keyword(s):

Pregnant Women ◽

Chagas Disease ◽

Latin American ◽

The United States ◽

Serological Tests ◽

Cross Sectional ◽

Congenital Transmission ◽

The Public ◽

Endemic Areas ◽

The Impact

Introduction: Argentina has been a preferential target for Bolivian immigrants for decades. The relatively recent migratory flux includes Germany, France, the United States, Australia, Japan, and some Latin American countries. The aim of this cross-sectional study was to describe the prevalence of Chagas disease in pregnant women, analyzing the Bolivian-specific Chagas prevalence as the main contributor of migratory populations from Chagas disease-endemic areas to Buenos Aires city, Argentina, and to evaluate the impact of these migrant influxes on the process of the "urbanization" of the disease in reference hospital José Maria Ramos Mejia (JMRM). Methodology: Overall, 21,332 pregnant women (100%) between 15 and 49 years of age derived from the public maternity service of JMRMH were studied. Serology data was obtained from registered serological diagnosis data, consisting of three different serological tests performed at the Public Parasitology Unit. Results: Although general prevalence decreased during the analyzed period, the specific prevalence of pregnant women from Bolivian origin showed a sustained growth during 1983–2013. Solely 5% of the total pregnant women population from Bolivia contributed to one third of the total Chagas prevalence. Conclusions: This study showed that a cohort of pregnant women from Bolivia who attended JMRMH during the period 1983–2007 constituted a population at risk for congenital transmission. Increased migration from endemic areas of Bolivia might potentially increase the prevalence of Chagas disease among pregnant women. In addition, this study highlights the importance to analyze specific prevalence according to endemic areas to determine the profiles of potential hidden prevalence.

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Trypanosoma cruzi infection in Latin American pregnant women living outside endemic countries and frequency of congenital transmission: a systematic review and meta-analysis

Journal of Travel Medicine ◽

10.1093/jtm/taaa170 ◽

2020 ◽

Cited By ~ 2

Author(s):

Valeria Colombo ◽

Andrea Giacomelli ◽

Giovanni Casazza ◽

Laura Galimberti ◽

Cecilia Bonazzetti ◽

...

Keyword(s):

Trypanosoma Cruzi ◽

Pregnant Women ◽

Chagas Disease ◽

Latin American ◽

Transmission Rate ◽

Congenital Infection ◽

Health Concern ◽

Congenital Transmission ◽

Global Rate ◽

Cruzi Infection

Abstract Background Chagas disease, as a consequence of globalization and immigration, is no more restricted to Central and Latin America. Therefore, congenital transmission represents a growing public health concern in non-endemic countries. Methods The aim of this study was to assess the prevalence of Trypanosoma cruzi infection in pregnant Latin American (LA) women living outside endemic countries and the rate of congenital transmission. Data were extracted from studies indexed in PubMed, Scopus, Embase, Lilacs and SciELO databases without language restriction. Two investigators independently collected data on study characteristics, diagnosis, prevalence of infection in pregnant women and congenital infection rate. The data were pooled using a random effects model. Results The search identified 1078 articles of which 29 were eligible regarding prevalence of T. cruzi infection among pregnant women and 1795 articles of which 32 were eligible regarding the congenital transmission rate. The estimated pooled prevalence of T. cruzi infection in LA pregnant women was 4.2% [95% confidence interval (CI): 3.0–5.5]. The prevalence of T. cruzi infection in pregnant women from Bolivia was 15.5% (95% CI: 11.7–19.7) and 0.5% (95% CI: 0.2–0.89) for those coming from all other LA countries. The estimated global rate of congenital transmission was 3.5% (95% CI: 2.5–4.5); excluding poor-quality studies, the rate of congenital transmission was 3.8% (95% CI: 2.4–5.1). Conclusions Prevalence of Chagas disease among LA pregnant women living outside endemic countries is high, particularly in Bolivian women. The rate of vertical transmission of T. cruzi infection is similar to the rate reported in South and Central American countries.

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Chagas’ Disease: Pregnancy and Congenital Transmission

BioMed Research International ◽

10.1155/2014/401864 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 27

Author(s):

Ana María Cevallos ◽

Roberto Hernández

Keyword(s):

Pregnant Women ◽

Clinical Response ◽

Chagas Disease ◽

Chronic Infection ◽

Significant Proportion ◽

Positive Serology ◽

Congenital Transmission ◽

Mass Migration

Chagas disease is a chronic infection that kills approximately 12,000 people a year. Mass migration of chronically infected and asymptomatic persons has caused globalization of Chagas disease and has made nonvectorial infection, including vertical and blood-borne transmission, more of a threat to human communities than vectorial infection. To control transmission, it is essential to test all pregnant women living in endemic countries and all pregnant women having migrated from, or having lived in, endemic countries. All children born to seropositive mothers should be tested not only within the first month of life but also at ~6 months and ~12 months of age. The diagnosis is made by identification of the parasite in blood before the age of 6 months and by identification of the parasite in blood and/or positive serology after 10 months of age. Follow up for a year is essential as a significant proportion of cases are initially negative and are only detected at a later stage. If the condition is diagnosed and treated early, the clinical response is excellent and the majority of cases are cured.

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Chagas Disease (Trypanosoma cruzi)

10.1093/med/9780190604813.003.0016 ◽

2018 ◽

Author(s):

Jaime Altcheh ◽

Guillermo Moscatelli ◽

Facundo Garcia Bournissen

Keyword(s):

Trypanosoma Cruzi ◽

Chagas Disease ◽

Latin American ◽

Reproductive Age ◽

Child Transmission ◽

Women Of Reproductive Age ◽

Systematic Screening ◽

Primary Means ◽

Means Of Transmission ◽

Mother To Child

Chagas disease (CD), or American trypanosomiasis, is caused by the hemoflagellate parasite Trypanosoma cruzi and has evolved from a regional, Latin American disease to one that is becoming widespread in other parts of the world. Mother-to-child transmission (MTCT) of Chagas disease has become the primary means of transmission of T. cruzi worldwide. Congenital Chagas disease can be prevented by treating women of reproductive age. It is important to develop strategies for the systematic screening of pregnant women for CD, as well as all children born to infected mothers, and also to treat every infected child as early as possible.

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Chagas disease in European countries: the challenge of a surveillance system

Eurosurveillance ◽

10.2807/ese.16.37.19968-en ◽

2011 ◽

Vol 16 (37) ◽

Cited By ~ 122

Author(s):

L Basile ◽

J M Jansá ◽

Y Carlier ◽

D D Salamanca ◽

A Angheben ◽

...

Keyword(s):

Chagas Disease ◽

Latin American ◽

Annual Incidence ◽

European Countries ◽

Undocumented Migrants ◽

Congenital Transmission ◽

Potential Difficulty ◽

Public Health Challenge ◽

Official Sources ◽

Cruzi Infection

A study of aggregate data collected from the literature and official sources was undertaken to estimate expected and observed prevalence of Trypanosoma cruzi infection, annual incidence of congenital transmission and rate of underdiagnosis of Chagas disease among Latin American migrants in the nine European countries with the highest prevalence of Chagas disease. Formal and informal data sources were used to estimate the population from endemic countries resident in Europe in 2009, diagnosed cases of Chagas disease and births from mothers originating from endemic countries. By 2009, 4,290 cases had been diagnosed in Europe, compared with an estimated 68,000 to 122,000 expected cases. The expected prevalence was very high in undocumented migrants (on average 45% of total expected cases) while the observed prevalence rate was 1.3 cases per 1,000 resident migrants from endemic countries. An estimated 20 to 183 babies with congenital Chagas disease are born annually in the study countries. The annual incidence rate of congenital transmission per 1,000 pregnancies in women from endemic countries was between none and three cases. The index of underdiagnosis of T. cruzi infection was between 94% and 96%. Chagas disease is a public health challenge in the studied European countries. Urgent measures need to be taken to detect new cases of congenital transmission and take care of the existing cases with a focus on migrants without legal residency permit and potential difficulty accessing care.

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