Chagas disease in Latin American pregnant immigrants: experience in a non-endemic country

Ramos, José Manuel; Milla, Alfredo Salvador; Rodríguez, Juan C.; López-Chejade, Paulo; Flores, María; Rodríguez, José Manuel Vázquez; Gutiérrez, Félix

doi:10.1007/s00404-011-2081-9

Cited by 20 publications

(24 citation statements)

References 18 publications

(19 reference statements)

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“…Within Spain, 7 of the 12 studies with prevalence estimates of Chagas disease in migrants were similar to the highest countrywide estimate (Del Pino and Coll, 2006; Giménez-Martí et al, 2006; Munoz-Vilches et al, 2012; Paricio-Talayero et al, 2008; Roca et al, 2011; Santiago et al, 2012; Soriano Arandes et al, 2009), two were lower(Piron et al, 2008; Ramos et al, 2012a), and three(Avila Arzanegui et al, 2013; Barona-Vilar et al, 2012; Lucas and Barba, 2009) were higher (Figure 2). One additional study was conducted in Spain, but its results are not summarized here because it was a non-representative sample of only Bolivian and Paraguayan participants (Ramos et al, 2012b).…”

Section: Resultssupporting

confidence: 57%

“…Of these studies, 11 reported higher prevalence estimates as compared to PAHO (Barona-Vilar et al, 2012; Jackson et al, 2010; Jackson et al, 2009; Lucas and Barba, 2009; Paricio-Talayero et al, 2008; Roca et al, 2011) and 6 had similar estimates (El Ghouzzi et al, 2010; Ramos et al, 2012a; Ramos et al, 2012b). For Paraguayan migrants, 3 studies had similar prevalence estimates to countrywide estimates (Ramos et al, 2012a; Ramos et al, 2012b), while 3 were higher (Figure 4) (Avila Arzanegui et al, 2013; Barona-Vilar et al, 2012; Lucas and Barba, 2009). However, it should be noted that one sample that was higher was only based on 6 individuals, and thus was very imprecise (95% CI: 3.0–56.4) (Lucas and Barba, 2009).…”

Section: Resultsmentioning

confidence: 99%

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A global systematic review of Chagas disease prevalence among migrants

et al. 2016

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Human migration has been identified as a potential factor for increased Chagas disease risk and has transformed the disease from a Latin American problem to a global one. We conducted a systematic review of the scientific literature between 2004–2014 in order to: summarize current seroprevalence estimates of Chagas disease among Latin American migrants, in both endemic and non-endemic settings; compare seroprevalence estimates in migrants to countrywide prevalence estimates; and identify risk factors for Chagas disease among migrants. A total of 320 studies were screened and 23 studies were included. We found evidence that the prevalence of Chagas disease is higher than expected in some migrant groups and that reliance on blood donor screening prevalence underestimates the burden of disease. Overall there is a dearth of high quality epidemiologic studies on the prevalence of Chagas in migrants, especially among intra-regional migrants within Latin America. Given that the disease cannot likely be eradicated, improved surveillance and reporting is vital to continuing control efforts. More accurate health surveillance of both Latin American migrants and the Chagas disease burden will help countries appropriately scale up their response to this chronic disease. Overall, improved estimates of Chagas disease among migrants would likely serve to highlight the real need for better screening, diagnostics, and treatment of individuals living with the disease.

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Section: Resultssupporting

confidence: 57%

Section: Resultsmentioning

confidence: 99%

A global systematic review of Chagas disease prevalence among migrants

et al. 2016

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“…Regarding the child-bearing age women (10–49 years) analyzed in the present study, the described prevalence of 6.1% [27] was higher than that described by Munhoz et al [13] but lower than those registered in Europe (Tables 1 and 2) [10,11,12,14,17,23,24]. Moreover, in recent and previous publications, a higher prevalence was registered for general Bolivian immigrants in European countries [5,12, Table 1] compared with São Paulo [27].…”

Section: Discussioncontrasting

confidence: 65%

Interdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of São Paulo

et al. 2017

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Background/MethodsIn a pioneering cross-sectional study among Bolivian immigrants in the city of São Paulo, Brazil, the epidemiological profile, clinical manifestations and morbidity of Chagas disease were described. The feasibility of the management of Chagas disease at primary healthcare clinics using a biomedical and psychosocial interdisciplinary approach was also tested. Previously, a Trypanosoma cruzi (T. cruzi) infection rate of 4.4% among 633 immigrants was reported. The samples were screened using two commercial enzyme-linked immunoassay (ELISA) tests generated with epimastigote antigens, and those with discrepant or seropositive results were analyzed by confirmatory tests: indirect immunofluorescence (IFI), TESA-blot and a commercial recombinant ELISA. PCR and blood cultures were performed in seropositive patients.ResultsThe majority of the 28 seropositive patients were women, of whom 88.89% were of child-bearing age. The predominant clinical forms of Chagas disease were the indeterminate and atypical cardiac forms. Less than 50% received the recommended antiparasitic treatment of benznidazole. An interdisciplinary team was centered on primary healthcare physicians who applied guidelines for the management of patients. Infectologists, cardiologists, pediatricians and other specialists acted as reference professionals. Confirmatory serology and molecular biology tests, as well as echocardiography, Holter and other tests, were performed for the assessment of affected organs in secondary healthcare centers. The published high performance of two commercial ELISA tests was not confirmed.ConclusionAn interdisciplinary approach including antiparasitic treatment is feasible at the primary healthcare level for the management of Chagas disease in Bolivian immigrants. The itinerant feature of immigration was associated with a lack of adherence to antiparasitic treatment and was considered a main challenge for the clinical management of this population. This approach is recommended for management of the infected population in endemic and nonendemic areas, although different strategies are needed depending on the severity of the disease and the structure of the healthcare system.

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“…Cancino 2015 [32] Frank 1997 [24] Paricio-Talayero 2008 [43] Angheben 2011 [23] Martínez 2009 [38] Angheben 2011 [23] Roca 2011 [9] Ramos 2012 [29] Study Perez-Ayala 2010 [6] Angheben 2011 [23] Soriano 2009 [31] Avila Arzanegui 2013 [36] Barona-Vilar 2012 [37] O'Brien 2013 [35] Perez-Molina 2011 [28] Otero…”

Section: Muñoz-vilches 2012 [40]mentioning

confidence: 99%

Screening for Trypanosoma cruzi infection in immigrants and refugees: Systematic review and recommendations from the Spanish Society of Infectious Diseases and Clinical Microbiology

et al. 2020

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Background: Chagas disease has spread beyond its original borders on the American continent with migration. It can be transmitted from mother to child, through organ transplantation and transfusion of blood and blood products. It is necessary to determine when to screen for this infection. Aim: Our objective was to evaluate the appropriateness of screening for Trypanosoma cruzi infection in Latin American migrants and their descendants. Methods: We reviewed the literature using rigorous criteria. The quality of evidence was ranked according to the GRADE classification. An evidence to decision framework was adopted to provide information on the most relevant aspects necessary to formulate recommendations. Results: The 33 studies evaluated revealed a prevalence of T. cruzi infection among Latin American migrants in Europe of 6.08% (95% confidence interval (CI): 3.24-9.69; 28 studies). Vertical transmission occurred in three of 100 live births (95% CI: 1-6; 13 studies). The prevalence of cardiovascular disease was 19% (95% CI: 13-27; nine studies), including only 1% severe cardiac events (95% CI: 0-2; 11 studies). The overall quality of evidence was low because of risk of bias in the studies and considerable heterogeneity of the evaluated populations. The recommendations took into account economic studies on the value of screening strategies and studies on acceptability of screening and knowledge of the disease in the affected population. Conclusions: We identified five situations in which screening for T. cruzi infection is indicated. We recommend screening persons from endemic areas and children of mothers from these areas.

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Chagas disease in Latin American pregnant immigrants: experience in a non-endemic country

Abstract: Seroprevalence of T. cruzi infection in Latin American pregnant women coming from Bolivia and Paraguay is high. Those women should be screened for T. cruzi to control mother-to-child transmission in non-endemic areas.

Cited by 20 publications

References 18 publications

A global systematic review of Chagas disease prevalence among migrants

A global systematic review of Chagas disease prevalence among migrants

Interdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of São Paulo

Screening for Trypanosoma cruzi infection in immigrants and refugees: Systematic review and recommendations from the Spanish Society of Infectious Diseases and Clinical Microbiology

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