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

Abstract

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.

A Questionnaire Integrated with the Digital Medical Record Improved the Coverage of a Control Program for Congenital Chagas Disease in Tuscany, Italy

“…However, the present study shows that screening coverage has only reached “sufficient” levels in recent years in Careggi University Hospital. Similar data come from the province of Alicante, where tests were performed in 39.8% of deliveries by women at risk between 2014 and 2018 despite the regional recommendation of universal screening for Chagas disease during pregnancy in women coming from endemic countries [ 32 ]. Of note, the main reasons for low screening coverage in this case were attributed to forgetfulness errors by midwives and obstetricians and lack of professional training on the screening program, together with a lack of knowledge of CD and of the possibility of its vertical transmission [ 32 ].…”

Community-based screening of Chagas disease among Latin American migrants in a non-endemic country: an observational study

“…These data are consistent with other published studies, which report similar percentages to ours in at-risk populations, both in endemic and non-endemic countries [ 17 , 44 , 48 ]. The vertical transmission route, which is the most relevant in non-endemic areas, has prompted governments to establish protocols for the early detection and treatment of neonatal infections [ 49 – 52 ], although much work remains to be done in this context [ 28 , 51 – 53 ].…”

Chagas Disease-Related Mortality in Spain, 1997 to 2018

“…Migration in women of childbearing age from Latin America may spread CD to non-endemic areas through vertical transmission [ 40 ]. If CD is diagnosed during pregnancy, the transmission of T. cruzi to the child cannot be prevented, so early diagnosis in newborns is essential for administering appropriate treatment [ 40 , 41 ]. In Spain, serological screening of T. cruzi infection in pregnant women from Latin American is not systematically carried out, but depends on each autonomous community; some regions have implemented prenatal screening programs since 2007 [ 42 , 43 ].…”