A global systematic review of Chagas disease prevalence among migrants

Abstract

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.

Trypanosoma cruzi I genotype among isolates from patients with chronic Chagas disease followed at the Evandro Chagas National Institute of Infectious Diseases (FIOCRUZ, Brazil)

“…However, the international migration, generally of asymptomatic patients, from Latin American to non-endemic countries of North America (United States and Canada), Western Pacific region (mainly Japan and Australia), and Europe (Spain, Portugal, France, and other countries), has spread the Chagas disease by non-vectorial routes. Nowadays, this disease has become an emerging global health problem [3][4][5] .…”

Epidemiology of Chagas Disease in Non-Endemic European Countries

“…The general prevalence was estimated to be 35 cases per 100,000 habitants, with a substantial absence of the disease in Eastern countries to 307 cases/100,000 inhabitants in Spain, 28 cases/100,000 inhabitants in Italy, 25 in Sweden and Portugal and 22 in Switzerland and the Netherlands. 7,8 Limited published evidence on the prevalence of CD among Bolivians in Europe revealed a prevalence ranging from 6.8 to 25%, the lowest being the Netherlands and the highest in Spain. Also, when compared to PAHO estimates of national prevalence rates the pooled prevalence of Chagas disease in migrants from Bolivia and from Paraguay living in Europe was significantly higher (prevalence ratio 2.67 and 2.17 respectively).…”

“…9,10 In France live 76,841 migrants of whom are an estimated 1311 and 1712 cases of CD and the United Kingdom has 59,189 migrants and this suggests that the number of CD carriers would be between 1,006 and 1,324. 7,8 Strasen et al recently published an estimate of affected people in Europe, indicating that a minimum of about 14,000 to a maximum of about 180,000 cases would be present in Europe. The general prevalence was estimated to be 35 cases per 100,000 habitants, with a substantial absence of the disease in Eastern countries to 307 cases/100,000 inhabitants in Spain, 28 cases/100,000 inhabitants in Italy, 25 in Sweden and Portugal and 22 in Switzerland and the Netherlands.…”

“…Also, when compared to PAHO estimates of national prevalence rates the pooled prevalence of Chagas disease in migrants from Bolivia and from Paraguay living in Europe was significantly higher (prevalence ratio 2.67 and 2.17 respectively). 7,8 Nevertheles, this initial distribution is changing due to the economic crisis and currently there is a redistribution or dispersion of LA migration, especially from South Europe to other European countries. Moreover, quite often migrants move to three or more countries in short periods of time.…”

“…About 1.4 million of these were in Spain, where 42,000 people (of which 25,000 were women of childbearing age) are estimated to be infected with T cruzi. 7,8 Italy is the second country in Europe, with around 390,000 people proceeding from endemic areas and an estimated prevalence rate ranging between 1.7 and 3.1%. 9,10 In France live 76,841 migrants of whom are an estimated 1311 and 1712 cases of CD and the United Kingdom has 59,189 migrants and this suggests that the number of CD carriers would be between 1,006 and 1,324.…”