Epidemiology of congenital Chagas disease 6 years after implementation of a public health surveillance system, Catalonia, 2010 to 2015

Abstract

Background Chagas disease is endemic in Latin America and affects 8 million people worldwide. In 2010, Catalonia introduced systematic public health surveillance to detect and treat congenital Chagas disease. Aim The objective was to evaluate the health outcomes of the congenital Chagas disease screening programme during the first 6 years (2010–2015) after its introduction in Catalonia. Methods In a surveillance system, we screened pregnant women and newborns and other children of positive mothers, and treated Chagas-positive newborns and children. Diagnosis was confirmed for pregnant women and children with two positive serological tests and for newborns with microhaematocrit and/or PCR at birth or serology at age 9 months. Results From 2010 to 2015, the estimated screening coverage rate increased from 68.4% to 88.6%. In this period, 33,469 pregnant women were tested for Trypanosoma cruzi and 937 positive cases were diagnosed. The overall prevalence was 2.8 cases per 100 pregnancies per year (15.8 in Bolivian women). We followed 82.8% of newborns until serological testing at age 9–12 months and 28 were diagnosed with Chagas disease (congenital transmission rate: 4.17%). Of 518 siblings, 178 (34.3%) were tested and 14 (7.8%) were positive for T. cruzi . Having other children with Chagas disease and the heart clinical form of Chagas disease were maternal risk factors associated with congenital T. cruzi infection (p < 0.05). Conclusion The increased screening coverage rate indicates consolidation of the programme in Catalonia. The rate of Chagas disease congenital transmission in Catalonia is in accordance with the range in non-endemic countries.

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

“…cruzi seroprevalence was somewhat lower than in previous studies where it ranged from 1.5% to 12% [ 19 , 30 – 36 ], probably due to the low percentage of Bolivian women included. In the largest study from Catalonia, the overall prevalence was 2.8 cases per 100 pregnancies per year but reached 15.8 in Bolivian women[ 30 ]. In our region several serological diagnostic tests are used.…”

“…In our study, T. cruzi seroprevalence was somewhat lower than in previous studies where it ranged from 1.5% to 12% [19,[30][31][32][33][34][35][36], probably due to the low percentage of Bolivian women included. In the largest study from Catalonia, the overall prevalence was 2.8 cases per 100…”

“…The absence of improvement in part might be due to the lack of an institutional program surveillance, with no feedback given to the program implementers. On the contrary, the systematic surveillance program in the region of Catalonia concluded that the congenital CD screening program was successful, with an overall coverage rate of 83.5% in 2010–15 and substantial improvements from 2010 (68.4%) to 2015 (88.6%)[ 30 ].…”

“…In the Catalonian study, 82.8% of newborns were followed until serological testing at age 9–12 months. Furthermore, the program tested 34.3% of siblings, with 7.8% of those siblings being positive for CD[ 30 ], illustrating the usefulness of opportunistic screening of other family members during gestational screening programs. Indeed, a cost-efficacy study showed that the most efficient screening strategy for Latin American migrants in Spain would be to screen Latin American mothers, their newborns, and the close relatives of the mothers with a positive serology[ 45 ].…”

Chagas disease in non-endemic settings

“…Learning from examples in Europe,15 the antenatal screening programme must be designed to ensure that babies of detected cases (and their siblings) are followed up, tested, and treated. Screening should also be offered to immunosuppressed patients—particularly people with HIV16 and those undergoing transplantation or cancer chemotherapy—as they may be at risk of reactivation of infection and associated complications.…”