Prevalence of Chagas Disease in Latin-American Migrants Living in Europe: A Systematic Review and Meta-analysis

Abstract

BackgroundFew studies have assessed the burden of Chagas disease in non-endemic countries and most of them are based on prevalence estimates from Latin American (LA) countries that likely differ from the prevalence in migrants living in Europe. The aim of this study was to systematically review the existing data informing current understanding of the prevalence of Chagas disease in LA migrants living in European countries.MethodsWe conducted a systematic review and meta-analysis of studies reporting prevalence of Chagas disease in European countries belonging to the European Union (EU) before 2004 in accordance with the MOOSE guidelines and based on the database sources MEDLINE and Global Health. No restrictions were placed on study date, study design or language of publication. The pooled prevalence was estimated using random effect models based on DerSimonian & Laird method.ResultsWe identified 18 studies conducted in five European countries. The random effect pooled prevalence was 4.2% (95%CI:2.2-6.7%); and the heterogeneity of Chagas disease prevalence among studies was high (I2 = 97%,p<0.001). Migrants from Bolivia had the highest prevalence of Chagas disease (18.1%, 95%CI:13.9–22.7%).ConclusionsPrevalence of Chagas in LA migrants living in Europe is high, particularly in migrants from Bolivia and Paraguay. Data are highly heterogeneous dependent upon country of origin and within studies of migrants from the same country of origin. Country-specific prevalence differs from the estimates available from LA countries. Our meta-analysis provides prevalence estimates of Chagas disease that should be used to estimate the burden of disease in European countries.

Cost-effectiveness of Chagas disease screening in Latin American migrants at primary health-care centres in Europe: a Markov model analysis

“…The cost-effectiveness reported in this study is based on the pooled Chagas disease prevalence of 4·2% estimated for Latin American migrants in Europe in a recent metaanalysis. 14 The high heterogeneity of prevalence in Latin American migrants from different countries, and even different regions within each country, complicates the interpretation of our results. For example, Chagas disease is more prevalent in migrants from Bolivia and Paraguay than from Brazil and Peru, and prevalence rates also vary by host country depending on the origin of migrants.…”

“…The x axis represents the QALYs gained by the option test in comparison with the no-test option, whereas the y axis represents the incremental costs. All the simulation dots are situated below and to the right of the threshold limit (yellow line on appendix p 14) indicating that the test option, in comparison with the no-test option, is cost-effective.…”

“…14 The pooled prevalence of Chagas disease by country of origin among Latin American migrants in European countries is summarised in the appendix (p 1). Because the meta-analysis involved studies from France, Germany, Italy, Switzerland, and Spain, only costs from these five countries were included in this economic evaluation.…”

“…The model started with a target population of 100 000 Latin American individuals from Chagas diseaseendemic countries, and 4·2% (95% CI 2·2-6·8) were assumed to be infected with T cruzi. 14 The first year-cycle of the model (year 0) starts with parameter values taken from the study by Salvador and colleagues, 17 indicating that 85·8% of individuals infected with T cruzi were asymptomatic and that 14·1% of asymptomatic patients were in the cardiac form, whereas the remainder were in the indeterminate form. 17 The mean age of the population was set at 35 years.…”

Manejo integrado de los riesgos ambientales y el control de vectores: una nueva propuesta para la prevención sostenible y el control oportuno de las enfermedades transmitidas por vectores

“…El impacto de la enfermedad de Chagas fuera de la América endémica se ha dejado sentir en Europa, donde se estima que hay de 68.000 a 120.000 personas que la padecen (8).…”