Abstract
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. Retrospective quality study using two data 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. 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.
Highlights
We need to improve the program in order to achieve universal Chagas disease (CD) screening in Latin American pregnant women, to enhance CD treatment in postpartum women, and to improve monitoring in exposed newborns through a wellestablished notification and follow-up circuit
Chagas disease (CD) is a chronic parasitic infection caused by the protozoa Trypanosoma cruzi, endemic in 21 countries in continental Latin America
The one-sample Kolmogorov-Smirnov test was used to assess continuous variables; as they were normally distributed, we present them as mean and standard deviation
Summary
Chagas disease (CD) is a chronic parasitic infection caused by the protozoa Trypanosoma cruzi, endemic in 21 countries in continental Latin America. Vector-borne transmission is the main route of contagion in endemic areas, infection can spread via blood transfusion, organ transplantation, orally or from mother to child[1]. Antiparasitic treatment with one of the two approved drugs (benznidazole and nifurtimox) is indicated for acute and congenital CD, reactivated infections, women of childbearing age and chronic disease in children. Treatment has shown to prevent vertical transmission of the infection when administered before pregnancy[5,6]. Chagas disease (CD) is a chronic parasitic disease caused by Trypanosoma cruzi and is endemic to continental Latin America. 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
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