Abstract
BackgroundIn Mexico, estimates of Chagas disease prevalence and burden vary widely. Updating surveillance data is therefore an important priority to ensure that Chagas disease does not remain a barrier to the development of Mexico's most vulnerable populations.Methodology/Principal findingsThe aim of this systematic review and meta-analysis was to analyze the literature on epidemiological surveys to estimate Chagas disease prevalence and burden in Mexico, during the period 2006 to 2017. A total of 2,764 articles were screened and 36 were retained for the final analysis. Epidemiological surveys have been performed in most of Mexico, but with variable study scale and geographic coverage. Based on studies reporting confirmed cases (i.e. using at least 2 serological tests), and taking into account the differences in sample sizes, the national estimated seroprevalence of Trypanosoma cruzi infection was 3.38% [95%CI 2.59–4.16], suggesting that there are 4.06 million cases in Mexico. Studies focused on pregnant women, which may transmit the parasite to their newborn during pregnancy, reported an estimated seroprevalence of 2.21% [95%CI 1.46–2.96], suggesting that there are 50,675 births from T. cruzi infected pregnant women per year, and 3,193 cases of congenitally infected newborns per year. Children under 18 years had an estimated seropositivity rate of 1.51% [95%CI 0.77–2.25], which indicate ongoing transmission. Cases of T. cruzi infection in blood donors have also been reported in most states, with a national estimated seroprevalence of 0.55% [95%CI 0.43–0.66].Conclusions/SignificanceOur analysis suggests a disease burden for T. cruzi infection higher than previously recognized, highlighting the urgency of establishing Chagas disease surveillance and control as a key national public health priority in Mexico, to ensure that it does not remain a major barrier to the economic and social development of the country's most vulnerable populations.
Highlights
The presence of T. cruzi infection in specific subpopulations such as pregnant women, children and blood donors informs on specific risks of infection and calls for the implementation of well-established control interventions
Chagas disease or American trypanosomiasis is an infection caused by the protozoan parasite Trypanosoma cruzi, which is mainly transmitted to humans and other mammals through the contaminated feces of hematophagous bugs called triatomines
Two studies were based on a single test and when considering only the studies in which at least 2 serological tests had been performed (26 studies), cases had been confirmed as currently recommended by the World Health Organization (WHO) for an accurate identification of cases, the national estimated seroprevalence was 3.38% [95%CI 2.59–4.16], with seroprevalences varying between 0.21% and 12.01% depending on the state (Fig 5)
Summary
Chagas disease or American trypanosomiasis is an infection caused by the protozoan parasite Trypanosoma cruzi, which is mainly transmitted to humans and other mammals through the contaminated feces of hematophagous bugs called triatomines (family Reduviidae). It can be spread via non-vectorial routes, such as blood transfusion, congenital transmission, organ transplantation, ingestion of food and beverages contaminated with T. cruzi, or laboratory accidents [1]. Some patients may suffer from digestive, neurological or multiple alterations This disease, classified by the World Health Organization (WHO) within the group of Neglected Tropical Diseases, is a major public health problem in Latin America where it is estimated that 6 to 7 million people are currently infected [1]. Updating surveillance data is an important priority to ensure that Chagas disease does not remain a barrier to the development of Mexico’s most vulnerable populations
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