Jara Llenas-García1,2,3, Philip Wikman-Jorgensen2,4, Concepción Gil-Anguita5, Violeta Ramos-Sesma6, Diego Torrús-Tendero7,8,9, Raquel Martínez-Goñi10, Mónica Romero-Nieto2,3,11, Javier García-Abellán2,12, María José Esteban-Giner13, Karenina Antelo14, María Navarro-Cots2,15, Fernando Buñuel2,16, Concepción Amador5, Josefa García-García17, Isabel Gascón2,18, Guillermo Telenti2,12, Encarna Fuentes-Campos19, Ignacio Torres20, Adelina Gimeno-Gascón8,21, María Montserrat Ruíz-García2,22, Miriam Navarro23, José-Manuel Ramos-Rincón3,7,8. 1. Internal Medicine Department, Hospital Vega Baja, Orihuela, Spain. 2. Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain. 3. Clinical Medicine Department, University Miguel Hernández, Elche, Spain. 4. Internal Medicine Department, University Hospital San Juan de Alicante, San Juan de Alicante, Spain. 5. Internal Medicine Department, Hospital Marina Baixa, Villajoyosa, Spain. 6. Internal Medicine Service, HLA Inmaculada Hospital, Granada, Spain. 7. Reference Unit of Imported Diseases and International Health, Alicante General University Hospital, Alicante, Spain. 8. Biomedical and Health Research Institute of Alicante (ISABIAL), Alicante, Spain. 9. Parasitology Area, University Miguel Hernández, Elche, Spain. 10. Internal Medicine Department, University Hospital Vinalopó, Elche, Spain. 11. Internal Medicine Department, Elda General University Hospital, Elda, Spain. 12. Infectious Diseases Unit. Elche General University Hospital, Elche, Spain. 13. Internal Medicine Department, Hospital Virgen de los Lirios, Alcoy, Spain. 14. Internal Medicine Department, Denia Hospital, Denia, Spain. 15. Microbiology Department, Hospital Vega Baja, Orihuela, Spain. 16. Microbiology Department, University Hospital San Juan de Alicante, San Juan de Alicante, Spain. 17. Internal Medicine Department, Torrevieja University Hospital, Torrevieja, Spain. 18. Microbiology Department, Elda General University Hospital, Elda, Spain. 19. Microbiology Department, Hospital Virgen de los Lirios, Alcoy, Spain. 20. Microbiology Department, Denia Hospital, Denia, Spain. 21. Microbiology Department, Alicante General University Hospital, Alicante, Spain. 22. Microbiology Department, Elche General University Hospital, Elche, Spain. 23. Department of Public Health, Science History and Gynaecology, University Miguel Hernández, Elche, Spain.
Abstract
BACKGROUND: 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. METHODOLOGY/PRINCIPAL FINDINGS: 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. CONCLUSIONS/SIGNIFICANCE: 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.
BACKGROUND: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. METHODOLOGY/PRINCIPAL FINDINGS: 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. CONCLUSIONS/SIGNIFICANCE: 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.