Elsevier

Acta Tropica

Volume 115, Issues 1–2, July–August 2010, Pages 22-27
Acta Tropica

Chagas disease in Spain, the United States and other non-endemic countries

https://doi.org/10.1016/j.actatropica.2009.07.019Get rights and content

Abstract

Due to recent trends in migration, there are millions of people from Chagas disease-endemic countries now living in North America, Europe, Australia and Japan, including thousands of people with Trypanosoma cruzi infection. Most infected individuals are not aware of their status. Congenital, transfusion- and/or transplant-associated transmission has been documented in the United States, Spain, Canada and Switzerland; most instances likely go undetected. High priorities include the implementation of appropriate screening, evaluation and clinical management, and better assessment of the true burden associated with this disease.

Introduction

American trypanosomiasis or Chagas disease is a zoonosis endemic to Latin America that currently affects around 8–10 million people (Organización Panamericana De La Salud, 2006). Nearly 60 million people live in areas with vector-borne transmission risk and the disease causes an estimated 14,000 deaths per year (Schofield et al., 2006, Senior, 2007). Historically a disease of poor, rural populations, recent trends in migration have brought Trypanosoma cruzi infection to Latin American cities, and far beyond the borders of Latin America (Gurtler et al., 2003, Gascon, 2005).

Section snippets

The disease

Vectorial transmission of T. cruzi occurs only in endemic countries of the Western Hemisphere. The haematophagous triatomine insect vector deposits excreta containing the parasite on the host while taking a blood meal; inoculation of the parasite into the bite-wound, conjunctivae or mucus membranes can result in T. cruzi infection. Recently, oral transmission has been reported in several outbreaks (Dias et al., 2008). Other routes such as blood transfusion, organ transplants and vertical

Epidemiology in non-endemic countries

Chagas disease arrived in non-endemic countries with migrants from Latin America, and the epidemiology reflects differences in the origins of immigrants and distribution of the infection in their countries of birth. The United States continues to be the most common country of destination, but since tightening of U.S. immigration regulations after the attacks of 9/11/2001, the number of Latin American immigrants in Europe has more than doubled, from an estimated 910,402 in 2001 to more than 2

Chagas control in endemic countries and effect on the epidemiology in non-endemic countries

In Latin America, vector control and blood bank screening have greatly expanded in the last 15 years (Dias et al., 2002, Schofield et al., 2006). PAHO has certified elimination of T. cruzi transmission by domestic vectors in Uruguay (1997), Chile (1999) and Brazil (2006) (Schofield et al., 2006, Pan American Health Organization, 2006). Transmission has decreased substantially, leading to lower infection rates in children and young adults, and steep declines in the number of acute infections (

Chagas disease in non-endemic countries: current challenges

In the absence of vectorial transmission, congenital and blood-borne routes take on proportionately more importance. Several cases of congenital T. cruzi infection have been reported in Spain, and one in Switzerland (Muñoz et al., 2009, Muñoz et al., 2007, Riera et al., 2006, Flores-Chavez et al., 2008a, Jackson et al., 2008). Raising awareness of the potential for congenital T. cruzi transmission is of particular importance in Spain, where more than 60% of Latin American immigrants are women (

Future directions and research gaps

Because Chagas disease has only been recognized recently as a public health issue in non-endemic countries, health care providers and policy makers lack both technical knowledge and awareness of the disease. Better disease burden estimates will require better data on endemic country seroprevalence, as well as direct assessments in high risk populations in non-endemic countries. Rational strategies need to be developed for screening and control in blood banks, organ procurement agencies and for

Acknowledgements

We are grateful to Alessandro Bortoloni (Italy), Yves Jackson (Switzerland), Michel Develoux (France), and Jorge Seixas (Portugal) for providing demographic and health system data.

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      Citation Excerpt :

      Chagas disease is a parasitic zoonosis which constitutes a severe public health problem and is endemic in 21 Latin American countries.1 It is estimated that between six and eight million people are infected with Trypanosoma cruzi (T cruzi), with an additional 65 million at risk of acquiring the disease by vector-borne transmission, blood or congenital transmission, or food-borne transmission.2,3 Chagas disease has both an acute, indeterminate, and chronic phase.

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