Controlling congenital and paediatric chagas disease through a community health approach with active surveillance and promotion of paediatric awareness

BMC Public Health

Mireia Jané²  Pedro Albajar-Viñas¹  Pilar Ciruela²  Juan Cabezos³  Jordi Gómez i Prat³  Isabel Clavería³  Hakima Ouaarab³  Luca Basile²  Antoni Soriano-Arandes³ 

[1] Department of HIV/AIDS, Tuberculosis, Malaria and Neglected Diseases, Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland;Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Barcelona, Spain;Unitat de Salut Internacional. PROSICS, Programa Especial de Malalties Infeccioses Vall d’Hebron-Drassanes, Barcelona, Spain

关键词: Active surveillance;    Trypanosoma cruzi;    Community health activity;    Congenital chagas disease;   

Others  :  1122916
DOI  :  10.1186/1471-2458-14-1201

 received in 2014-06-20, accepted in 2014-11-10,  发布年份 2014

【 摘 要 】

Background

Chagas disease (CD) is endemic in countries of continental Latin America. Congenital transmission is a major concern worldwide. In 2010, the Public Health Agency of Catalonia (ASPCAT) launched a screening protocol for Trypanosoma cruzi infection in pregnant women and their newborns. In 2012, ASPCAT detected appropriate follow-up of pregnant women but incomplete information about their offspring.

Methods

The PROSICS community health team carried out active surveillance and community health action in target populations. These activities included active case searches, group awareness workshops and visualization campaigns as well as investigation of all lost children born from pregnant women with CD and their families.

Results

Overall, 42/179 (23.5%) cases were included in the study: 35/42 (83.3%) children were born in Hospitalet de Llobregat (Catalonia, Spain); 4/42 (16.7%) were born in Latin America; two were miscarried and one was stillborn. The mean age of pregnant women was 31.3 years (SD 5.52; range: 21–44): 90.5% were Bolivian, of whom 74% were diagnosed with CD during pregnancy. Of the 35 newborns, 31 were recovered by community health action; 12/31 were correctly controlled at Hospitalet de Llobregat and 19/31 were controlled at a primary health centre. Of these 19 (73.7%) cases, 14 were not tested for CD by family paediatricians and were recovered by the PROSICS community health team. Finally, two (6.9%) of the 29 newborns tested with serology were positive.

Conclusions

It is essential to implement active surveillance, education and information activities at paediatric primary care and community levels to avoid the loss of CD-infected mothers and their newborns. Training sessions addressed to paediatricians and other involved health professionals would consolidate surveillance and care reference circuits, improving the control of congenital CD.

【 授权许可】

   
2014 Soriano-Arandes et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Prata A: Clinical and epidemiological aspects of Chagas disease. Lancet Infect Dis 2009, 1:92-100.
• [2]PAHO: Reporte Sobre la Enfermedad de Chagas. In Reporte del Grupo de Trabajo Científico Sobre la Enfermedad de Chagas 17-20/04/2005. Edited by Guhl F, Lazdins-Helds JK. Buenos Aires: Argentina: World Health Organization on behalf of the Special Programme for Research and Training in Tropical Diseases, 2007; 2005. actualizado en Julio 2007
• [3]World Health Organization: Working to Overcome the Global Impact of Neglected Tropical Diseases: First WHO Report on Neglected Tropical Diseases. Geneva: World Health Organization; 2010. WHO/HTM/NTD/2010.1
• [4]World Health Organization: Sustaining the Drive to Overcome the Global Impact of Neglected Tropical Diseases: Second WHO Report on Neglected Tropical Diseases. Geneva: World Health Organization; 2013. WHO/HTM/NTD/2013.1
• [5]Schofield CJ, Jannin J, Salvatella R: The future of Chagas disease control. Trends Parasitol 2006, 22:583-588.
• [6]Bern C, Montgomery SP, Herwaldt BL, Rassi A Jr, Marin-Neto JA, Dantas RO, Maguire JH, Acquatella H, Morillo C, Kirchhoff LV, Gilman RH, Reyes PA, Salvatella R, Moore AC: Evaluation and treatment of Chagas disease in the United States: a systematic review. JAMA 2007, 298:2171-2181.
• [7]Coura JR, Vinas PA: Chagas disease: a new worldwide challenge. Nature 2010, 465(n7301_supp):S6-S7.
• [8]Ministerio de Sanidad y Consumo –España: Real Decreto 1088/2005 por el que se establecen los requisitos técnicos y condiciones mínimas de la hemodonación y de los centros y servicios de transfusión. Boletín oficial del estado 2005, 225:31288-31304.
• [9]Carlier Y, Torrico F, Sosa-Estani S, Russomando G, Luquetti A, Freilij H, Albajar Vinas P: Congenital Chagas disease: recommendations for diagnosis, treatment and control of newborns, siblings and pregnant women. PLoS Negl Trop Dis 2011, 5(10):e1250. doi:10.1371/journal.pntd.0001250
• [10]Howard EJ, Xiong X, Carlier Y, Sosa-Estani S, Buekens P: Frequency of the congenital transmission of Trypanosoma cruzi: a systematic review and meta-analysis. BJOG 2014, 121:22-33.
• [11]Riera C, Guarro A, Kassab HE, Jorba JM, Castro M, Angrill R, Gállego M, Fisa R, Martin C, Lobato A, Portús M: Congenital transmission of Trypanosoma cruzi in Europe (Spain): a case report. Am J Trop Med Hyg 2006, 75:1078-1081.
• [12]Muñoz J, Coll O, Juncosa T, Vergés M, del Pino M, Fumado V, Bosch J, Posada EJ, Hernandez S, Fisa R, Boguña JM, Gállego M, Sanz S, Portús M, Gascón J: Prevalence and vertical transmission of Trypanosoma cruzi infection among pregnant Latin American women attending 2 maternity clinics in Barcelona, Spain. Clin Infect Dis 2009, 48:1736-1740.
• [13]Public Health Agency of Catalonia: Protocol for Screening and Diagnosing Chagas Disease in Pregnant Latin American and Their Newborns. Barcelona: Generalitat de Catalunya; 2010. http://canalsalut.gencat.cat/web/.content/home_canal_salut/professionals/temes_de_salut/chagas/documents/arxius/chagas_angles.pdf webcite; accessed October 2014
• [14]Basile L, Oliveira I, Ciruela P, Plasencia A: Working Group for developing the Catalonian screening programme for congenital transmission of Chagas disease. The current screening programme for congenital transmission of Chagas disease in Catalonia, Spain. Euro Surveill 2011, 16(38):19972.
• [15]Public Health Agency of Catalonia: Vigilància Epidemiològica del Protocol de Cribratge i Diagnostic de la Malaltia de Chagas en Dones Embarassades Llatinoamericanes i els Seus Nadons. Informe Anual 2010. Barcelona: Generalitat de Catalunya; 2010. http://canalsalut.gencat.cat/web/.content/home_canal_salut/professionals/temes_de_salut/chagas/documents/arxius/informe_anual_2010_chagas.pdf webcite; accessed October 2014
• [16]Institut d’estadística de Catalunya (IDESCAT): Població Estrangera per Municipis, Catalunya 2013 [Internet]. Barcelona: IDESCAT; 2014. Available from: http://www.idescat.cat/pub/?id=aec&n=26&lang=en webcite; accessed October 2014
• [17]Sicuri E, Muñoz J, Pinazo MJ, Posada E, Sanchez J, Alonso PL, Gascon J: Economic evaluation of Chagas disease screening of pregnant Latin American women and of their infants in a non endemic area. Acta Trop 2011, 118(2):110-117.
• [18]Freilij H, Altcheh J: Congenital Chagas’ disease: diagnostic and clinical aspects. Clin Infect Dis 1995, 21:551-555.
• [19]Schijman AG, Altcheh J, Burgos JM, Biancardi M, Bisio M, Levin MJ, Freilij H: Aetiological treatment of congenital Chagas’ disease diagnosed and monitored by the polymerase chain reaction. J Antimicrob Chemother 2003, 52:441-449.
• [20]Neto EC, Rubin R, Schulte J, Giugliani R: Newborn screening for congenital infectious diseases. Emerg Infect Dis 2004, 10:1068-1073.
• [21]Zulantay I, Apt W, Ramos D, Godoy L, Valencia C, Molina M, Sepúlveda E, Thieme P, Martínez G, Corral G: The epidemiological relevance of family study in Chagas disease. PLoS Negl Trop Dis 2013, 7(2):e1959.
• [22]Singh P, Choksh DA: Community health workers – a local solution to a global problem. N Engl J Med 2013, 369:894-896.
• [23]Ospina JE, Orcau A, Millet JP, Sánchez F, Casals M, Caylà JA: Community health workers improve contract tracing among immigrants with tuberculosis in Barcelona. BMC Public Health 2012, 12:158. BioMed Central Full Text
• [24]Ventura-Garcia L, Roura M, Pell C, Posada E, Gascón J, Aldasoro E, Muñoz J, Pool R: Socio-cultural aspects of Chagas disease: a systematic review of qualitative research. PLoS Negl Trop Dis 2013, 7(9):e2410. doi:10.1371/journal.pntd.0002410
• [25]Briceño-León R, Galván JM: The social determinants of Chagas disease and the transformations of Latin America. Mem Inst Oswaldo Cruz 2007, 102(Suppl. I):109-112.