-
Epidemiology of congenital Chagas disease 6 years after implementation of a public health surveillance system, Catalonia, 2010 to 2015
- Luca Basile1 , Pilar Ciruela1,2 , Ana Requena-Méndez3 , Mª José Vidal1 , Eva Dopico4 , Andrea Martín-Nalda5 , Elena Sulleiro6 , Joaquim Gascon3 , Mireia Jané1,2 , the Working Group of Congenital Chagas disease in Catalonia7
-
View Affiliations Hide AffiliationsAffiliations: 1 Public Health Agency of Catalonia, Barcelona, Spain 2 CIBER Epidemiology and Public Health CIBERESP, Carlos III Health Institute, Madrid, Spain 3 Barcelona Institute for Global Health (ISGlobal), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain 4 Laboratori Clínic de l'Hospitalet, Hospitalet de Llobregat, Barcelona, Spain 5 Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain 6 Microbiology Department, Hospital Universitari Vall d'Hebron (HUVH), PROSICS Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain 7 The members of the network are listed at the end of the articleLuca Basilechagas gencat.cat
-
View Citation Hide Citation
Citation style for this article: Basile Luca, Ciruela Pilar, Requena-Méndez Ana, Vidal Mª José, Dopico Eva, Martín-Nalda Andrea, Sulleiro Elena, Gascon Joaquim, Jané Mireia, the Working Group of Congenital Chagas disease in Catalonia. Epidemiology of congenital Chagas disease 6 years after implementation of a public health surveillance system, Catalonia, 2010 to 2015. Euro Surveill. 2019;24(26):pii=1900011. https://doi.org/10.2807/1560-7917.ES.2019.24.26.19-00011 Received: 21 Dec 2018; Accepted: 02 Apr 2019
Abstract
Chagas disease is endemic in Latin America and affects 8 million people worldwide. In 2010, Catalonia introduced systematic public health surveillance to detect and treat congenital Chagas disease.
The objective was to evaluate the health outcomes of the congenital Chagas disease screening programme during the first 6 years (2010–2015) after its introduction in Catalonia.
In a surveillance system, we screened pregnant women and newborns and other children of positive mothers, and treated Chagas-positive newborns and children. Diagnosis was confirmed for pregnant women and children with two positive serological tests and for newborns with microhaematocrit and/or PCR at birth or serology at age 9 months.
From 2010 to 2015, the estimated screening coverage rate increased from 68.4% to 88.6%. In this period, 33,469 pregnant women were tested for Trypanosoma cruzi and 937 positive cases were diagnosed. The overall prevalence was 2.8 cases per 100 pregnancies per year (15.8 in Bolivian women). We followed 82.8% of newborns until serological testing at age 9–12 months and 28 were diagnosed with Chagas disease (congenital transmission rate: 4.17%). Of 518 siblings, 178 (34.3%) were tested and 14 (7.8%) were positive for T. cruzi. Having other children with Chagas disease and the heart clinical form of Chagas disease were maternal risk factors associated with congenital T. cruzi infection (p < 0.05).
The increased screening coverage rate indicates consolidation of the programme in Catalonia. The rate of Chagas disease congenital transmission in Catalonia is in accordance with the range in non-endemic countries.
Article metrics loading...
Full text loading...
References
-
WHO Expert Committee. Control of Chagas disease. World Health Organ Tech Rep Ser. 2002;905:i-vi, 1-109, back cover. PMID: 12092045
-
Silveira AC, Rojas de Arias A, Segura E, Guillén G, Russomando G, Schenone H, et al. El control de la enfermedad de Chagas en los países del Cono Sur de América. Historia de una iniciativa internacional 1991/2001. [The control of Chagas disease in the countries of the Southern Cone of America. History of an international initiative 1991/2001]. Washington: Pan American Health Organization; 2002. Spanish. Available from: http://www1.paho.org/spanish/ad/dpc/cd/dch-historia-incosur.PDF
-
Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388-402. https://doi.org/10.1016/S0140-6736(10)60061-X PMID: 20399979
-
Prata A. Clinical and epidemiological aspects of Chagas disease. Lancet Infect Dis. 2001;1(2):92-100. https://doi.org/10.1016/S1473-3099(01)00065-2 PMID: 11871482
-
Pinazo MJ, Lacima G, Elizalde JI, Posada EJ, Gimeno F, Aldasoro E, et al. Characterization of digestive involvement in patients with chronic T. cruzi infection in Barcelona, Spain. PLoS Negl Trop Dis. 2014;8(8):e3105. https://doi.org/10.1371/journal.pntd.0003105 PMID: 25144648
-
Muñoz J, Gómez i Prat J, Gállego M, Gimeno F, Treviño B, López-Chejade P, et al. Clinical profile of Trypanosoma cruzi infection in a non-endemic setting: immigration and Chagas disease in Barcelona (Spain). Acta Trop. 2009;111(1):51-5. https://doi.org/10.1016/j.actatropica.2009.02.005 PMID: 19426663
-
Schmunis GA, Yadon ZE. Chagas disease: a Latin American health problem becoming a world health problem. Acta Trop. 2010;115(1-2):14-21. https://doi.org/10.1016/j.actatropica.2009.11.003 PMID: 19932071
-
Basile L, Jansa JM, Carlier Y, Salamanca DD, Angheben A, Bartoloni A, et al. Chagas disease in European countries: the challenge of a surveillance system. Euro Surveill. 2011;16(37):19968. PMID: 21944556
-
Requena-Méndez A, Aldasoro E, de Lazzari E, Sicuri E, Brown M, Moore DA, et al. Prevalence of Chagas disease in Latin-American migrants living in Europe: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2015;9(2):e0003540. https://doi.org/10.1371/journal.pntd.0003540 PMID: 25680190
-
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(1):22-33. https://doi.org/10.1111/1471-0528.12396 PMID: 23924273
-
Requena-Méndez A, Albajar-Viñas P, Angheben A, Chiodini P, Gascón J, Muñoz J, et al. Health policies to control Chagas disease transmission in European countries. PLoS Negl Trop Dis. 2014;8(10):e3245. https://doi.org/10.1371/journal.pntd.0003245 PMID: 25357193
-
Oliveira I, Torrico F, Muñoz J, Gascon J. Congenital transmission of Chagas disease: a clinical approach. Expert Rev Anti Infect Ther. 2010;8(8):945-56. https://doi.org/10.1586/eri.10.74 PMID: 20695749
-
Carlier Y, Torrico F, Sosa-Estani S, Russomando G, Luquetti A, Freilij H, et al. Congenital Chagas disease: recommendations for diagnosis, treatment and control of newborns, siblings and pregnant women. PLoS Negl Trop Dis. 2011;5(10):e1250. https://doi.org/10.1371/journal.pntd.0001250 PMID: 22039554
-
Jackson Y, Angheben A, Carrilero Fernandez B, Jansa i Lopez del Vallado JM, Jannin JG, Albajar-Viñas P. [Management of Chagas disease in Europe. Experiences and challenges in Spain, Switzerland and Italy]. Bull Soc Pathol Exot. 2009;102(5):326-9. French. PMID: 20131427
-
Ministry of Health. Real Decreto 1088/2005, de 16 de septiembre, por el que se establecen los requisitos técnicos y condiciones mínimas de la hemodonación y de los centros y servicios de transfusión. [Royal decree 1088/2005 of September 16 which establishes the technical requirements and minimum conditions of blood donation and of transfusion centres and services]. Madrid: Ministeri de Sanitat y Consum; 2005:31288-304. Spanish. Available from: http://www.boe.es/boe/dias/2005/09/20/pdfs/A31288-31304.pdf
-
Basile L, Oliveira I, Ciruela P, Plasencia AWorking 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. https://doi.org/10.2807/ese.16.38.19972-en PMID: 21958532
-
Sicuri E, Muñoz J, Pinazo MJ, Posada E, Sanchez J, Alonso PL, et al. 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):110-7. https://doi.org/10.1016/j.actatropica.2011.02.012 PMID: 21396345
-
Organització Mundial de la Salut. Chagas disease in Latin America: an epidemiological update based on 2010 estimates. Wkly Epidemiol Rec. 2015;90(6):33-43. https://doi.org/10.2147/IBPC.S70402 PMID: 25671846
-
Soriano-Arandes A, Angheben A, Serre-Delcor N, Treviño-Maruri B, Gómez I Prat J, Jackson Y. Control and management of congenital Chagas disease in Europe and other non-endemic countries: current policies and practices. Trop Med Int Health. 2016;21(5):590-6. https://doi.org/10.1111/tmi.12687 PMID: 26932338
-
Autonomous government of Catalonia. Protocol for screening and diagnosing Chagas disease in pregnant Latin American women and their newborns. Barcelona: Generalitat de Catalunya; 2010. Available from: https://scientiasalut.gencat.cat/bitstream/handle/11351/1173/protocol_cribratge_diagnostic_malaltia_chagas_embarassades_2010_ang.pdf
-
A Bayón Rueda, R Borrás Salvador, E Calabuig Muñoz, MT Fraile Fariña, MJ Giménez Martí, E Montesinos Sanchis, Elena, et al. Enfermedad de Chagas importada: protocolo de actuación en la Comunitat Valenciana. [Imported Chagas Disease. Protocol of actions in the Valencian Community]. Valencia: Conselleria de Sanitat. Generalitat Valenciana; 2009. Spanish. Available from: http://publicaciones.san.gva.es/publicaciones/documentos/V-5243-2008.pdf
-
Autonomous Government of Galicia. Protocolo de cribado da enfermidade de Chagas en mulleres embarazadas. [Chagas disease screening protocol in pregnant women]. Santiago de Compostela: Xunta de Galicia; 2014. Spanish. Available from: https://www.sergas.es/Asistencia-sanitaria/Protocolo-de-cribado-da-enfermidade-de-chagas-en-mulleres-embarazadas-Actualizacion-2014
-
Bartoloni A, Strohmeyer M, Mantella A, Zammarchi L, Trotta M, Rossolini GM, et al. Programma regionale per la prevenzione e il controllo della malattia di Chagas congenita: indicazioni per l’assistenza in gravidanza. [Regional program for the prevention and control of congenital Chagas disease: indications for assistance during pregnancy]. Firenze: Regione Toscana; 2012. Italian. Available from: http://www.regione.toscana.it/documents/10180/13329059/Allegato+parere+n.+46-2015+Prev+e+conrollo+malattia+di+Chagas.pdf/6e153700-0d7b-4d70-b098-faba975c6de8?version=1.0
-
Martinez de Tejada B, Jackson Y, Paccolat C, Irion OGroupe Chagas Congénital Genéve. [Congenital Chagas disease in Geneva: diagnostic and clinical aspects]. Rev Med Suisse. 2009;5(222):2091-2, 2094-6. French. PMID: 19947451
-
Rodari P, Angheben A, Gennati G, Trezzi L, Bargiggia G, Maino M, et al. Congenital Chagas disease in a non-endemic area: Results from a control programme in Bergamo province, Northern Italy. Travel Med Infect Dis. 2018;25:31-4. https://doi.org/10.1016/j.tmaid.2018.04.011 PMID: 29680285
-
Merino FJ, Martínez-Ruiz R, Olabarrieta I, Merino P, García-Bujalance S, Gastañaga T, et al. [Control of Chagas disease in pregnant Latin-American women and her children]. Rev Esp Quimioter. 2013;26(3):253-60. Spanish. PMID: 24080893
-
Institut d’Estadística de Catalunya. [Statistical Institute of Catalonia]. Població estrangera resident a Catalunya segons la seva nacionalitat 2016. [Foreign population resident in Catalonia by nationality]. Barcelona: Generalitat de Catalunya. [Accessed: 13/06/2019]. Catalan. Available from: http://www.idescat.cat/poblacioestrangera/
-
Agència de Salut Pública de Catalunya. [Public Health Agency of Catalonia]. Xifres i dades de salut maternoinfantil 2018. [Figures and data on maternal and child health 2018]. Barcelona: Generalitat de Catalunya. [Accessed: 13 Jun 2019]. Catalan. Available from: http://salutpublica.gencat.cat/ca/ambits/promocio_salut/Embaras-part-i-puerperi/Xifres-i-dades/
-
Subdirecció general de vigilància i resposta a emergencies en salut pública, Agència de Salut Pública de Catalunya. [Deputy director of public health surveillance and response to emergencies, Public Health Agency of Catalonia]. Centres collaboradors del Programa de prevenció i control de la malaltia de Chagas congènita a Catalunya. [Collaborating Centers of the Congenital Chagas disease Screening Program in Catalonia]. Barcelona: Generalitat de Catalunya; 2019. Catalan. Available from: http://canalsalut.gencat.cat/web/.content/_A-Z/C/chagas/arxius/llistatcentres.pdf
-
Departament de Salut. [Department of Health]. Decret 203/2015, de 15 de setembre, pel qual es crea la Xarxa de Vigilància Epidemiológica i es regulen els sistemes de notificació de malalties de declaració obligatòria i brots epidémics. [Decree 203/2015, of September 15, which creates the Epidemiological Surveillance Network and regulates the reporting systems for compulsory declaration diseases and epidemic outbreaks]. Barcelona: Generalitat de Catalunya; 2015. Catalan. Available from: http://dogc.gencat.cat/ca/pdogc_canals_interns/pdogc_resultats_fitxa/?action=fitxa&documentId=702922&language=ca_ES
-
Jané M, Vidal MJ, Tomas Z, Maresma M, Mayoral LK. Indicators of perinatal health in Catalonia 2016. Executive Report. Barcelona: Sub-directorate General for Epidemiological Surveillance and Public Health Emergency Response. Secretariat for Public Health; 2018. Available from: http://canalsalut.gencat.cat/web/.content/_Professionals/Vigilancia_epidemiologica/documents/arxius/Perinatal_Indicator_Catalonia_2016.pdf
-
Firth D. Bias reduction of maximum likelihood estimates. Biometrika. 1993;80(1):27-38. https://doi.org/10.1093/biomet/80.1.27
-
Muñoz J, Coll O, Juncosa T, Vergés M, del Pino M, Fumado V, et al. 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(12):1736-40. https://doi.org/10.1086/599223 PMID: 19438393
-
Otero S, Sulleiro E, Molina I, Espiau M, Suy A, Martín-Nalda A, et al. Congenital transmission of Trypanosoma cruzi in non-endemic areas: evaluation of a screening program in a tertiary care hospital in Barcelona, Spain. Am J Trop Med Hyg. 2012;87(5):832-6. https://doi.org/10.4269/ajtmh.2012.12-0152 PMID: 22987653
-
Alonso-Vega C, Billot C, Torrico F. Achievements and challenges upon the implementation of a program for national control of congenital Chagas in Bolivia: results 2004-2009. PLoS Negl Trop Dis. 2013;7(7):e2304. https://doi.org/10.1371/journal.pntd.0002304 PMID: 23875039
-
Barona-Vilar C, Giménez-Martí MJ, Fraile T, González-Steinbauer C, Parada C, Gil-Brusola A, et al. Prevalence of Trypanosoma cruzi infection in pregnant Latin American women and congenital transmission rate in a non-endemic area: the experience of the Valencian Health Programme (Spain). Epidemiol Infect. 2012;140(10):1896-903. https://doi.org/10.1017/S0950268811002482 PMID: 22129521
-
Avila Arzanegui O, Liendo Arenaza P, Martinez Indart L, Martinez Astorkiza T, Pocheville Guruceta MI, Egurbide Arberas MV. [Prevalence of Trypanosoma cruzi infection and vertical transmission in Latin-American pregnant women in a health area of Biscay.] Enferm Infecc Microbiol Clin. 2013;31(4):210-6. Spanish. https://doi.org/10.1016/j.eimc.2012.01.029 PMID: 22621813
-
Flores-Chavez MD, Merino FJ, Garcia-Bujalance S, Martin-Rabadan P, Merino P, Garcia-Bermejo I, et al. Surveillance of Chagas disease in pregnant women in Madrid, Spain, from 2008 to 2010. Euro Surveill. 2011;16(38):19974. https://doi.org/10.2807/ese.16.38.19974-en PMID: 21958533
-
Muñoz-Vilches MJ, Salas J, Cabezas T, Metz D, Vázquez J, Soriano MJ. [Chagas screening in pregnant Latin-American women. Experience in Poniente Almeriense (Almeria, Spain)]. Enferm Infecc Microbiol Clin. 2012;30(7):380-2. Spanish. https://doi.org/10.1016/j.eimc.2011.11.012 PMID: 22277372
-
Ramos JM, Milla A, Rodríguez JC, López-Chejade P, Flóres M, Rodríguez JM, et al. Chagas disease in Latin American pregnant immigrants: experience in a non-endemic country. Arch Gynecol Obstet. 2012;285(4):919-23. https://doi.org/10.1007/s00404-011-2081-9 PMID: 21927962
-
Russomando G, Almirón M, Candia N, Franco L, Sánchez Z, de Guillen I. [Implementation and evaluation of a locally sustainable system of prenatal diagnosis to detect cases of congenital Chagas disease in endemic areas of Paraguay]. Rev Soc Bras Med Trop. 2005;38(Suppl 2):49-54. Spanish. PMID: 16482814
-
Kolliker-Frers RA, Insua I, Razzitte G, Capani F. Chagas disease prevalence in pregnant women: migration and risk of congenital transmission. J Infect Dev Ctries. 2016;10(9):895-901. https://doi.org/10.3855/jidc.7118 PMID: 27694720
-
Castellanos-Domínguez YZ, Cucunubá ZM, Orozco LC, Valencia-Hernández CA, León CM, Florez AC, et al. Risk factors associated with Chagas disease in pregnant women in Santander, a highly endemic Colombian area. Trop Med Int Health. 2016;21(1):140-8. https://doi.org/10.1111/tmi.12634 PMID: 26578246
-
Apt W, Zulantay I, Arnello M, Oddó D, González S, Rodríguez J, et al. Congenital infection by Trypanosoma cruzi in an endemic area of Chile: a multidisciplinary study. Trans R Soc Trop Med Hyg. 2013;107(2):98-104. https://doi.org/10.1093/trstmh/trs013 PMID: 23222947
-
Carrera Vargas C, Narváez AO, Muzzio Aroca J, Shiguango G, Robles LM, Herrera C, et al. Seroprevalence of Trypanosoma cruzi infection in schoolchildren and in pregnant women from an Amazonian region in Orellana Province, Ecuador. Am J Trop Med Hyg. 2015;93(4):774-8. https://doi.org/10.4269/ajtmh.14-0807 PMID: 26283751
-
Martins-Melo FR, Lima M da S, Ramos ANJ Jr, Alencar CH, Heukelbach J. Prevalence of Chagas disease in pregnant women and congenital transmission of Trypanosoma cruzi in Brazil: a systematic review and meta-analysis. Trop Med Int Health. 2014;19(8):943-57. https://doi.org/10.1111/tmi.12328 PMID: 24815954
-
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(1):22-33. https://doi.org/10.1111/1471-0528.12396 PMID: 23924273
-
Salas Clavijo NA, Postigo JR, Schneider D, Santalla JA, Brutus L, Chippaux J-P. Prevalence of Chagas disease in pregnant women and incidence of congenital transmission in Santa Cruz de la Sierra, Bolivia. Acta Trop. 2012;124(1):87-91. https://doi.org/10.1016/j.actatropica.2012.06.012 PMID: 22772023
-
Torrico F, Alonso-Vega C, Suarez E, Rodriguez P, Torrico M-C, Dramaix M, et al. Maternal Trypanosoma cruzi infection, pregnancy outcome, morbidity, and mortality of congenitally infected and non-infected newborns in Bolivia. Am J Trop Med Hyg. 2004;70(2):201-9. https://doi.org/10.4269/ajtmh.2004.70.201 PMID: 14993634
-
Luquetti AO, Tavares SB, Siriano LR, Oliveira RA, Campos DE, de Morais CA, et al. Congenital transmission of Trypanosoma cruzi in central Brazil. A study of 1,211 individuals born to infected mothers. Mem Inst Oswaldo Cruz. 2015;110(3):369-76. https://doi.org/10.1590/0074-02760140410 PMID: 25993506
-
Rodriguez-Guerineau L, Posfay-Barbe KM, Monsonis-Cabedo M, Juncosa-Morros T, Diana A, Wyler-Lazarevic CA, et al. Pediatric Chagas disease in Europe: 45 cases from Spain and Switzerland. Pediatr Infect Dis J. 2014;33(5):458-62. https://doi.org/10.1097/INF.0000000000000139 PMID: 24153010
-
Russomando G, Cousiño B, Sanchez Z, Franco LX, Nara EM, Chena L, et al. Chagas disease: national survey of seroprevalence in children under five years of age conducted in 2008. Mem Inst Oswaldo Cruz. 2017;112(5):348-53. https://doi.org/10.1590/0074-02760160407 PMID: 28443980
-
Fumadó V, Juncosa T, Posada E, Fisa R, Gállego M, Gascón J. [Paediatric Chagas in a non-endemic area.] Enferm Infecc Microbiol Clin. 2014;32(5):293-6. Spanish. https://doi.org/10.1016/j.eimc.2013.04.024 PMID: 24491481
-
Virreira M, Torrico F, Truyens C, Alonso-Vega C, Solano M, Carlier Y, et al. Comparison of polymerase chain reaction methods for reliable and easy detection of congenital Trypanosoma cruzi infection. Am J Trop Med Hyg. 2003;68(5):574-82. https://doi.org/10.4269/ajtmh.2003.68.574 PMID: 12812349
-
Schijman AG, Bisio M, Orellana L, Sued M, Duffy T, Mejia Jaramillo AM, et al. International study to evaluate PCR methods for detection of Trypanosoma cruzi DNA in blood samples from Chagas disease patients. PLoS Negl Trop Dis. 2011;5(1):e931. https://doi.org/10.1371/journal.pntd.0000931 PMID: 21264349
-
Bua J, Volta BJ, Perrone AE, Scollo K, Velázquez EB, Ruiz AM, et al. How to improve the early diagnosis of Trypanosoma cruzi infection: relationship between validated conventional diagnosis and quantitative DNA amplification in congenitally infected children. PLoS Negl Trop Dis. 2013;7(10):e2476. https://doi.org/10.1371/journal.pntd.0002476 PMID: 24147166
-
Abras A, Muñoz C, Ballart C, Berenguer P, Llovet T, Herrero M, et al. Towards a new strategy for diagnosis of congenital Trypanosoma cruzi infection. J Clin Microbiol. 2017;55(5):1396-407. https://doi.org/10.1128/JCM.02248-16 PMID: 28202792
-
Volta BJ, Perrone AE, Rivero R, Scollo K, Bustos PL, Bua J. Some limitations for early diagnosis of congenital Chagas infection by PCR. Pediatrics. 2018;141(Suppl 5):S451-5. https://doi.org/10.1542/peds.2016-3719 PMID: 29610170
-
Schijman AG, Altcheh J, Burgos JM, Biancardi M, Bisio M, Levin MJ, et al. Aetiological treatment of congenital Chagas’ disease diagnosed and monitored by the polymerase chain reaction. J Antimicrob Chemother. 2003;52(3):441-9. https://doi.org/10.1093/jac/dkg338 PMID: 12917253
-
Álvarez MG, Vigliano C, Lococo B, Bertocchi G, Viotti R. Prevention of congenital Chagas disease by Benznidazole treatment in reproductive-age women. An observational study. Acta Trop. 2017;174:149-52. https://doi.org/10.1016/j.actatropica.2017.07.004 PMID: 28720492
-
Fabbro DL, Danesi E, Olivera V, Codebó MO, Denner S, Heredia C, et al. Trypanocide treatment of women infected with Trypanosoma cruzi and its effect on preventing congenital Chagas. PLoS Negl Trop Dis. 2014;8(11):e3312. https://doi.org/10.1371/journal.pntd.0003312 PMID: 25411847
-
Murcia L, Simón M, Carrilero B, Roig M, Segovia M. Treatment of infected women of childbearing age prevents congenital Trypanosoma cruzi infection by eliminating the parasitemia detected by PCR. J Infect Dis. 2017;215(9):1452-8. https://doi.org/10.1093/infdis/jix087 PMID: 28201741
-
Soriano-Arandes A, Basile L, Ouaarab H, Clavería I, Gómez i Prat J, Cabezos J, et al. Controlling congenital and paediatric chagas disease through a community health approach with active surveillance and promotion of paediatric awareness. BMC Public Health. 2014;14(1):1201. https://doi.org/10.1186/1471-2458-14-1201 PMID: 25416081
Data & Media loading...