1887
  1. Home
  2. Eurosurveillance
  3. Volume 25, Issue 8, 27/Feb/2020
  4. Article
Systematic Review Open Access
Like 0
Download

Abstract

Background

Chagas disease has spread beyond its original borders on the American continent with migration. It can be transmitted from mother to child, through organ transplantation and transfusion of blood and blood products. It is necessary to determine when to screen for this infection.

Aim

Our objective was to evaluate the appropriateness of screening for infection in Latin American migrants and their descendants.

Methods

We reviewed the literature using rigorous criteria. The quality of evidence was ranked according to the GRADE classification. An evidence to decision framework was adopted to provide information on the most relevant aspects necessary to formulate recommendations.

Results

The 33 studies evaluated revealed a prevalence of infection among Latin American migrants in Europe of 6.08% (95% confidence interval (CI): 3.24–9.69; 28 studies). Vertical transmission occurred in three of 100 live births (95% CI: 1–6; 13 studies). The prevalence of cardiovascular disease was 19% (95% CI: 13–27; nine studies), including only 1% severe cardiac events (95% CI: 0–2; 11 studies). The overall quality of evidence was low because of risk of bias in the studies and considerable heterogeneity of the evaluated populations. The recommendations took into account economic studies on the value of screening strategies and studies on acceptability of screening and knowledge of the disease in the affected population.

Conclusions

We identified five situations in which screening for infection is indicated. We recommend screening persons from endemic areas and children of mothers from these areas.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2020.25.8.1900393
2020-02-27
2024-12-21
/content/10.2807/1560-7917.ES.2020.25.8.1900393
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/25/8/eurosurv-25-8-3.html?itemId=/content/10.2807/1560-7917.ES.2020.25.8.1900393&mimeType=html&fmt=ahah

References

  1. World Health Organization (WHO). Chagas disease (American trypanosomiasis). Geneva: WHO; 2019. Available from: https://www.who.int/news-room/fact-sheets/detail/chagas-disease-(american-trypanosomiasis)
  2. Pérez-Molina JA, Molina I. Chagas disease. Lancet. 2018;391(10115):82-94.  https://doi.org/10.1016/S0140-6736(17)31612-4  PMID: 28673423 
  3. European Centre for Disease Prevention and Control (ECDC). Assessing the burden of key infectious diseases affecting migrant populations in the EU/EEA. Stockholm: ECDC; 2014. Available from: https://doi.org/ https://doi.org/10.2900/28792 
  4. 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):1-10.  https://doi.org/10.2807/ese.16.37.19968-en  PMID: 21944556 
  5. Piron M, Vergés M, Muñoz J, Casamitjana N, Sanz S, Maymó RM, et al. Seroprevalence of Trypanosoma cruzi infection in at-risk blood donors in Catalonia (Spain). Transfusion. 2008;48(9):1862-8.  https://doi.org/10.1111/j.1537-2995.2008.01789.x  PMID: 18522707 
  6. Pérez-Ayala A, Pérez-Molina JA, Norman F, Navarro M, Monge-Maillo B, Díaz-Menéndez M, et al. Chagas disease in Latin American migrants: a Spanish challenge. Clin Microbiol Infect. 2011;17(7):1108-13.  https://doi.org/10.1111/j.1469-0691.2010.03423.x  PMID: 21073628 
  7. 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 
  8. Pérez-Molina JA, López-Polín A, Treviño B, Molina I, Goikoetxea J, Díaz-Menéndez M, et al. 6-year review of +Redivi: a prospective registry of imported infectious diseases in Spain. J Travel Med. 2017;24(5):24.  https://doi.org/10.1093/jtm/tax035  PMID: 28931128 
  9. Roca C, Pinazo M-J, López-Chejade P, Bayó J, Posada E, López-Solana J, et al. Chagas disease among the Latin American adult population attending in a primary care center in Barcelona, Spain. PLoS Negl Trop Dis. 2011;5(4):e1135-5.  https://doi.org/10.1371/journal.pntd.0001135  PMID: 21572511 
  10. Grupo de Trabajo Donación de Sangre e Inmigración. [Blood Donation and Immigration Working Group]. Enfermedad de Chagas y donación de sangre. [Chagas disease and blood donation]. Madrid: Dirección General de Salud Pública y Sanidad Exterior, Ministerio de Sanidad y Política Social. 2009. Spanish. Available from: https://www.mscbs.gob.es/en/profesionales/saludPublica/medicinaTransfusional/publicaciones/docs/informeChagasJulio09.pdf
  11. Imaz-Iglesia I, Miguel LG-S, Ayala-Morillas LE, García-Pérez L, González-Enríquez J, Blasco-Hernández T, et al. Economic evaluation of Chagas disease screening in Spain. Acta Trop. 2015;148:77-88.  https://doi.org/10.1016/j.actatropica.2015.04.014  PMID: 25917718 
  12. World Health Organization (WHO). Control of Chagas disease: second report of the WHO expert Committee. Geneva: WHO; 2002. Available from: https://apps.who.int/iris/handle/10665/42443
  13. Pan American Health Organization (PAHO). Guidelines for the diagnosis and treatment of Chagas disease. Washington: PAHP; 2018. Available from: http://iris.paho.org/xmlui/handle/123456789/49653
  14. Dias JCP, Ramos AN Jr, Gontijo ED, Luquetti A, Shikanai-Yasuda MA, Coura JR, et al. 2 nd Brazilian consensus on Chagas disease, 2015. Rev Soc Bras Med Trop. 2016;49(49) Suppl 1;3-60.  https://doi.org/10.1590/0037-8682-0505-2016  PMID: 27982292 
  15. Higgins J, Green S, editors. Cochrane handbook for systematic reviews of interventions. version 5.1.0 (updated March 2011). London: The Cochrane Collaboration 2011. Available from www.handbook.cochrane.org
  16. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.  https://doi.org/10.1371/journal.pmed.1000097  PMID: 19621072 
  17. Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934-9.  https://doi.org/10.1016/j.jclinepi.2011.11.014  PMID: 22742910 
  18. Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health. 2014;72(1):39.  https://doi.org/10.1186/2049-3258-72-39  PMID: 25810908 
  19. Schünemann HJ, Brozek J, Guyatt GH, Oxman AD. Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. The GRADE network; 2013. Available from: https://gdt.gradepro.org/app/handbook/handbook.html
  20. Schünemann HJ, Oxman AD, Higgins J, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and ‘Summary of findings’ tables. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). London: The Cochrane Collaboration, 2011. Available from: www.handbook.cochrane.org.
  21. Alonso-Coello P, Schünemann HJ, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ. 2016;353:i2016.  https://doi.org/10.1136/bmj.i2016  PMID: 27353417 
  22. Angheben A, Anselmi M, Gobbi F, Marocco S, Monteiro G, Buonfrate D, et al. Chagas disease in Italy: breaking an epidemiological silence. Euro Surveill. 2011;16(37):19969.  https://doi.org/10.2807/ese.16.37.19969-en  PMID: 21944554 
  23. Frank M, Hegenscheid B, Janitschke K, Weinke T. Prevalence and epidemiological significance of Trypanosoma cruzi infection among Latin American immigrants in Berlin, Germany. Infection. 1997;25(6):355-8.  https://doi.org/10.1007/BF01740817  PMID: 9427054 
  24. Jackson Y, Gétaz L, Wolff H, Holst M, Mauris A, Tardin A, et al. Prevalence, clinical staging and risk for blood-borne transmission of Chagas disease among Latin American migrants in Geneva, Switzerland. PLoS Negl Trop Dis. 2010;4(2):e592.  https://doi.org/10.1371/journal.pntd.0000592  PMID: 20126397 
  25. Lescure F-X, Paris L, Elghouzzi MH, Le Loup G, Develoux M, Touafek F, et al. [Experience of targeted screening of Chagas disease in Ile-de-France]. Bull Soc Pathol Exot. 2009;102(5):295-9. French. PMID: 20131423 
  26. Navarro M, Pérez-Ayala A, Guionnet A, Perez-Molina JA, Navaza B, Estevez L, et al. Targeted screening and health education for Chagas disease tailored to at-risk migrants in Spain, 2007 to 2010. Euro Surveill. 2011;16(38):19973.  https://doi.org/10.2807/ese.16.38.19973-en  PMID: 21958531 
  27. Perez-Molina JA, Perez-Ayala A, Parola P, Jackson Y, Odolini S, Lopez-Velez R, et al. EuroTravNet: imported Chagas disease in nine European countries, 2008 to 2009. Euro Surveill. 2011;16(37):19966.  https://doi.org/10.2807/ese.16.37.19966-en  PMID: 21944557 
  28. Ramos JM, Ponce Y, Gallegos I, Flóres-Chávez M, Cañavate C, Gutiérrez F. Trypanosoma cruzi infection in Elche (Spain): comparison of the seroprevalence in immigrants from Paraguay and Bolivia. Pathog Glob Health. 2012;106(2):102-6.  https://doi.org/10.1179/2047773212Y.0000000013  PMID: 22943545 
  29. Rodríguez-Guardado A, Rodríguez M, Alonso P, Seco C, Flores-Chavez M, Mejuto P, et al. Serological screening of Chagas disease in an immigrant population in Asturias, Spain proceeding from Chagas-endemic areas. Scand J Infect Dis. 2009;41(10):774-6.  https://doi.org/10.1080/00365540903161523  PMID: 19685377 
  30. Soriano Arandes A, Muñoz Gutierrez J, Vergés Navarro M, Castells Doménech C, Portús Vinyeta M, Gascón Brustenga J. Prevalence of Chagas disease in the Latin American immigrant population in a primary health centre in Barcelona (Spain). Acta Trop. 2009;112(2):228-30.  https://doi.org/10.1016/j.actatropica.2009.07.014  PMID: 19631185 
  31. Cancino-Faure B, Fisa R, Riera C, Bula I, Girona-Llobera E, Jimenez-Marco T. Evidence of meaningful levels of Trypanosoma cruzi in platelet concentrates from seropositive blood donors. Transfusion. 2015;55(6):1249-55.  https://doi.org/10.1111/trf.12989  PMID: 25683267 
  32. El Ghouzzi M-H, Boiret E, Wind F, Brochard C, Fittere S, Paris L, et al. Testing blood donors for Chagas disease in the Paris area, France: first results after 18 months of screening. Transfusion. 2010;50(3):575-83.  https://doi.org/10.1111/j.1537-2995.2009.02476.x  PMID: 19906038 
  33. Gabrielli S, Girelli G, Vaia F, Santonicola M, Fakeri A, Cancrini G. Surveillance of Chagas disease among at-risk blood donors in Italy: preliminary results from Umberto I Polyclinic in Rome. Blood Transfus. 2013;11(4):558-62. PMID: 24120609 
  34. O’Brien SF, Scalia V, Goldman M, Fan W, Yi Q-L, Dines IR, et al. Selective testing for Trypanosoma cruzi: the first year after implementation at Canadian Blood Services. Transfusion. 2013;53(8):1706-13.  https://doi.org/10.1111/j.1537-2995.2012.03950.x  PMID: 23145895 
  35. 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 
  36. 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 
  37. Martinez de Tejada B, Jackson Y, Paccolat C, Irion O, Groupe 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 
  38. Muñoz J, Coll O, Juncosa T, Vergés M, del Pino M, Fumadó 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 
  39. 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. PMID: 22277372 
  40. Lucas RM, Barba MC. [Prevalence of american trypanosomiasis in pregnant women from a health area of Valencia, Spain: 2005-2007.] Rev Esp Salud Publica. 2009;83(4):543-55. Spanish. https://doi.org/10.1590/S1135-57272009000400006  PMID: 19893882 
  41. 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 
  42. Paricio-Talayero JM, Benlloch-Muncharaz MJ, Collar-del-Castillo JI, Rubio-Soriano A, Serrat-Pérez C, Magraner-Egea J, et al. [Epidemiological surveillance of vertically-transmitted Chagas disease at three maternity hospitals in the Valencian Community]. Enferm Infecc Microbiol Clin. 2008;26(10):609-13. Spanish.  https://doi.org/10.1016/S0213-005X(08)75276-5  PMID: 19100190 
  43. 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 
  44. Favila Escobio P, Ribas J, G Morillo M, Rodríguez-Ramírez G, Vicens-Ferrer J, Esteva M. Prevalence of Chagas disease in the Bolivian population of Majorca (Spain). Gac Sanit. 2015;29(4):288-91.  https://doi.org/10.1016/j.gaceta.2015.03.012  PMID: 26026727 
  45. Lescure FX, Canestri A, Melliez H, Jauréguiberry S, Develoux M, Dorent R, et al. Chagas disease, France. Emerg Infect Dis. 2008;14(4):644-6.  https://doi.org/10.3201/eid1404.070489  PMID: 18394284 
  46. Ramos JM, Torrús D, Amador C, Jover F, Pérez-Chacón F, Ponce Y, et al. Multicenter epidemiological and clinical study on imported Chagas diseases in Alicante, Spain. Pathog Glob Health. 2012;106(6):340-5.  https://doi.org/10.1179/2047773212Y.0000000039  PMID: 23182138 
  47. Salvador F, Treviño B, Sulleiro E, Pou D, Sánchez-Montalvá A, Cabezos J, et al. Trypanosoma cruzi infection in a non-endemic country: epidemiological and clinical profile. Clin Microbiol Infect. 2014;20(7):706-12.  https://doi.org/10.1111/1469-0691.12443  PMID: 24329884 
  48. Valerio-Sallent L, Roure S, Basile L, Ballesteros LA, Sabrià M, Rodrigo C, et al. [A clinical and epidemiological study of the Trypanosoma cruzi infected population in the north metropolitan area of Barcelona]. Rev Clin Esp. 2012;212(7):329-36.  https://doi.org/10.1016/j.rce.2012.03.017  PMID: 22608192 
  49. Blasco GL, Nuñez MV, Cruceyra BM, Magdaleno DF, García BS. Enfermedad de Chagas y embarazo. Rev Chil Obstet Ginecol. 2011;76(3):162-8.  https://doi.org/10.4067/S0717-75262011000300005 
  50. Murcia L, Carrilero B, Munoz-Davila MJ, Thomas MC, López MC, Segovia M. Risk factors and primary prevention of congenital Chagas disease in a nonendemic country. Clin Infect Dis. 2013;56(4):496-502.  https://doi.org/10.1093/cid/cis910  PMID: 23097582 
  51. Pérez-Molina JA, Pérez-Ayala A, Moreno S, Fernández-González MC, Zamora J, López-Velez R. Use of benznidazole to treat chronic Chagas’ disease: a systematic review with a meta-analysis. J Antimicrob Chemother. 2009;64(6):1139-47.  https://doi.org/10.1093/jac/dkp357  PMID: 19819909 
  52. Morillo CA, Marin-Neto JA, Avezum A, Sosa-Estani S, Rassi A Jr, Rosas F, et al. Randomized trial of benznidazole for chronic Chagas’ cardiomyopathy. N Engl J Med. 2015;373(14):1295-306.  https://doi.org/10.1056/NEJMoa1507574  PMID: 26323937 
  53. Molina I, Gómez i Prat J, Salvador F, Treviño B, Sulleiro E, Serre N, et al. Randomized trial of posaconazole and benznidazole for chronic Chagas’ disease. N Engl J Med. 2014;370(20):1899-908.  https://doi.org/10.1056/NEJMoa1313122  PMID: 24827034 
  54. Torrico F, Gascon J, Ortiz L, Alonso-Vega C, Pinazo M-J, Schijman A, et al. Treatment of adult chronic indeterminate Chagas disease with benznidazole and three E1224 dosing regimens: a proof-of-concept, randomised, placebo-controlled trial. Lancet Infect Dis. 2018;18(4):419-30.  https://doi.org/10.1016/S1473-3099(17)30538-8  PMID: 29352704 
  55. Morillo CA, Waskin H, Sosa-Estani S, Del Carmen Bangher M, Cuneo C, Milesi R, et al. Benznidazole and posaconazole in eliminating parasites in asymptomatic T. cruzi carriers: the STOP-CHAGAS trial. J Am Coll Cardiol. 2017;69(8):939-47.  https://doi.org/10.1016/j.jacc.2016.12.023  PMID: 28231946 
  56. Crespillo-Andújar C, Venanzi-Rullo E, López-Vélez R, Monge-Maillo B, Norman F, López-Polín A, et al. Safety profile of benznidazole in the treatment of chronic Chagas disease: experience of a referral centre and systematic literature review with meta-analysis. Drug Saf. 2018;41(11):1035-48.  https://doi.org/10.1007/s40264-018-0696-5  PMID: 30006773 
  57. Drugs for Neglected Diseases initiative (DNDi). The BENDITA study: A phase II study to assess safety, tolerability and efficacy of different benznidazole regimens, alone and in combination with fosravuconazole. 2019:1-2. Available from: https://www.dndi.org/wp-content/uploads/2019/03/2page_BenditatStudyOverview_ENG.pdf
  58. Agència de Salut Pública de Catalunya (ASPC). Protocol de seguiment de l’embaràs a Catalunya. [Protocol for monitoring pregnancy in Catalonia]. 3rd ed. Barcelona: Departament de Salut, Generalitat de Catalunya; 2018. Catalan. Available from: http://salutpublica.gencat.cat/web/.content/minisite/aspcat/promocio_salut/embaras_part_puerperi/protocol_seguiment_embaras/protocol-seguiment-embaras-2018.pdf
  59. Guía de práctica clínica de atención en el embarazo y puerperio. [Clinical practice guide for pregnancy and postnatal care]. Sevilla: Ministerio de Sanidad, Servicios Sociales e Igualdad, Agencia de Evaluación de Tecnologías Sanitarias; 2014. Available from: https://portal.guiasalud.es/wp-content/uploads/2018/12/GPC_533_Embarazo_AETSA_compl.pdf
  60. 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 
  61. López-Fabal F, Gómez-Garcés JL. [Serological markers of Spanish and immigrant pregnant women in the south of Madrid during the period 2007-2010]. Rev Esp Quimioter. 2013;26(2):108-11. Spanish. PMID: 23817647 
  62. Sampedro A, Mazuelas P, Rodríguez-Granger J, Torres E, Puertas A, Navarro JM. [Serological markers in immigrant and Spanish pregnant women in Granada]. Enferm Infecc Microbiol Clin. 2010;28(10):694-7. Spanish.  https://doi.org/10.1016/j.eimc.2010.04.007  PMID: 20961669 
  63. Ramos JM, Milla A, Sánchez V, Vergés M, Toro C, Gutiérrez F. [Prenatal screening for Trypanosoma cruzi and human T lymphotropic virus types 1 and 2 in pregnant Latin American women]. Enferm Infecc Microbiol Clin. 2009;27(3):165-7. Spanish.  https://doi.org/10.1016/j.eimc.2008.04.006  PMID: 19306717 
  64. Santiago B, Blázquez D, López G, Sainz T, Muñoz M, Alonso T, et al. [Serological profile of immigrant pregnant women against HIV, HBV, HCV, rubella, Toxoplasma gondii, Treponema pallidum, and Trypanosoma cruzi]. Enferm Infecc Microbiol Clin. 2012;30(2):64-9. Spanish.  https://doi.org/10.1016/j.eimc.2011.07.010  PMID: 22079225 
  65. 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 
  66. Instituto Nacional de Estadística. [National Statistics Institute]. Estadística del Padrón continuo. Población inscrita en el padrón a 01/01/2019. [Continuous census statistics. Population registered as of 1 Jan 2019]. Instituto Nacional de Estadística, 2019. Available from: https://www.ine.es/dyngs/INEbase/es/operacion.htm?c=Estadistica_C&cid=1254736177012&menu=ultiDatos&idp=1254734710990
  67. European Centre for Disease Prevention and Control (ECDC). Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/public-health-guidance-screening-and-vaccination-infectious-diseases-newly
  68. Villar JC, Perez JG, Cortes OL, Riarte A, Pepper M, Marin-Neto JA, et al. Trypanocidal drugs for chronic asymptomatic Trypanosoma cruzi infection. Cochrane Database Syst Rev. 2014;5(5):CD003463. PMID: 24867876 
  69. Blasco-Hernández T, García-San Miguel L, Navaza B, Navarro M, Benito A. Knowledge and experiences of Chagas disease in Bolivian women living in Spain: a qualitative study. Glob Health Action. 2016;9(1):30201.  https://doi.org/10.3402/gha.v9.30201  PMID: 26976265 
  70. Forsyth CJ, Hernandez S, Flores CA, Roman MF, Nieto JM, Marquez G, et al. "It’s like a phantom disease": patient perspectives on access to treatment for Chagas disease in the United States. Am J Trop Med Hyg. 2018;98(3):735-41.  https://doi.org/10.4269/ajtmh.17-0691  PMID: 29380723 
  71. Requena-Méndez A, Bussion S, Aldasoro E, Jackson Y, Angheben A, Moore D, et al. Cost-effectiveness of Chagas disease screening in Latin American migrants at primary health-care centres in Europe: a Markov model analysis. Lancet Glob Health. 2017;5(4):e439-47.  https://doi.org/10.1016/S2214-109X(17)30073-6  PMID: 28256340 
  72. Sicuri E, Muñoz J, Pinazo M-J, 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 
Screening for Trypanosoma cruzi infection in immigrants and refugees: Systematic review and recommendations from the Spanish Society of Infectious Diseases and Clinical Microbiology
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Mar%C3%ADa+Velasco&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Velasco María</a>, <a href="/search?value1=Luis+Andr%C3%A9s+Gimeno-Feli%C3%BA&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gimeno-Feliú Luis Andrés</a>, <a href="/search?value1=Israel+Molina&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Molina Israel</a>, <a href="/search?value1=Joaqu%C3%ADn+Salas-Coronas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Salas-Coronas Joaquín</a>, <a href="/search?value1=Ivan+Sol%C3%A0&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Solà Ivan</a>, <a href="/search?value1=Bego%C3%B1a+Monge-Maillo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Monge-Maillo Begoña</a>, <a href="/search?value1=Diego+Torr%C3%BAs-Tendero&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Torrús-Tendero Diego</a>, <a href="/search?value1=Joan+Cayl%C3%A0&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Caylà Joan</a>, <a href="/search?value1=Ena+Ni%C3%B1o+de+Guzm%C3%A1n&option1=author&noRedirect=true" class="nonDisambigAuthorLink">de Guzmán Ena Niño</a>, <a href="/search?value1=JL+P%C3%A9rez+Arellano&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Arellano JL Pérez</a>, <a href="/search?value1=Jose+A+P%C3%A9rez-Molina&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pérez-Molina Jose A</a></span>. Screening for Trypanosoma cruzi infection in immigrants and refugees: Systematic review and recommendations from the Spanish Society of Infectious Diseases and Clinical Microbiology . <a href="/content/ecdc">Euro Surveill.</a> 2020;25(8):pii=1900393. <a href="https://doi.org/10.2807/1560-7917.ES.2020.25.8.1900393" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2020.25.8.1900393</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 19 Jun 2019;&nbsp;&nbsp; <span class="generated">Accepted</span>: 22 Nov 2019 </span> </p>
/content/10.2807/1560-7917.ES.2020.25.8.1900393
/content/10.2807/1560-7917.ES.2020.25.8.1900393
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error