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      Prevalence of Chagas Disease in Latin-American Migrants Living in Europe: A Systematic Review and Meta-analysis

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          Abstract

          Background

          Few studies have assessed the burden of Chagas disease in non-endemic countries and most of them are based on prevalence estimates from Latin American (LA) countries that likely differ from the prevalence in migrants living in Europe. The aim of this study was to systematically review the existing data informing current understanding of the prevalence of Chagas disease in LA migrants living in European countries.

          Methods

          We conducted a systematic review and meta-analysis of studies reporting prevalence of Chagas disease in European countries belonging to the European Union (EU) before 2004 in accordance with the MOOSE guidelines and based on the database sources MEDLINE and Global Health. No restrictions were placed on study date, study design or language of publication. The pooled prevalence was estimated using random effect models based on DerSimonian & Laird method.

          Results

          We identified 18 studies conducted in five European countries. The random effect pooled prevalence was 4.2% (95%CI:2.2-6.7%); and the heterogeneity of Chagas disease prevalence among studies was high (I2 = 97%,p<0.001). Migrants from Bolivia had the highest prevalence of Chagas disease (18.1%, 95%CI:13.9–22.7%).

          Conclusions

          Prevalence of Chagas in LA migrants living in Europe is high, particularly in migrants from Bolivia and Paraguay. Data are highly heterogeneous dependent upon country of origin and within studies of migrants from the same country of origin. Country-specific prevalence differs from the estimates available from LA countries. Our meta-analysis provides prevalence estimates of Chagas disease that should be used to estimate the burden of disease in European countries.

          Author Summary

          Chagas disease is emerging in European countries due to the migration flows from Latin-American endemic countries to Europe, particularly to southern countries. Some studies have evaluated the prevalence of this disease in several European countries although these estimates are based on national population prevalence rates from countries of origin and the estimated size of the corresponding migrant population. The objective of this study is to review the studies about the prevalence of Chagas disease in Latin American migrants living in European countries. Our meta-analysis provides prevalence estimates of Chagas disease that should be used to estimate the burden of disease in European countries. This accurate data about country specific prevalence of Chagas disease could be used to evaluate the cost-effectiveness of screening programmes and also could help policy makers to design health interventions concerning Chagas disease.

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          Most cited references32

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

          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. 2009 Elsevier B.V. All rights reserved.
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            Efficacy of chemotherapy with benznidazole in children in the indeterminate phase of Chagas' disease.

            A double-blind, randomized, clinical field trial was designed to test the efficacy and tolerance of a specific drug treatment in children in the indeterminate phase of infection by Trypanosoma cruzi. Children were treated with benznidazole at a dose of 5 mg/kg/day for 60 days or placebo and followed-up for 48 months. The treated children showed a significant decrease in geometric mean titers of antibodies against T. cruzi measured by indirect hemagglutination, indirect immunofluorescence, and ELISA. After a four year follow-up, 62% of the benznidazole-treated children and no placebo-treated child were seronegative for T. cruzi when tested by an ELISA using a T. cruzi flagellar calcium-binding protein (F29). Xenodiagnosis carried out after 48 months of follow-up was positive in 4.7% of the benznidazole-treated children and in 51.2% of the placebo-treated children. These results show the tolerance to and efficacy of benznidazole against T. cruzi in seropositive children six to 12 years of age. We used an early serologic marker of cure after treatment, consisting of a recombinant antigen implemented in a rapid, conventional serologic procedure.
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              • Article: not found

              Antitrypanosomal therapy for chronic Chagas' disease.

              Caryn Bern (2011)
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS Negl Trop Dis
                PLoS Negl Trop Dis
                plos
                plosntds
                PLoS Neglected Tropical Diseases
                Public Library of Science (San Francisco, CA USA )
                1935-2727
                1935-2735
                13 February 2015
                February 2015
                : 9
                : 2
                Affiliations
                [1 ]ISGlobal, Barcelona Center for International Health Research, (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
                [2 ]Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
                Federal University of São Paulo, BRAZIL
                Author notes

                The authors have declared that no competing interests exist.

                Conceived and designed the experiments: ARM JM. Performed the experiments: ARM ES. Analyzed the data: ARM ES EdL JM. Contributed reagents/materials/analysis tools: EdL. Wrote the paper: ARM EA ES DAJM MB JM JG.

                Article
                PNTD-D-14-01859
                10.1371/journal.pntd.0003540
                4332678
                25680190
                61df5623-82d3-4653-86d7-031343e76948

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                Page count
                Figures: 2, Tables: 4, Pages: 15
                Product
                Funding
                This work has been supported by the EC within the 7th Framework Program under grant agreement no. FP7?GA-261495. The CRESIB Research group receives funds from AGAUR, (project 2014SGR26) and also from the project RICET (RD12/0018/0010) within the Spanish National plan of R+D+I and co-funded by ISCIII-Subdireccion General de Evaluacion and the Fondo Europeo de Desarrollo Regional (FEDER). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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