Internal Medicine Department, Hospital Vega Baja, Orihuela, Spain.
Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain.
PLoS Negl Trop Dis. 2021 Mar 24;15(3):e0009281. doi: 10.1371/journal.pntd.0009281. eCollection 2021 Mar.
Chagas disease (CD) is a chronic parasitic disease caused by Trypanosoma cruzi and is endemic to continental Latin America. In Spain, the main transmission route is congenital. We aimed to assess adherence to regional recommendations of universal screening for CD during pregnancy in Latin American women in the province of Alicante from 2014 to 2018.
METHODOLOGY/PRINCIPAL FINDINGS: Retrospective quality study using two data sources: 1) delivery records of Latin American women that gave birth in the 10 public hospitals of Alicante between January 2014 and December 2018; and 2) records of Chagas serologies carried out in those centers between May 2013 and December 2018. There were 3026 deliveries in Latin American women during the study period; 1178 (38.9%) underwent CD serology. Screening adherence ranged from 17.2% to 59.3% in the different health departments and was higher in Bolivian women (48.3%). Twenty-six deliveries (2.2%) had a positive screening; CD was confirmed in 23 (2%) deliveries of 21 women. Bolivians had the highest seroprevalence (21/112; 18.7%), followed by Colombians (1/333; 0.3%) and Ecuadorians (1/348; 0.3%). Of 21 CD-positive women (19 Bolivians, 1 Colombian, 1 Ecuadorian), infection was already known in 12 (57.1%), and 9 (42.9%) had already been treated. Only 1 of the 12 untreated women (8.3%) was treated postpartum. Follow-up started in 20 of the 23 (87.0%) neonates but was completed only in 11 (47.8%); no cases of congenital transmission were detected. Among the 1848 unscreened deliveries, we estimate 43 undiagnosed cases of CD and 1 to 2 undetected cases of congenital transmission.
CONCLUSIONS/SIGNIFICANCE: Adherence to recommendations of systematic screening for CD in Latin American pregnant women in Alicante can be improved. Strategies to strengthen treatment of postpartum women and monitoring of exposed newborns are needed. Currently, there may be undetected cases of congenital transmission in our province.
恰加斯病（CD）是一种由克氏锥虫引起的慢性寄生虫病，流行于拉丁美洲大陆。在西班牙，主要传播途径是先天传播。我们旨在评估 2014 年至 2018 年期间，在阿利坎特省的拉丁裔妇女中，对 CD 进行妊娠常规筛查的区域建议的遵守情况。
方法/主要发现：使用两个数据源进行回顾性质量研究：1）2014 年 1 月至 2018 年 12 月期间，在阿利坎特的 10 家公立医院分娩的拉丁裔妇女的分娩记录；2）2013 年 5 月至 2018 年 12 月期间在这些中心进行的克氏锥虫血清学检测记录。研究期间，共有 3026 名拉丁裔妇女分娩；1178 名（38.9%）进行了 CD 血清学检查。在不同的卫生部门，筛查的依从率从 17.2%到 59.3%不等，玻利维亚妇女的依从率更高（48.3%）。26 次分娩（2.2%）的筛查呈阳性；23 次（2%）阳性分娩的 21 名妇女中，CD 得到确认。玻利维亚人的血清阳性率最高（21/112；18.7%），其次是哥伦比亚人（1/333；0.3%）和厄瓜多尔人（1/348；0.3%）。在 21 名 CD 阳性妇女（19 名玻利维亚人、1 名哥伦比亚人和 1 名厄瓜多尔人）中，12 名（57.1%）已知感染，9 名（42.9%）已接受治疗。未接受治疗的 12 名妇女中只有 1 名（8.3%）在产后接受了治疗。23 名新生儿中有 20 名（87.0%）开始接受随访，但仅完成 11 名（47.8%）；未发现先天性传播病例。在 1848 名未筛查的分娩中，我们估计有 43 例未确诊的 CD 病例和 1 至 2 例未发现的先天性传播病例。
结论/意义：可以提高阿利坎特省拉丁裔孕妇对 CD 进行系统筛查的建议的依从性。需要加强对产后妇女的治疗和对暴露新生儿的监测的策略。目前，我省可能存在未发现的先天性传播病例。
