Modelling congenital transmission of Chagas’ disease

A description of the epidemiological dynamics of Chagas disease via mathematical modeling

Chagas disease is caused by the protozoan Trypanosoma cruzi, which parasitizes many mammals, including humans. Its vectors are blood-feeding hematophagous triatomine insects of different species, which vary according to the geographical area. One of the 17 neglected diseases targeted by the World Health Organization, Chagas disease is endemic to the Americas, but has spread to other countries due to human migratory movements. In this study, we describe the epidemiological dynamics of Chagas disease in an endemic area, considering the main transmission mechanisms and the demographic effects of birth, mortality, and human migration in this phenomenon. We apply mathematical models as a methodological approach to simulate the interactions between reservoirs, vectors, and humans using a system of ordinary differential equations. The results show that the Chagas disease control measures currently in place cannot be relaxed without endangering the progress achieved to date.

Risk Factors for Maternal Chagas Disease and Vertical Transmission in a Bolivian Hospital

BACKGROUND

Vertical transmission of Trypanosoma cruzi infection accounts for a growing proportion of new cases of Chagas disease. Better risk stratification is needed to predict which women are more likely to transmit the infection.

METHODS

This study enrolled women and their infants at the Percy Boland Women's Hospital in Santa Cruz, Bolivia. Pregnant women were screened for Chagas disease by rapid test and received confirmatory serology. Infants of seropositive mothers underwent diagnostic testing with quantitative polymerase chain reaction (qPCR).

RESULTS

Among 5,828 enrolled women, 1,271 (21.8%) screened positive for Chagas disease. Older maternal age, family history of Chagas disease, home conditions, lower education level, and history of living in a rural area were significantly associated with higher adjusted odds of maternal infection. Of the 1,325 infants of seropositive mothers, 65 infants (4.9%) were diagnosed with congenital Chagas disease. Protective factors against transmission included Cesarean delivery (adjusted OR [aOR]: 0.60, 95% CI: 0.36-0.99) and family history of Chagas disease (aOR: 0.58, 95% CI: 0.34-0.99). Twins were significantly more likely to be congenitally infected than singleton births (OR: 3.32, 95% CI: 1.60-6.90). Among congenitally infected infants, 32.3% had low birth weight, and 30.8% required hospitalization after birth.

CONCLUSIONS

Although improved access to screening and qPCR increased the number of infants diagnosed with congenital Chagas disease, many infants remain undiagnosed. A better understanding of risk factors and improved access to highly sensitive and specific diagnostic techniques for congenital Chagas disease may help improve regional initiatives to reduce disease burden.

Who benefits from cellular immune response during the Chagas disease?

We extend our previous model for the dynamical interaction between a mammal's immune response and the Trypanosoma cruzi parasite during the acute phase of Chagas disease. The model here considers both humoral and cellular responses and the different stages of T. cruzi (intracellular and extracellular phases) inside the mammal host. We analyze the dynamical time evolution of the populations obtaining phase diagrams of the model results. The steady-state solution of the system yields two outcomes associated to Healing and Chronic stationary cases, the death case obtained when just the humoral immune response alone was considered is not being present. This result implies that, surprisingly, although the immune cellular response is obviously beneficial for the host, it is also evolutionary advantageous for the parasite, as it helps to preserve the host alive and, after transmission to a healthy host, perpetuate the disease. Of course, if the cell damage by the parasite's intracellular stage is high, it may cause the host death. This possibility is accounted in the model by introducing a death criterion related to cell destruction. We present a new phase diagram, that restores the host death case and generates a phase diagram similar to the one arising from the original model.

Modeling Chagas disease in Chile: From vector to congenital transmission

Chagaś disease is a human health problem in Latin America. It is highly prevalent in northern Chile between the Arica-Parinacota and Coquimbo regions, with reported incidence of 3-11/100000 inhabitants and mortality of 0.3-0.4/100000. The interruption of vector transmission was reported in 1999 by means of the elimination of the primary vector, Triatoma infestans, from human dwellings, thus the epidemiologic dynamics of this disease should be modified. Here we model the dynamics of Chagaś disease based on previous models for vector and congenital transmission, propose a model that includes both transmission forms and perform simulations. We derive useful relationships for the reproductive number (R₀) showing that it may be expressed as the sum of the vector (R_0V) and congenital (R_0C) contributions. The vector contribution is larger than the congenital one; without the former Chagaś disease vanishes exponentially in two to three generations. Sensitivity analyses showed that the main parameters that intervene are the human bite rate, the density of vectors per human and the mortality rate of the insect vectors. Our model showed that the success of the eradication of Chagaś disease is based on the interruption of domestic transmission. Once this is obtained, the control strategies should focus on avoiding the domiciliation of wild vectors, re-colonization by the primary vector, and an adequate coverage of congenital case treatment.

Modeling Chagas Disease at Population Level to Explain Venezuela's Real Data

Objectives

In this paper we present an age-structured epidemiological model for Chagas disease. This model includes the interactions between human and vector populations that transmit Chagas disease.

Methods

The human population is divided into age groups since the proportion of infected individuals in this population changes with age as shown by real prevalence data. Moreover, the age-structured model allows more accurate information regarding the prevalence, which can help to design more specific control programs. We apply this proposed model to data from the country of Venezuela for two periods, 1961–1971, and 1961–1991 taking into account real demographic data for these periods.

Results

Numerical computer simulations are presented to show the suitability of the age-structured model to explain the real data regarding prevalence of Chagas disease in each of the age groups. In addition, a numerical simulation varying the death rate of the vector is done to illustrate prevention and control strategies against Chagas disease.

Conclusion

The proposed model can be used to determine the effect of control strategies in different age groups.

A MATHEMATICAL MODEL TO ASSESS THE IMMUNE RESPONSE AGAINSTTRYPANOSOMA CRUZIINFECTION

A mathematical model is developed to assess humoral and cellular immune responses against Trypanosoma cruzi infection. Analysis of the model shows a unique non-trivial equilibrium, which is locally asymptotically stable, except in the case of a strong cellular response. When the proliferation of the activated CD8 T cells is increased, this equilibrium becomes unstable and a limit cycle appears. However, this behavior can be avoided by increasing the action of the humoral response. Therefore, unbalanced humoral and cellular responses can be responsible for long asymptomatic period, and the control of Trypanosoma cruzi infection is a consequence of well coordinated action of both humoral and cellular responses.

The basic reproduction number obtained from Jacobian and next generation matrices - A case study of dengue transmission modelling

The basic reproduction number is a key parameter in mathematical modelling of transmissible diseases. From the stability analysis of the disease free equilibrium, by applying Routh-Hurwitz criteria, a threshold is obtained, which is called the basic reproduction number. However, the application of spectral radius theory on the next generation matrix provides a different expression for the basic reproduction number, that is, the square root of the previously found formula. If the spectral radius of the next generation matrix is defined as the geometric mean of partial reproduction numbers, however the product of these partial numbers is the basic reproduction number, then both methods provide the same expression. In order to show this statement, dengue transmission modelling incorporating or not the transovarian transmission is considered as a case study. Also tuberculosis transmission and sexually transmitted infection modellings are taken as further examples.

Prevalence of Chagas disease in pregnant women and congenital transmission of Trypanosoma cruzi in Brazil: a systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence of Chagas disease in pregnant women and the risk of congenital transmission of Trypanosoma cruzi infection in Brazil, through a systematic review and meta-analysis.

METHODS

We searched electronic databases, grey literature and reference lists of included publications to identify epidemiological studies on the prevalence of Chagas disease in pregnant women and on the congenital transmission rate of T. cruzi infection in Brazil published between January 1980 and June 2013. Pooled estimates and 95% confidence intervals (95% CIs) were calculated using fixed- and random-effects models.

RESULTS

Sixteen articles were included - 12 studies on the prevalence of Chagas disease in pregnant women (549,359 pregnant women) and nine on congenital transmission rates (1687 children born to infected mothers). Prevalence of Chagas disease in pregnant women ranged from 0.1% to 8.5%, and congenital transmission rates from 0% to 5.2%. The pooled prevalence of Chagas disease among pregnant women across studies was 1.1% (95% CI: 0.6-2.0); the pooled congenital transmission rate was 1.7% (95% CI: 0.9-3.1). In 2010, 34,629 pregnant women were estimated to be infected with T. cruzi, and 312-1073 children born (mean: 589 cases) with congenital infection.

CONCLUSION

Congenital Chagas disease is a neglected public health problem in Brazil. Systematic congenital Chagas disease control programs through routine prenatal screening for T. cruzi should be widely implemented in Brazil's endemic areas, to identify infected pregnant women and newborns at risk of congenital infection.

Modelling American trypanosomiasis in an endemic zone: application to the initial spread of household infection in the Argentine Chaco

The complex dynamics of Trypanosoma cruzi infection (Chagas disease) involves different actors and multiple transmission routes. Based on the information currently available, here, we propose a new and more comprehensive model to better understand the dynamics of the infection. This mathematical deterministic model was formulated considering: (i) the three clinical forms in humans: acute, chronic indeterminate and chronic with determinate pathology, (ii) the three main modes of transmission in the human population: vector-borne, congenital and transfusional, (iii) populations of triatomines and dogs as the main domestic reservoirs of T. cruzi and (iv) open populations. A numerical simulation was also performed to estimate the initial spread of the infection in a typical rural household in the endemic zone of the Argentine Gran Chaco. We also analysed the incidence of infected individuals corresponding to each of the three species (humans/triatomines/dogs) over times until the appearance of the first case in the other species. The model predicts that, in the absence of control measures, a few infected individuals are sufficient for the establishment and dispersion of the infection in all the inhabitants of the household. The model proposed and the results obtained allow describing the consequences of the presence of infected individuals in any of the three species considered in the dynamics and the output of the infection.

Modelling inter-human transmission dynamics of Chagas disease: analysis and application

Transmission ofTrypanosoma cruzi, the causal agent of Chagas disease, has expanded from rural endemic to urban areas due to migration. This so-calledurban Chagasis an emerging health problem in American, European, Australian and Japanese cities. We present a mathematical model to analyse the dynamics of urban Chagas to better understand its epidemiology. The model considers the three clinical stages of the disease and the main routes of inter-human transmission. To overcome the complexities of the infection dynamics, the next-generation matrix method was developed. We deduced expressions which allowed estimating the number of new infections generated by an infected individual through each transmission route at each disease stage, the basic reproduction number and the number of individuals at each disease stage at the outbreak of the infection. The analysis was applied to Buenos Aires city (Argentina). We estimated that 94% of the new infections are generated by individuals in the chronic indeterminate stage. When migration was not considered, the infection disappeared slowly andR0 = 0·079, whereas when migration was considered, the number of individuals in each stage of the infection tended to stabilize. The expressions can be used to estimate different numbers of infected individuals in any place where only inter-human transmission is possible.

Congenital and oral transmission of American trypanosomiasis: an overview of physiopathogenic aspects

Chagas disease or American trypanosomiasis is a pathology affecting about 8-11 million people in Mexico, Central America, and South America, more than 300 000 persons in the United States as well as an indeterminate number of people in other non-endemic countries such as USA, Spain, Canada and Switzerland. The aetiological agent is Trypanosoma cruzi, a protozoan transmitted by multiple routes; among them, congenital route emerges as one of the most important mechanisms of spreading Chagas disease worldwide even in non-endemic countries and the oral route as the responsible of multiple outbreaks of acute Chagas disease in regions where the vectorial route has been interrupted. The aim of this review is to illustrate the recent research and advances in host-pathogen interaction making a model of how the virulence factors of the parasite would interact with the physiology and immune system components of the placental barrier and gastrointestinal tract in order to establish a response against T. cruzi infection. This review also presents the epidemiological, clinical and diagnostic features of congenital and oral Chagas disease in order to update the reader about the emerging scenarios of Chagas disease transmission.

Mathematical modeling of solid cancer growth with angiogenesis

Background

Cancer arises when within a single cell multiple malfunctions of control systems occur, which are, broadly, the system that promote cell growth and the system that protect against erratic growth. Additional systems within the cell must be corrupted so that a cancer cell, to form a mass of any real size, produces substances that promote the growth of new blood vessels. Multiple mutations are required before a normal cell can become a cancer cell by corruption of multiple growth-promoting systems.

Methods

We develop a simple mathematical model to describe the solid cancer growth dynamics inducing angiogenesis in the absence of cancer controlling mechanisms.

Results

The initial conditions supplied to the dynamical system consist of a perturbation in form of pulse: The origin of cancer cells from normal cells of an organ of human body. Thresholds of interacting parameters were obtained from the steady states analysis. The existence of two equilibrium points determine the strong dependency of dynamical trajectories on the initial conditions. The thresholds can be used to control cancer.

Conclusions

Cancer can be settled in an organ if the following combination matches: better fitness of cancer cells, decrease in the efficiency of the repairing systems, increase in the capacity of sprouting from existing vascularization, and higher capacity of mounting up new vascularization. However, we show that cancer is rarely induced in organs (or tissues) displaying an efficient (numerically and functionally) reparative or regenerative mechanism.

Congenital parasitic infections: a review

This review defines the concepts of maternal-fetal (congenital) and vertical transmissions (mother-to-child) of pathogens and specifies the human parasites susceptible to be congenitally transferred. It highlights the epidemiological features of this transmission mode for the three main congenital parasitic infections due to Toxoplasma gondii, Trypanosoma cruzi and Plasmodium sp. Information on the possible maternal-fetal routes of transmission, the placental responses to infection and timing of parasite transmission are synthesized and compared. The factors susceptible to be involved in parasite transmission and development of congenital parasitic diseases, such as the parasite genotypes, the maternal co-infections and parasitic load, the immunological features of pregnant women and the capacity of some fetuses/neonates to overcome their immunological immaturity to mount an immune response against the transmitted parasites are also discussed and compared. Analysis of clinical data indicates that parasitic congenital infections are often asymptomatic, whereas symptomatic newborns generally display non-specific symptoms. The long-term consequences of congenital infections are also mentioned, such as the imprinting of neonatal immune system and the possible trans-generational transmission. The detection of infection in pregnant women is mainly based on standard serological or parasitological investigations. Amniocentesis and cordocentesis can be used for the detection of some fetal infections. The neonatal infection can be assessed using parasitological, molecular or immunological methods; the place of PCR in such neonatal diagnosis is discussed. When such laboratory diagnosis is not possible at birth or in the first weeks of life, standard serological investigations can also be performed 8-10 months after birth, to avoid detection of maternal transmitted antibodies. The specific aspects of treatment of T. gondii, T. cruzi and Plasmodium congenital infections are mentioned. The possibilities of primary and secondary prophylaxes, as well as the available WHO corresponding recommendations are also presented.