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González-Guzmán S, González-Cano P, Bagu ET, Vázquez-Vega S, Martínez-Salazar M, Juárez-Montiel M, Gutiérrez-Hoya A, Crescencio-Trujillo JA, Sánchez-Montes S, Fernández-Figueroa E, Contreras-López EA, Guerra-Márquez Á, Arroyo-Anduiza CI, Ángeles-Márquez LE, Rodríguez-Trejo E, Bekker-Méndez C, Guerra-Castillo FX, Regalado-Santiago C, Tesoro-Cruz E, Oviedo N, Victoria-Jardón AM, Bautista-Olvera J, García-Ramírez P, Vázquez-Meraz JE, Contreras-Lozano MC, Castillo-Flores VS, Guevara-Reyes R, Girón-Sánchez AR, Arenas-Luis HD, Pecero-Hidalgo MJ, Ríos-Antonio E, Ramírez-Pereda N, Martínez-Mora A, Paredes-Cervantes V. Seroprevalence of Trypanosoma cruzi in Eight Blood Banks in Mexico. Arch Med Res 2022; 53:625-633. [PMID: 36109203 DOI: 10.1016/j.arcmed.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/16/2022] [Accepted: 08/19/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The true prevalence of Chagas disease in Mexico is unknown. However, it has been estimated that 1.1-4 million people are infected with Trypanosoma cruzi, which represents a potential risk for transmission of the disease via contaminated blood. AIM OF THE STUDY To determine the Chagas disease seroprevalence in donors from eight blood banks in the north of Mexico City, and the northeast of the State of Mexico. STUDY DESIGN AND METHODS Serum samples from blood donors (n = 515,038) were tested to detect the presence of anti-Trypanosoma cruzi antibodies in eight blood banks. The serologic screening test was performed in each of the blood banks. To confirm the seropositive blood donors, only two out of the eight blood banks used a test with a different principle with the aim of identifying anti-Trypanosoma cruzi antibodies. All tests were validated by the Mexican Institute for Epidemiological Diagnosis and Reference. RESULTS One thousand two hundred and ten blood donors were seropositive for Trypanosoma cruzi, which represents a 0.23% seroprevalence (95% CI 0.22-0.25%). Of the seropositive blood donors, 97.03 % resided in the northeast area of the State of Mexico, Mexico City, and southern part of the State of Hidalgo. CONCLUSIONS Active transmission of Chagas disease may be occurring in non-endemic regions in the northeast of the State of Mexico.
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Affiliation(s)
- Saúl González-Guzmán
- Banco Central de Sangre, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México; Hospital Regional de Alta Especialidad de Zumpango, Estado de México, México
| | - Patricia González-Cano
- Departamento de Farmacobiología, Universidad de La Cañada, Teotitlán de Flores Magón, Oaxaca, México
| | - Edward T Bagu
- Sanford School of Medicine School, University of South Dakota, Vermillion, South Dakota, USA
| | - Salvador Vázquez-Vega
- Unidad de Investigación Epidemiológica y Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Martha Martínez-Salazar
- División Atención Oncológica Pediátrica, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Margarita Juárez-Montiel
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - Adriana Gutiérrez-Hoya
- Cátedra-CONACyT. Unidad de Diferenciación Celular e Investigación del Cáncer, Facultad de Estudios Superiores, Zaragoza, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - Sokani Sánchez-Montes
- Centro de Medicina Tropical, Universidad Nacional Autónoma de México, Ciudad de México, México; Facultad de Ciencias Biológicas y Agropecuarias, Universidad Veracruzana, Veracruz, México
| | - Edith Fernández-Figueroa
- Departamento de Genómica Poblacional, Genómica Computacional y Biología integrativa. Instituto Nacional De Medicina Genómica, Ciudad de México, México
| | - Erik A Contreras-López
- Hospital General de Zona #25, Instituto Mexicano del Seguro Social, Ciudad de México, México; Hospital General Tacuba, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Ciudad de México, México
| | - Ángel Guerra-Márquez
- Banco Central de Sangre, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Carla I Arroyo-Anduiza
- Banco Central de Sangre, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Laura E Ángeles-Márquez
- Banco Central de Sangre, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Eduardo Rodríguez-Trejo
- Banco Central de Sangre, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Carolina Bekker-Méndez
- Unidad de Investigación Médica en Inmunología e Infectología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Francisco X Guerra-Castillo
- Unidad de Investigación Médica en Inmunología e Infectología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Emiliano Tesoro-Cruz
- Unidad de Investigación Médica en Inmunología e Infectología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Norma Oviedo
- Unidad de Investigación Médica en Inmunología e Infectología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | | | | | - José E Vázquez-Meraz
- Banco de Sangre Regional Ecatepec Las Américas, Ecatepec Estado de México, México
| | | | | | | | | | - H D Arenas-Luis
- Hospital Regional de Alta Especialidad de Zumpango, Estado de México, México
| | | | - Emiliano Ríos-Antonio
- Departamento de Farmacobiología, Universidad de La Cañada, Teotitlán de Flores Magón, Oaxaca, México
| | - Natividad Ramírez-Pereda
- Departamento de Farmacobiología, Universidad de La Cañada, Teotitlán de Flores Magón, Oaxaca, México
| | - Adalberto Martínez-Mora
- Departamento de Farmacobiología, Universidad de La Cañada, Teotitlán de Flores Magón, Oaxaca, México
| | - Vladimir Paredes-Cervantes
- Unidad de Investigación Médica en Inmunología e Infectología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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Worldwide Control and Management of Chagas Disease in a New Era of Globalization: a Close Look at Congenital Trypanosoma cruzi Infection. Clin Microbiol Rev 2022; 35:e0015221. [PMID: 35239422 PMCID: PMC9020358 DOI: 10.1128/cmr.00152-21] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Population movements have turned Chagas disease (CD) into a global public health problem. Despite the successful implementation of subregional initiatives to control vectorial and transfusional Trypanosoma cruzi transmission in Latin American settings where the disease is endemic, congenital CD (cCD) remains a significant challenge. In countries where the disease is not endemic, vertical transmission plays a key role in CD expansion and is the main focus of its control. Although several health organizations provide general protocols for cCD control, its management in each geopolitical region depends on local authorities, which has resulted in a multitude of approaches. The aims of this review are to (i) describe the current global situation in CD management, with emphasis on congenital infection, and (ii) summarize the spectrum of available strategies, both official and unofficial, for cCD prevention and control in countries of endemicity and nonendemicity. From an economic point of view, the early detection and treatment of cCD are cost-effective. However, in countries where the disease is not endemic, national health policies for cCD control are nonexistent, and official regional protocols are scarce and restricted to Europe. Countries of endemicity have more protocols in place, but the implementation of diagnostic methods is hampered by economic constraints. Moreover, most protocols in both countries where the disease is endemic and those where it is not endemic have yet to incorporate recently developed technologies. The wide methodological diversity in cCD diagnostic algorithms reflects the lack of a consensus. This review may represent a first step toward the development of a common strategy, which will require the collaboration of health organizations, governments, and experts in the field.
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Assis TMD, Rabello A, Cota G. Economic evaluations addressing diagnosis and treatment strategies for neglected tropical diseases: an overview. Rev Inst Med Trop Sao Paulo 2021; 63:e41. [PMID: 34037157 PMCID: PMC8149103 DOI: 10.1590/s1678-9946202163041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/23/2021] [Indexed: 11/22/2022] Open
Abstract
Neglected tropical diseases (NTDs) are those affecting vulnerable people and
causing additional social and economic burden. The aim of this study was to
carry out a general overview of the health economic assessments involving the
diagnosis and treatment of six NTDs: cutaneous leishmaniasis (CL), Chagas
disease, cysticercosis, filariasis, schistosomiasis and visceral leishmaniasis
(VL). The literature search was based on two of the main medical literature
databases (Medline and SciELO) and identified 46 studies. Twenty-six studies
(57%) addressed therapeutic strategies, while other 20 (43%) assessed diagnostic
or both diagnostic and therapeutic approaches. The studies were published
between 1994 and 2021, and 57% of them (26/46) were carried out in four
countries. Cost-effectiveness analyses were conducted in 59% (27/46) of the
studies. Economic studies of NTDs have timidly increased in recent years.
Despite the improvement of analytical methods, completeness and accuracy of
information, there are few new technologies applied to NTDs and public health
systems. In addition, economic studies for NTDs are concentrated in a few
countries. Thus, this review points out the need for investment in research,
development and training of human resources dedicated to the economic analysis
in health, especially on NTDs, as a strategy to reduce inequalities by
optimizing the use of health resources.
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Affiliation(s)
- Tália Machado de Assis
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, Minas Gerais, Brazil.,Centro Federal de Educação Tecnológica de Minas Gerais, Contagem, Minas Gerais, Brazil
| | - Ana Rabello
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Cota
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, Minas Gerais, Brazil
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Russell WA, Custer B, Brandeau ML. Optimal portfolios of blood safety interventions: test, defer or modify? Health Care Manag Sci 2021; 24:551-568. [PMID: 33666808 DOI: 10.1007/s10729-021-09557-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/09/2021] [Indexed: 01/13/2023]
Abstract
A safe supply of blood for transfusion is a critical component of the healthcare system in all countries. Most health systems manage the risk of transfusion-transmissible infections (TTIs) through a portfolio of blood safety interventions. These portfolios must be updated periodically to reflect shifting epidemiological conditions, emerging infectious diseases, and new technologies. However, the number of available blood safety portfolios grows exponentially with the number of available interventions, making it impossible for policymakers to evaluate all feasible portfolios without the assistance of a computer model. We develop a novel optimization model for evaluating blood safety portfolios that enables systematic comparison of all feasible portfolios of deferral, testing, and modification interventions to identify the portfolio that is preferred from a cost-utility perspective. We present structural properties that reduce the state space and required computation time in certain cases, and we develop a linear approximation of the model. We apply the model to retrospectively evaluate U.S. blood safety policies for Zika and West Nile virus for the years 2017, 2018, and 2019, defining donor groups based on season and geography. We leverage structural properties to efficiently find an optimal solution. We find that the optimal portfolio varies geographically, seasonally, and over time. Additionally, we show that for this problem the approximated model yields the same optimal solution as the exact model. Our method enables systematic identification of the optimal blood safety portfolio in any setting and any time period, thereby supporting decision makers in efforts to ensure the safety of the blood supply.
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Affiliation(s)
- W Alton Russell
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA. .,Vitalant Research Institute, San Francisco, CA, USA.
| | - Brian Custer
- Vitalant Research Institute, San Francisco, CA, USA.,The University of California, San Francisco, San Francisco, CA, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
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5
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Kruse CS, Guerra DA, Gelillo-Smith R, Vargas A, Krishnan L, Stigler-Granados P. Leveraging Technology to Manage Chagas Disease by Tracking Domestic and Sylvatic Animal Hosts as Sentinels: A Systematic Review. Am J Trop Med Hyg 2020; 101:1126-1134. [PMID: 31549619 PMCID: PMC6838565 DOI: 10.4269/ajtmh.19-0050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Surveillance of Chagas in the United States show more is known about prevalence in animals and vectors than in humans. Leveraging health information technology (HIT) may augment surveillance efforts for Chagas disease (CD), given its ability to disseminate information through health information exchanges (HIE) and geographical information systems (GISs). This systematic review seeks to determine whether technological tracking of Trypanosoma cruzi–infected domestic and/or sylvatic animals as sentinels can serve as a potential surveillance resource to manage CD in the southern United States. A Boolean search string was used in PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Relevance of results was established and analysis of articles was performed by multiple reviewers. The overall Cohen statistic was 0.73, demonstrating moderate agreement among the study team. Four major themes were derived for this systematic review (n = 41): animals act as reservoir hosts to perpetuate CD, transmission to humans could be dependent on cohabitation proximity, variations in T. cruzi genotypes could lead to different clinical manifestations, and leveraging technology to track T. cruzi in domestic animals could reveal prevalent areas or “danger zones.” Overall, our systematic review identified that HIT can serve as a surveillance tool to manage CD. Health information technology can serve as a surveillance tool to manage CD. This can be accomplished by tracking domestic and/or sylvatic animals as sentinels within a GIS. Information can be disseminated through HIE for use by clinicians and public health officials to reach at-risk populations.
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6
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Bern C, Messenger LA, Whitman JD, Maguire JH. Chagas Disease in the United States: a Public Health Approach. Clin Microbiol Rev 2019; 33:e00023-19. [PMID: 31776135 PMCID: PMC6927308 DOI: 10.1128/cmr.00023-19] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Trypanosoma cruzi is the etiological agent of Chagas disease, usually transmitted by triatomine vectors. An estimated 20 to 30% of infected individuals develop potentially lethal cardiac or gastrointestinal disease. Sylvatic transmission cycles exist in the southern United States, involving 11 triatomine vector species and infected mammals such as rodents, opossums, and dogs. Nevertheless, imported chronic T. cruzi infections in migrants from Latin America vastly outnumber locally acquired human cases. Benznidazole is now FDA approved, and clinical and public health efforts are under way by researchers and health departments in a number of states. Making progress will require efforts to improve awareness among providers and patients, data on diagnostic test performance and expanded availability of confirmatory testing, and evidence-based strategies to improve access to appropriate management of Chagas disease in the United States.
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Affiliation(s)
- Caryn Bern
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Jeffrey D Whitman
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - James H Maguire
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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7
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Espinoza B, Martínez I, Schabib-Hany M. First report of family clusters of Chagas disease seropositive blood donors in Mexico City and their epidemiological relevance. Acta Trop 2019; 193:23-30. [PMID: 30771283 DOI: 10.1016/j.actatropica.2019.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/06/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Chagas disease is an important health problem in Latin America. Relatives of T. cruzi seropositive donors could also test positive in serological assays. Therefore, the study of Chagas diseases in family clusters has become important to accurately evaluate the problem that this infectious disease represents. OBJECTIVE to investigate family cluster from blood donors, their serological, clinical and epidemiological status. METHODS 53 family clusters consisting of index case and a variable number of relatives were studied. All the participants had ELISA and Western blot assays, as well as, clinical tests including an electrocardiogram and chest x ray. RESULTS We found that 24.52% of the family clusters had at least one T. cruzi seropositive family member, in addition to the blood donor. Importantly, 20.75% of the index cases and 5.0% of the relatives presented pathological manifestations associated to Chagas disease. Several epidemiological conditions are associated to being T. cruzi seropositive. CONCLUSION blood donor's family clusters have several seropositive to T. cruzi members. Mother-child pairs were also seropositive, suggesting vertical transmition. Pathological symptom associated to Chagas Diseases were present in index cases and family member. These results highlight the importance of studying family clusters to clarify the true magnitude of Chagas disease in Mexico.
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8
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Genetic variation and phylogeography of the Triatoma dimidiata complex evidence a potential center of origin and recent divergence of haplogroups having differential Trypanosoma cruzi and DTU infections. PLoS Negl Trop Dis 2019; 13:e0007044. [PMID: 30689662 PMCID: PMC6366694 DOI: 10.1371/journal.pntd.0007044] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 02/07/2019] [Accepted: 12/02/2018] [Indexed: 11/19/2022] Open
Abstract
The population genetics of Triatoma dimidiata haplogroups was analyzed at landscape and sub-regional scales in Chiapas and regional level across the Mexican Neotropics, and phylogeography of the complex was re-analyzed across its complete geographic range. Two contiguous fragments of the ND4 gene were analyzed due to bias from differential haplogroup specificity using a previously designed sequence. At both landscape (anthropic modification gradient) and regional (demographic, fragmentation, biogeographic, climate) scales, lowest T. dimidiata genetic diversity occurs where there is greatest historical anthropic modification, and where T. cruzi infection prevalence is significantly highest. Trypanosoma cruzi prevalence was significantly higher than expected in haplogroups 1 and 3, while lower than expected in haplogroup 2. There was also a significant difference of DTUI and DTUVI infection frequencies in both haplogroups 1 and 3, while no difference of either in haplogroup 2. All haplogroups from the Mexican Neotropics had moderate to high haplotype diversity, while greatest genetic differentiation was between haplogroups 1 and 3 (above FST = 0.868, p < 0.0001). Divergence of the complex from the MRCA was estimated between 0.97 MYA (95% HPD interval = 0.55–1.53 MYA) and 0.85 MYA (95% HPD interval = 0.42–1.5 MYA) for ND4A and both concatenated fragments, respectively, with primary divergence from the MRCA of haplogroups 2 and 3. Effective population size for Mexican haplogroups 1 and 2 increased between 0.02 and 0.03 MYA. This study supports previous ecological niche evidence for the complex´s origin surrounding the Tehuantepec Isthmus, and provides evidence for recent divergence of three primary dimidiata haplogroups, with differential T. cruzi infection frequency and DTU specificity, important components of vector capacity. Triatoma dimidiata is one of the broadest distributed triatomine species´ complexes transmitting Trypanosoma cruzi. In Mexico, three haplogroups of the T. dimidiata complex have been reported and all are primary vectors of Chagas disease south of the Tehuantepec Isthmus. Given their epidemiological importance, the question arises whether haplogroups have similar genetic diversity in domestic/modified landscapes, as well as infection characteristics and parasite DTU associations, key components of vector capacity. The aim of the present study was to analyze Triatoma dimidiata population genetics across landscapes, sub-regional, regional, and global Neotropical realm scales, using two contiguous fragments of the ND4 gene. Our results support previous evidence for the complex´s origin surrounding the Tehuantepec Isthmus, and provides evidence for recent divergence of three principal dimidiata haplogroups and significant secondary divergence within each. Differential T. cruzi prevalence and Discrete Typing Unit (DTU) specificity for individual haplogroups provide evidence for potential differential vector capacity within the complex in Mexico.
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9
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González-Guzmán S, Paredes-Cervantes V, Bagu ET, Crescencio-Trujillo JA, Guerra-Marquez Á, Rivas N, Alejandre-Aguilar R, Bermúdez-Torres E, González-Cano P. Seroprevalence and geographical distribution of sero-positive blood donors to Trypanosoma cruzi at the central blood bank of the National Medical Center "La Raza". Transfusion 2018; 59:639-647. [PMID: 30520031 DOI: 10.1111/trf.15074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/22/2018] [Accepted: 10/02/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Trypanosoma cruzi is a protozoan parasite that causes Chagas disease endemic to Latin-America. It is estimated that 1.0 to 1.5% of Mexicans are infected with T. cruzi, which constitutes a potential risk of disease transmission via contaminated blood. New cases are being reported worldwide due to the migration of infected people from endemic areas. STUDY DESIGN AND METHODS Serum samples were collected from donors at the Central Blood Bank of the National Medical Center "La Raza" from July 2008 to December 2015 and analyzed for T. cruzi antibodies using Enzyme-linked Immunosorbent Assays. Blood donors were classified serologically as either negative or positive for Chagas disease based on the Official Mexican Standard NOM-032-SSA2-2014. The geographical distribution of sero-positive donors for Chagas disease was then determined based on the donor's areas of residence. RESULTS Of the 510, 047 donors, 595 tested positive for Chagas disease. We found a prevalence of 0.12%, was higher in males (0.13%) than females (0.08%) In both genders, there were more sero-positive donors aged 51-65 years as compared to other age groups. Overall there were more positive donors from the State of Mexico, northern area of Mexico City, and southern area of Hidalgo State, with rates of 67.4%, 20.6%, and 5.9%, respectively. CONCLUSIONS The seroprevalence of Chagas disease in blood donors attending to La Raza BB is low. Chagas disease is more prevalent in the older age groups; most sero-positive donors are from areas considered non-endemic to Chagas disease.
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Affiliation(s)
- Saúl González-Guzmán
- Laboratorio del Banco Central de Sangre del Centro Médico Nacional "La Raza", IMSS, Ciudad de México, Mexico.,Departamento de Investigación del Hospital Regional de Alta Especialidad de Zumpango, Zumpango, Estado de México, Mexico
| | - Vladimir Paredes-Cervantes
- Laboratorio de Urgencias del Hospital General del Centro Médico Nacional "La Raza", IMSS, Ciudad de México, Mexico.,Escuela Nacional de Ciencias Biológicas del Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Edward Tshima Bagu
- Department of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillon, South Dakota, USA
| | - José A Crescencio-Trujillo
- Departamento de Medicina Preventiva del Hospital Regional de Alta Especialidad de Zumpango, Zumpango, Estado de México, Mexico
| | - Ángel Guerra-Marquez
- Banco Central de Sangre del Centro Médico Nacional "La Raza", IMSS, Ciudad de México, Mexico
| | - Nancy Rivas
- Departamento de Parasitología de la Escuela Nacional de Ciencias Biológicas del Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Ricardo Alejandre-Aguilar
- Departamento de Parasitología de la Escuela Nacional de Ciencias Biológicas del Instituto Politécnico Nacional, Ciudad de México, Mexico
| | | | - Patricia González-Cano
- Departamento de Farmacobiología, Universidad de "La Cañada", Teotitlán de Flores Magón, Oaxaca, Mexico
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10
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Bartsch SM, Avelis CM, Asti L, Hertenstein DL, Ndeffo-Mbah M, Galvani A, Lee BY. The economic value of identifying and treating Chagas disease patients earlier and the impact on Trypanosoma cruzi transmission. PLoS Negl Trop Dis 2018; 12:e0006809. [PMID: 30395603 PMCID: PMC6237415 DOI: 10.1371/journal.pntd.0006809] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 11/15/2018] [Accepted: 09/02/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The World Health Organization's 2020 Goals for Chagas disease include access to antiparasitic treatment and care of all infected/ill patients. Policy makers need to know the economic value of identifying and treating patients earlier. However, the economic value of earlier treatment to cure and prevent the Chagas' spread remains unknown. METHODS We expanded our existing Chagas disease transmission model to include identification and treatment of Chagas disease patients. We linked this to a clinical and economic model that translated chronic Chagas disease cases into health and economic outcomes. We evaluated the impact and economic outcomes (costs, cost-effectiveness, cost-benefit) of identifying and treating different percentages of patients in the acute and indeterminate disease states in a 2,000-person village in Yucatan, Mexico. RESULTS In the absence of early treatment, 50 acute and 22 new chronic cases occurred over 50 years. Identifying and treating patients in the acute stage averted 0.5-5.4 acute cases, 0.6-5.5 chronic cases, and 0.6-10.8 disability-adjusted life years (DALYs), saving $694-$7,419 and $6,976-$79,950 from the third-party payer and societal perspectives, respectively. Treating in the indeterminate stage averted 2.2-4.9 acute cases, 6.1-12.8 chronic cases, and 11.7-31.1 DALYs, saving $7,666-$21,938 from the third-party payer perspective and $90,530-$243,068 from the societal perspective. Treating patients in both stages averted ≤9 acute cases and ≤15 chronic cases. Identifying and treating patients early was always economically dominant compared to no treatment. Identifying and treating patients earlier resulted in a cumulative cost-benefit of $7,273-$224,981 at the current cost of identification and treatment. CONCLUSIONS Even when identifying and treating as little as 5% of cases annually, treating Chagas cases in the acute and indeterminate stages reduces transmission and provides economic and health benefits. This supports the need for improved diagnostics and access to safe and effective treatment.
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Affiliation(s)
- Sarah M. Bartsch
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Cameron M. Avelis
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Lindsey Asti
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Daniel L. Hertenstein
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Martial Ndeffo-Mbah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, United States of America
| | - Alison Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, United States of America
| | - Bruce Y. Lee
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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11
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Ingber A, Garcia MN, Leon J, Murray KO. Chagas Disease Knowledge and Risk Behaviors of the Homeless Population in Houston, TX. J Racial Ethn Health Disparities 2018; 5:229-234. [PMID: 28567616 PMCID: PMC6239415 DOI: 10.1007/s40615-017-0362-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
Chagas disease is a parasitic infection, caused by Trypanosoma cruzi, endemic in Latin America. Sylvatic T. cruzi-infected triatomine vectors are present in rural and urban areas in the southern USA and may transmit T. cruzi infection to at-risk populations, such as homeless individuals. Our study aimed to evaluate Chagas disease knowledge and behaviors potentially associated with transmission risk of Chagas disease among Houston, Texas' homeless population by performing interviews with 212 homeless individuals. The majority of the 212 surveyed homeless individuals were male (79%), African-American (43%), American-born individuals (96%). About 30% of the individuals reported having seen triatomines in Houston, and 25% had evidence of blood-borne transmission risk (IV drug use and/or unregulated tattoos). The median total time homeless was significantly associated with recognition of the triatomine vector. Our survey responses indicate that the homeless populations may exhibit potential risks for Chagas disease, due to increased vector exposure, and participation in blood-borne pathogen risk behaviors. Our findings warrant additional research to quantify the prevalence of Chagas disease among homeless populations.
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Affiliation(s)
- Alexandra Ingber
- Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Melissa N Garcia
- National School of Tropical Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Juan Leon
- Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Kristy O Murray
- National School of Tropical Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
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12
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Lee BY, Bartsch SM, Skrip L, Hertenstein DL, Avelis CM, Ndeffo-Mbah M, Tilchin C, Dumonteil EO, Galvani A. Are the London Declaration's 2020 goals sufficient to control Chagas disease?: Modeling scenarios for the Yucatan Peninsula. PLoS Negl Trop Dis 2018; 12:e0006337. [PMID: 29554086 PMCID: PMC5875875 DOI: 10.1371/journal.pntd.0006337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/29/2018] [Accepted: 02/22/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The 2020 Sustainable Development goals call for 100% certified interruption or control of the three main forms of Chagas disease transmission in Latin America. However, how much will achieving these goals to varying degrees control Chagas disease; what is the potential impact of missing these goals and if they are achieved, what may be left? METHODS We developed a compartmental simulation model that represents the triatomine, human host, and non-human host populations and vector-borne, congenital, and transfusional T. cruzi transmission between them in the domestic and peridomestic settings to evaluate the impact of limiting transmission in a 2,000 person virtual village in Yucatan, Mexico. RESULTS Interruption of domestic vectorial transmission had the largest impact on T. cruzi transmission and prevalence in all populations. Most of the gains were achieved within the first few years. Controlling vectorial transmission resulted in a 46.1-83.0% relative reduction in the number of new acute Chagas cases for a 50-100% interruption in domestic vector-host contact. Only controlling congenital transmission led to a 2.4-8.1% (30-100% interruption) relative reduction in the total number of new acute cases and reducing only transfusional transmission led to a 0.1-0.3% (30-100% reduction). Stopping all three forms of transmission resulted in 0.5 total transmission events over five years (compared to 5.0 with no interruption); interrupting all forms by 30% resulted in 3.4 events over five years per 2,000 persons. CONCLUSIONS While reducing domestic vectorial, congenital, and transfusional transmission can successfully reduce transmission to humans (up to 82% in one year), achieving the 2020 goals would still result in 0.5 new acute cases per 2,000 over five years. Even if the goals are missed, major gains can be achieved within the first few years. Interrupting transmission should be combined with other efforts such as a vaccine or improved access to care, especially for the population of already infected individuals.
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Affiliation(s)
- Bruce Y. Lee
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
| | - Sarah M. Bartsch
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Laura Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, United States of America
| | - Daniel L. Hertenstein
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Cameron M. Avelis
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Martial Ndeffo-Mbah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, United States of America
| | - Carla Tilchin
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Eric O. Dumonteil
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States of America
| | - Alison Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, United States of America
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Alvis NJ, Díaz DP, Castillo L, Alvis NR, Bermúdez MI, Berrío OM, Beltrán M, Castañeda-Orjuela CA. [Costs of Chagas' disease screening test in blood donors in two Colombian blood banks, 2015]. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2018; 38:61-68. [PMID: 29668135 DOI: 10.7705/biomedica.v38i0.3477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 01/25/2017] [Accepted: 04/09/2017] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Transfusion is a mechanism of transmission of Chagas' disease. There are no studies on the costs of the screening test in Colombian blood banks. OBJECTIVE To estimate the costs of the screening test for Chagas' disease among blood donors in two Colombian blood banks, 2015. MATERIALS AND METHODS We conducted a micro-costing study from the perspective of the health care provider to estimate the cost of Chagas' disease testing in two blood banks, Banco de Sangre de la Cruz Roja, Seccional Bolívar, and Banco de Sangre del Hospital de Yopal, Casanare, taking into account four cost categories: 1) Administrative costs: public services and insurance costs were calculated based on the blood bank area in square meters; 2) capital costs: building and equipment costs that were annualized using a 3% discount rate and a lifespan of 20 years for building and five for equipment; 3) costs of Chagas' disease test materials and reagents adjusted by blood bank production level, and 4) costs of staff in charge of Chagas' disease test processing. The costs of transfusion bagsand immunohematology tests are also reported. RESULTS The cost of Chagas' disease test in the blood bank of Seccional Bolívar was COP$ 37,804 (USD$ 12), and the blood bag and immunohematology test costs were COP$ 25,941 (USD$ 8.2) and COP$ 6,800 (USD$ 2.2), respectively. In the blood bank of Yopal, Casanare, the costs were COP$ 77,384 (USD$ 24.6), COP$ 30,141 (USD$ 9.6) and COP$ 12,627 (USD$ 4), respectively. Personnel cost accounted for the highest percentage of the total cost for both blood banks (47.5% in Seccional Bolívar, and 55.7% in Yopal, Casanare). CONCLUSION Our results are an important input for the planning of services and cost-effectiveness studies for screening tests for Chagas' disease in Colombian blood banks.
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Affiliation(s)
- Nelson José Alvis
- Observatorio Nacional de Salud, Instituto Nacional de Salud, Bogotá, D.C., Colombia Grupo de Investigación en Gestión Hospitalaria y Políticas de Salud, ALZAK Foundation-Universidad de la Costa, Barranquilla, Colombia.
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Carmona-Castro O, Moo-Llanes DA, Ramsey JM. Impact of climate change on vector transmission of Trypanosoma cruzi (Chagas, 1909) in North America. MEDICAL AND VETERINARY ENTOMOLOGY 2018; 32:84-101. [PMID: 28887895 DOI: 10.1111/mve.12269] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/05/2017] [Accepted: 07/29/2017] [Indexed: 06/07/2023]
Abstract
Climate change can influence the geographical range of the ecological niche of pathogens by altering biotic interactions with vectors and reservoirs. The distributions of 20 epidemiologically important triatomine species in North America were modelled, comparing the genetic algorithm for rule-set prediction (GARP) and maximum entropy (MaxEnt), with or without topographical variables. Potential shifts in transmission niche for Trypanosoma cruzi (Trypanosomatida: Trypanosomatidae) (Chagas, 1909) were analysed for 2050 and 2070 in Representative Concentration Pathway (RCP) 4.5 and RCP 8.5. There were no significant quantitative range differences between the GARP and MaxEnt models, but GARP models best represented known distributions for most species [partial-receiver operating characteristic (ROC) > 1]; elevation was an important variable contributing to the ecological niche model (ENM). There was little difference between niche breadth projections for RCP 4.5 and RCP 8.5; the majority of species shifted significantly in both periods. Those species with the greatest current distribution range are expected to have the greatest shifts. Positional changes in the centroid, although reduced for most species, were associated with latitude. A significant increase or decrease in mean niche elevation is expected principally for Neotropical 1 species. The impact of climate change will be specific to each species, its biogeographical region and its latitude. North American triatomines with the greatest current distribution ranges (Nearctic 2 and Nearctic/Neotropical) will have the greatest future distribution shifts. Significant shifts (increases or decreases) in mean elevation over time are projected principally for the Neotropical species with the broadest current distributions. Changes in the vector exposure threat to the human population were significant for both future periods, with a 1.48% increase for urban populations and a 1.76% increase for rural populations in 2050.
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Affiliation(s)
- O Carmona-Castro
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Mexico
| | - D A Moo-Llanes
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), México City, Mexico
| | - J M Ramsey
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Mexico
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