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Limongi JE, Santos KAR, Perissato IL, Pinto RDMC, Mendonça TMDS, Rinaldi AEM. Survival analysis of Chagas disease patients, beneficiaries of social security and social assistance in Brazil, 1942-2016. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27:e240020. [PMID: 38775617 PMCID: PMC11111094 DOI: 10.1590/1980-549720240020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/29/2023] [Accepted: 02/02/2024] [Indexed: 05/24/2024] Open
Abstract
OBJECTIVE To analyze the survival of patients with Chagas disease, beneficiaries of social security and social assistance, in Brazil, from 1942 to 2016. METHODS This is a retrospective cohort study with data from the Brazilian Ministry of Social Security. The event of interest was death, and the survival functions were estimated by the Kaplan-Meier and Cox regression methods. RESULTS In the period "onset of the disease until death", women (HR=0.54; 95%CI 0.43-0.53) and receiving social security benefits (HR=0.13; 95%CI 0.11-0.23) were associated with longer survival. Lower survival was associated with the cardiac form of the disease (HR=2.64; 95%CI 2.23-3.12), living in a rural area (HR=1.23; 95%CI 1.14-1.21), and manifestation of the disease between the years 2000 and 2016 (HR=5.32; 95%CI 4.74-5.93). Likewise, in the period "work disability until death", women (HR=0.51; 95%CI 0.41-0.52) and receiving social security benefits (HR=0.24; 95%CI 0,14-0.45) were associated with longer survival, as well as the cardiac form of the disease (HR=1.95; 95%CI 1.83-2.13), living in a rural area (HR=1.31; 95%CI 1.21-1.54), and manifestation of the disease between 2000 and 2016 (HR=1.53; 95%CI 1.33-1.71) were associated with lower survival. CONCLUSION The main predictors of mortality and survival of patients with Chagas disease who receive social security and assistance benefits in Brazil were presented. These findings can guide the definition of priorities for follow-up actions by Primary Health Care, currently recommended for the longitudinal management of the disease.
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Affiliation(s)
- Jean Ezequiel Limongi
- Universidade Federal de Uberlândia, Collective Health Program – Uberlândia (MG), Brazil
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Laporta GZ, Lima MM, Maia da Costa V, de Lima Neto MM, Palmeira SL, Rodovalho SR, Aragón López MA. [Estimation of prevalence of chronic Chagas disease in Brazilian municipalitiesEstimación de la prevalencia de la enfermedad de Chagas crónica en los municipios brasileños]. Rev Panam Salud Publica 2024; 48:e28. [PMID: 38576844 PMCID: PMC10993810 DOI: 10.26633/rpsp.2024.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/23/2024] [Indexed: 04/06/2024] Open
Abstract
Objective The objective of this study is to estimate the prevalence of chronic Chagas disease (CCD) in Brazil: in the general population, in women, and in women of childbearing age. Methods A meta-analysis of the literature was conducted to extract data on the prevalence of CCD in municipalities in Brazil in the 2010-2022 period: in the general population, in women, and in women of childbearing age. Municipal-level CCD indicators available in health information systems were selected. Statistical modeling of the data extracted from the meta-analysis (based on data obtained from information systems) was applied to linear, generalized linear, and additive models. Results The five most appropriate models were selected from a total of 549 models tested to obtain a consensus model (adjusted R2 = 54%). The most important predictor was self-reported CCD in the primary health care information system. Zero prevalence was estimated in 1 792 (32%) of Brazil's 5 570 municipalities; in the remaining 3 778 municipalities, average prevalence of the disease was estimated at 3.25% (± 2.9%). The number of carriers of CCD was estimated for the Brazilian population (~3.7 million), for women (~2.1 million) and for women of childbearing age (~590 000). The disease reproduction rate was calculated at 1.0336. All estimates refer to the 2015-2016 period. Conclusions The estimated prevalence of CCD, especially among women of childbearing age, highlights the challenge of vertical transmission in Brazilian municipalities. Mathematical projections suggest that these estimates should be included in the national program for the elimination of vertical transmission of Chagas disease.
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Affiliation(s)
- Gabriel Zorello Laporta
- Centro Universitário FMABCSanto AndréSPBrasilCentro Universitário FMABC, Santo André, SP, Brasil
| | - Mayara Maia Lima
- Secretaria de Vigilância em Saúde e AmbienteMinistério da SaúdeBrasíliaDFBrasilSecretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasília, DF, Brasil
| | - Veruska Maia da Costa
- Secretaria de Vigilância em Saúde e AmbienteMinistério da SaúdeBrasíliaDFBrasilSecretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasília, DF, Brasil
| | - Milton Martins de Lima Neto
- Secretaria de Vigilância em Saúde e AmbienteMinistério da SaúdeBrasíliaDFBrasilSecretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasília, DF, Brasil
| | - Swamy Lima Palmeira
- Secretaria de Vigilância em Saúde e AmbienteMinistério da SaúdeBrasíliaDFBrasilSecretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasília, DF, Brasil
| | - Sheila Rodrigues Rodovalho
- Organização Pan-Americana da SaúdeOrganização Mundial da SaúdeBrasíliaDFBrasilOrganização Pan-Americana da Saúde/Organização Mundial da Saúde, Brasília, DF, Brasil
| | - Miguel Angel Aragón López
- Organização Pan-Americana da SaúdeOrganização Mundial da SaúdeBrasíliaDFBrasilOrganização Pan-Americana da Saúde/Organização Mundial da Saúde, Brasília, DF, Brasil
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Pavan TBS, Dias DP, Cangussú MM, Dutra VPP, Sampaio DD, Santos FLN. Seroepidemiology of Chagas disease in at-risk individuals in Caraíbas, a city with high endemicity in Bahia State, Brazil. Front Public Health 2023; 11:1196403. [PMID: 37808995 PMCID: PMC10556690 DOI: 10.3389/fpubh.2023.1196403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction In Brazil, an estimated 1.1 million people are infected with Trypanosoma cruzi, the causative agent of Chagas disease (CD). Despite the high number of cases, the estimated prevalence of infection per 100 inhabitants is low (0.03). However, the actual number of chronically infected individuals is still unknown. Therefore, we sought to determine the prevalence of chronic CD in at-risk individuals in Caraíbas (Bahia, Brazil) through active case finding. Methods A total of 572 individuals living in rural or urban areas of Caraíbas were eligible for the study. A serum sample was collected from 226 individuals, and the diagnosis performed according to international guidelines. Results The overall prevalence of anti-T. cruzi IgG was 4.42%. The median age of anti-T. cruzi IgG-positive individuals was 54.5 years, and the female-to-male ratio was 1.5:1. The prevalence of anti-T. cruzi IgG was similar in rural (4.29%) and urban areas (4.65%). Discussion Compared with national estimates, we concluded that Caraíbas had a high prevalence for chronic CD and a high risk for persistent transmission. Through our study, it was possible to monitor individuals who were unaware of their clinical condition, thus improving their quality of life.
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Affiliation(s)
- Tycha Bianca Sabaini Pavan
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (Fiocruz-BA), Salvador, Brazil
| | - Deorlan Pereira Dias
- Chagas Disease Working Group, Municipal Health Department, Center for Endemic Diseases, Caraíbas, Brazil
| | - Márcia Moraes Cangussú
- Bahia State Department of Health, Southwest Regional Health Center, Vitória da Conquista, Brazil
| | | | - Daniel Dias Sampaio
- Brazil’s Family Health Strategy, Municipal Health Department, Tremedal, Brazil
| | - Fred Luciano Neves Santos
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (Fiocruz-BA), Salvador, Brazil
- Integrated Translational Program in Chagas Disease from Fiocruz (Fio-Chagas), Oswaldo Cruz Foundation (Fiocruz-RJ), Rio de Janeiro, Brazil
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Portela LF, Mesquita MB, Giraldes JM, Varela MC, Brasil PEAA, Costa AR, Mediano MFF, Sangenis LHC, Pedrosa RC, Hasslocher-Moreno AM, Saraiva RM. Socio-epidemiological factors and comorbidities associated with Chagas disease manifestations in two urban reference health care centres in Rio de Janeiro, Brazil. Trans R Soc Trop Med Hyg 2023; 117:102-110. [PMID: 35896031 DOI: 10.1093/trstmh/trac068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/11/2022] [Accepted: 07/02/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Chagas disease (CD) is still an important public health issue in Latin America. This study aims to analyse the association between socio-epidemiological factors and comorbidities with clinical manifestations of CD. METHODS We performed a cross-sectional study of 985 adult patients (65±11 y; 59.5% women) with CD. Data collection was based on questionnaires and medical records review. CD clinical forms (indeterminate, digestive, cardiac and cardiodigestive) and the stages of the cardiac form were classified according to the II Brazilian Consensus on CD. Statistical analyses were based on univariate and multivariate logistic regression. RESULTS Older age and Brazilian birth state (Minas Gerais and Bahia) were associated with a greater likelihood of the cardiac form of CD. A greater likelihood of the digestive form was seen in men and those of older age. Patients with arterial hypertension and diabetes were less likely to have the digestive form. Men had a greater likelihood of having a more severe cardiac presentation. Those from Minas Gerais and Bahia states had a greater likelihood of having stage B1 or B2. CONCLUSIONS The results reinforce the aging of the CD population living in urban areas in Brazil, the high prevalence of comorbidities and that epidemiology, sex and the presence of comorbidities may be related to the clinical form of CD.
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Affiliation(s)
- Luciana F Portela
- Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Av. Brasil 4365, Rio de Janeiro, 21040-900, Brazil
| | - Maíra B Mesquita
- Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Av. Brasil 4365, Rio de Janeiro, 21040-900, Brazil
| | - Juliana M Giraldes
- Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Av. Brasil 4365, Rio de Janeiro, 21040-900, Brazil
| | - Margareth C Varela
- Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Av. Brasil 4365, Rio de Janeiro, 21040-900, Brazil
| | - Pedro Emmanuel A A Brasil
- Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Av. Brasil 4365, Rio de Janeiro, 21040-900, Brazil
| | - Andréa R Costa
- Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Av. Brasil 4365, Rio de Janeiro, 21040-900, Brazil
| | - Mauro F F Mediano
- Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Av. Brasil 4365, Rio de Janeiro, 21040-900, Brazil
| | - Luiz Henrique C Sangenis
- Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Av. Brasil 4365, Rio de Janeiro, 21040-900, Brazil
| | - Roberto C Pedrosa
- Hospital Universitário Clementino Fraga Filho/Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco 255, Rio de Janeiro, 21941-913, Brazil
| | - Alejandro Marcel Hasslocher-Moreno
- Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Av. Brasil 4365, Rio de Janeiro, 21040-900, Brazil.,Latin American Network for Chagas Disease, NHEPACHA
| | - Roberto M Saraiva
- Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Av. Brasil 4365, Rio de Janeiro, 21040-900, Brazil.,Latin American Network for Chagas Disease, NHEPACHA
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Santana MDA, Leal ARDS, de Sousa RLT, Brandão Dos Santos LV, Mascarenhas MDM, Rodrigues MTP, Mendonça VJ. Epidemiological aspects of Chagas disease in the state of Piauí (Northeast Brazil) in the period 2010-2019. Acta Trop 2022; 228:106338. [PMID: 35114171 DOI: 10.1016/j.actatropica.2022.106338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/23/2022] [Accepted: 01/29/2022] [Indexed: 11/16/2022]
Abstract
Chagas disease (ChD), caused by the hemoflagellate protozoan Trypanosoma cruzi, is an important morbidity that affects approximately six million people in the American continent. T. cruzi parasites are mainly transmitted to human by the infected feces of blood-sucking triatomine insects. The persistent disease is endemic in many regions of South America, mostly affecting residents of rural areas. The aim of this study was to evaluate epidemiological aspects of ChD in the state of Pi-auí located in northeastern Brazil. This is an analytical cross-sectional study carried out from the collection of data of the Notifiable Diseases Information System (SINAN, in Portuguese, Sistema de Informações de Agravos de Notificação) of suspected and confirmed cases of acute ChD in the state of Piauí, in the period 2010-2019. Associations between T. cruzi positivity and the study variables were determined by the chi-square test or Fisher's exact test and were raised as prevalence ratios (PR) with 95% confidence interval. According to this survey, 517 suspected cases of acute ChD were reported in Piauí, with 70 cases (13.5%) confirmed. In 88.5% of confirmed cases, confirmation occurred by laboratory diagnosis. Most of the confirmed cases occurred in municipalities located in the semiarid region, with the municipality of São João do Piauí presenting the highest number of cases. Regarding sociodemographic data, females represent 55.7% of cases, people over 50 years of age (55.7%), being three cases in people up to 18 years of age, and less than 8 years of schooling (67.1%). 77.9% of confirmed cases had vector transmission as the probable form of infection. The data available in this study conclude that vectorial transmission of ChD in the state of Piauí remains active. This fact is corroborated by the number of notified and confirmed cases of acute ChD, requiring housing improvement programs and more effective epidemiological surveillance to control the transmission of the disease in the state.
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Affiliation(s)
- Maricélia de Aquino Santana
- Centro de Ciências da Saúde, Departamento de Parasitologia e Microbiologia, Programa de Pós-Graduação em Saúde e Comunidade, Universidade Federal do Piauí Campus Ministro Petrônio Portella, Teresina, Piauí CEP 64049-550, Brazil
| | - Anangela Ravena da Silva Leal
- Departamento de Biologia Parasitária, Laboratório de Biologia Molecular e Doenças Endêmicas-LABIMDOE, Instituto Oswaldo Cruz (IOC/Fiocruz), Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro CEP 21040-900, Brazil
| | - Raimundo Leoberto Torres de Sousa
- Departamento de Biologia Parasitária, Laboratório de Biologia Molecular e Doenças Endêmicas-LABIMDOE, Instituto Oswaldo Cruz (IOC/Fiocruz), Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro CEP 21040-900, Brazil
| | - Luan Victor Brandão Dos Santos
- Centro de Ciências da Saúde, Departamento de Parasitologia e Microbiologia, Programa de Pós-Graduação em Saúde e Comunidade, Universidade Federal do Piauí Campus Ministro Petrônio Portella, Teresina, Piauí CEP 64049-550, Brazil
| | - Márcio Denis Medeiros Mascarenhas
- Centro de Ciências da Saúde, Departamento de Medicina Comunitária, Programa de Pós-Graduação em Saúde e Comunidade, Universidade Federal do Piauí Campus Ministro Petrônio Portella, Teresina, Piauí CEP 64049-550, Brazil; Centro de Inteligências em Agravos Tropicais e negligenciados, Teresina, Piauí, Brazil, CEP 64001-450
| | - Malvina Thaís Pacheco Rodrigues
- Centro de Ciências da Saúde, Departamento de Medicina Comunitária, Programa de Pós-Graduação em Saúde e Comunidade, Universidade Federal do Piauí Campus Ministro Petrônio Portella, Teresina, Piauí CEP 64049-550, Brazil; Centro de Inteligências em Agravos Tropicais e negligenciados, Teresina, Piauí, Brazil, CEP 64001-450
| | - Vagner José Mendonça
- Centro de Ciências da Saúde, Departamento de Parasitologia e Microbiologia, Programa de Pós-Graduação em Saúde e Comunidade, Universidade Federal do Piauí Campus Ministro Petrônio Portella, Teresina, Piauí CEP 64049-550, Brazil; Centro de Inteligências em Agravos Tropicais e negligenciados, Teresina, Piauí, Brazil, CEP 64001-450..
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Fidalgo ASODBV, Costa ACD, Ramos Júnior AN, Leal LKAM, Martins AMC, Silva Filho JDD, Ferreira AF, Nunes FMM, Marinho Júnior FAA, Lacerda JM, Oliveira MDF. Seroprevalence and risk factors of Chagas disease in a rural population of the Quixeré municipality, Ceará, Brazil. Rev Soc Bras Med Trop 2021; 54:S0037-86822021000100625. [PMID: 33681912 PMCID: PMC8008851 DOI: 10.1590/0037-8682-0247-2020] [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: 05/01/2020] [Accepted: 10/15/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION This study estimated the seroprevalence and risk factors of Chagas disease (CD) in a population of the Quixeré municipality, Ceará. METHODS We conducted serological methods to detect the Trypanosoma cruzi infection. The other variables were evaluated by a standardized questionnaire. RESULTS The estimated prevalence of CD was 3.7%. Male sex, age >40 years, being farmers, low education level, origin from rural areas, and being born in Quixeré were significantly associated with infection. CONCLUSION CD persists in this rural population of Northeast Brazil. Poverty, low education, and limited information regarding CD are critical issues that need to be addressed.
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Affiliation(s)
| | - Alanna Carla da Costa
- Universidade Federal do Ceará, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, CE, Brasil
| | - Alberto Novaes Ramos Júnior
- Universidade Federal do Ceará, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Fortaleza, CE, Brasil
| | | | - Alice Maria Costa Martins
- Universidade Federal do Ceará, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, CE, Brasil
| | - José Damião da Silva Filho
- Universidade Federal do Ceará, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Fortaleza, CE, Brasil
| | - Anderson Fuentes Ferreira
- Universidade Federal do Ceará, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Fortaleza, CE, Brasil
| | | | | | | | - Maria de Fátima Oliveira
- Universidade Federal do Ceará, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, CE, Brasil
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Mills RM. Chagas Disease: Epidemiology and Barriers to Treatment. Am J Med 2020; 133:1262-1265. [PMID: 32592664 DOI: 10.1016/j.amjmed.2020.05.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/24/2022]
Abstract
Chronic human infection by the protozoan parasite Trypanosoma cruzi, known as Chagas disease, results in heart failure and death in 20%-30% of affected individuals. Recognition and treatment of the infection are difficult. Disease control requires elimination of the vector, the reduviid bug, that infests housing of poor quality in endemic areas. In South America, control has largely succeeded in the Southern Cone countries-Argentina, Chile, Uruguay, southern Brazil and São Paulo, and Paraguay-but lags severely in the Northern Triangle (Central American) countries: El Salvador, Honduras, and Guatemala. Surges in poverty and violence in Central America have increased immigration of persons at risk for Chagas disease to the United States, and immigrants to the United States with Chagas disease face multiple barriers to obtaining effective care. These include issues with financing and payment for health care, limited effectiveness of screening and diagnosis, limited effectiveness of available treatment, and lack of provider awareness, public health education, and research. Each of these barriers presents a unique public health challenge.
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Affiliation(s)
- Roger M Mills
- Vice President, Clinical Development, Renova Therapeutics, Inc., Carlsbad, CA.
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Dias JCA, Monteiro LHA. Clustered Breeding Sites: Shelters for Vector-Borne Diseases. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:2575017. [PMID: 30112017 PMCID: PMC6077366 DOI: 10.1155/2018/2575017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/03/2018] [Indexed: 11/17/2022]
Abstract
Here, the propagation of vector-borne diseases is modeled by using a probabilistic cellular automaton. Numerical simulations considering distinct spatial distributions and time variations of the vector abundance are performed, in order to investigate their impacts on the number of infected individuals of the host population. The main conclusion is as follows: in the clustered distributions, the prevalence is lower, but the eradication is more difficult to be achieved, as compared to homogeneous distributions. This result can be relevant in the implementation of preventive surveillance measures.
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Affiliation(s)
- J. C. A. Dias
- Universidade Presbiteriana Mackenzie, PPGEEC, São Paulo, SP, Brazil
| | - L. H. A. Monteiro
- Universidade Presbiteriana Mackenzie, PPGEEC, São Paulo, SP, Brazil
- Universidade de São Paulo, Escola Politécnica, São Paulo, SP, Brazil
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Fidalgo ASODBV, Costa ACD, Silva Filho JDD, Cândido DDS, Freitas EC, Pereira LDS, Andrade MCD, Gomes KCMS, Bezerra CM, Oliveira MDF. Insect vectors of Chagas disease (Trypanosoma cruzi) in Northeastern Brazil. Rev Soc Bras Med Trop 2018; 51:174-182. [DOI: 10.1590/0037-8682-0408-2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/07/2018] [Indexed: 11/22/2022] Open
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