ABSTRACT
In Argentina, around 1500 children are born each year with Trypanosoma cruzi infection. Mother-to-child transmission is the main source of new cases of Chagas disease and of its occurrence in non-endemic areas. Our objective was to survey the information available on congenital T. cruzi infection, to analyze its evolution and its relation with the index of maternal infection and the risk for vector-borne infection by province of Argentina. Data concerning the public health sector for the period 1997-2014 were retrieved from national and local records. An increase in the number and proportion of pregnant women examined for Chagas was observed, reaching 60.3% coverage in 2014. The prevalence of maternal infection dropped from 9.0% to 2.6%. The control of newborns from infected women was highly variable (23.3%-93.6%), and data quality was deficient, varying amply by province and year. The rate of congenital infection had an irregular evolution and its national average fluctuated between 1.9 and 8.2%. An association was observed between the risk for vector-borne infection and the prevalence of maternal infection by province (Wilcoxon test p = 0.017). The rate of congenital transmission by province was neither associated with the rate of maternal infection (linear regression p = 0.686) nor with the risk for vectorial infection (Kruskal-Wallis test p = 0.3154). The available data show insufficient control of children born from infected mothers, as well as deficient recording of these procedures. Both aspects must be improved to achieve better epidemiological information and to enable timely access of infected children to treatment.
En Argentina nacen alrededor de 1500 niños por año con infección por Trypanosoma cruzi. La transmisión vertical es la principal vía de generación de nuevos casos de Chagas, y de su presencia en zonas no endémicas. Nuestro objetivo fue relevar datos disponibles sobre infección congénita por T. cruzi, analizar su evolución y relación con indicadores de prevalencia materna y riesgo vectorial por regiones de Argentina. Se investigaron fuentes oficiales y bibliografía científica. Se obtuvieron datos nacionales y provinciales del período 1997-2014 del subsector público de salud. Se observó un aumento de embarazadas controladas, que alcanzó una cobertura del 60.3% en 2014. La prevalencia de infección materna descendió de 9.0% a 2.6%. El control en hijos de mujeres infectadas fue variable (entre 23.3% y 93.6% de los niños en riesgo) y la calidad del dato fue deficiente según provincia y año. La tasa de transmisión congénita tuvo una evolución irregular y, según un indicador corregido, la tasa media nacional fluctuó entre 1.9 y 8.2%. Se observó asociación entre la prevalencia materna y el riesgo vectorial en las provincias (test Wilcoxon p = 0.017). La tasa de transmisión congénita provincial no mostró relación con la tasa de infección materna (regresión lineal p = 0.686) ni con el nivel de riesgo vectorial (test Kruskal-Wallis p = 0.3154). Los datos disponibles muestran una deficiencia en los controles de hijos de madres infectadas y de su notificación en el período analizado. Deben mejorar ambos aspectos para obtener información epidemiológica fiable y permitir el acceso oportuno de los niños infectados al tratamiento.
Subject(s)
Chagas Disease/epidemiology , Chagas Disease/transmission , Infectious Disease Transmission, Vertical/statistics & numerical data , Pregnancy Complications, Parasitic/epidemiology , Argentina/epidemiology , Chagas Disease/congenital , Female , Humans , Infant , Infant, Newborn , Linear Models , Male , Pregnancy , Prevalence , Risk Assessment , Risk Factors , Statistics, Nonparametric , Time FactorsABSTRACT
With the control of the vectorial and transfusional routes of infection with Trypanosoma cruzi, congenital transmission has become an important source of new cases. This study evaluated the efficacy of trypanocidal therapy to prevent congenital Chagas disease and compared the clinical and serological evolution between treated and untreated infected mothers. We conducted a multicenter, observational study on a cohort of mothers infected with T. cruzi, with and without trypanocidal treatment before pregnancy. Their children were studied to detect congenital infection. Among 354 "chronically infected mother-biological child" pairs, 132 were treated women and 222 were untreated women. Among the children born to untreated women, we detected 34 infected with T. cruzi (15.3%), whose only antecedent was maternal infection. Among the 132 children of previously treated women, no infection with T. cruzi was found (0.0%) (p<0.05). Among 117 mothers with clinical and serological follow up, 71 had been treated and 46 were untreated. The women were grouped into three groups. Group A: 25 treated before 15 years of age; Group B: 46 treated at 15 or more years of age; Group C: untreated, average age of 29.2 ± 6.2 years at study entry. Follow-up for Groups A, B and C was 16.3 ± 5.8, 17.5 ± 9.2 and 18.6 ± 8.6 years respectively. Negative seroconversion: Group A, 64.0% (16/25); Group B, 32.6% (15/46); Group C, no seronegativity was observed. Clinical electrocardiographic alterations compatible with chagasic cardiomyopathy: Group A 0.0% (0/25); B 2.2% (1/46) and C 15.2% (7/46). The trypanocidal treatment of women with chronic Chagas infection was effective in preventing the congenital transmission of Trypanosoma cruzi to their children; it had also a protective effect on the women's clinical evolution and deparasitation could be demonstrated in many treated women after over 10 years of follow up.
