Mother-to-Child Transmission of Chagas Disease in El Salvador.

To estimate the incidence (any mother to child) and rate (from seropositive mother to child) of mother-to-child transmission of Trypanosoma cruzi, a serological census was conducted, targeting pregnant women and infants born to seropositive mothers, in four municipalities of El Salvador. Of 943 pregnant women, 36 (3.8%) were seropositive for T. cruzi. Of 36, 32 proceeded to serological tests of their infants when they became 6-8 months of age. Six infants seropositive at the age of 6-8 months further proceeded to second-stage serological test at the age of 9-16 months. As the result, one infant was congenitally infected. Thus, serological tests at the age of 6-8 months produced five false positives. To ensure earlier effective medication only for true positives, identification of seropositive infants at the age of 9-16 months is crucial. Incidence and rate of mother-to-child transmission were 0.14 (per 100 person-years) and 4.0%, respectively. Estimated number of children infected through mother-to-child transmission in El Salvador (170 per year) was much higher than that of human immunodeficiency virus (HIV; seven per year). It is recommended that serological testing for T. cruzi be integrated into those for HIV and syphilis as part of antenatal care package.

Risk factors for Chagas disease among pregnant women in El Salvador.

OBJECTIVES: To determine the seroprevalence of Chagas disease among pregnant women and estimate the risk factors for Chagas disease during pregnancies. METHODS: Community-based serological tests on Trypanosoma cruzi and structured interviews on socio-demographic and socio-economic status were conducted with pregnant women registered at three health centres in Sonsonate province, El Salvador. RESULTS: Of 797 pregnant women participating in the study, 29 (3.6%) were infected with Chagas disease. None had clinical symptoms. The results of bivariate analyses showed the significant association between seropositivity and maternal age ≥35 years, anaemia, illiteracy, having no formal school education and having knowledge on Chagas disease (P < 0.05). The results of multivariate analysis indicate that age ≥35 years and anaemia were significantly associated with being infected with Chagas disease among pregnant women (OR = 3.541 and 5.197, respectively). CONCLUSION: We recommend that the national Chagas disease control programme be better coordinated with the national maternal and child health programme to introduce blood screening for T. cruzi during antenatal visits. If financial constraint allows systematic blood screening to be only partially implemented, resources should be focused on pregnant women ≥35 years and women who have anaemia.

Prevalence of Trypanosoma cruzi infection in blood donors in El Salvador between 2001 and 2011.

INTRODUCTION: El Salvador is regarded as a highly endemic country for Chagas disease, as evidenced by the relatively high estimated positive serology rate for Trypanosoma cruzi among blood donors. This study aimed to identify the factors contributing to this high rate by analyzing changes in T. cruzi seroprevalence. METHODOLOGY: Secondary data were collected from 31 blood banks operated by the Ministry of Health, the Red Cross, the Institute of Salvadoran Social Security, and the Military Hospital. The data were analyzed to determine the number of cases of T. cruzi seropositivity, and the average prevalence of seropositivity by province. Simple linear regression was performed to identify trends in T. cruzi seropositivity. RESULTS: Analysis of the 885,187 blood samples collected between 2001 and 2011 revealed 21,693 cases of transfusion-related infections, with a significant reduction of T. cruzi seropositivity from 3.7% in 2001 to 1.7% in 2011, reflecting a 54% decrease over the course of a decade (R(2) = 89.6%, p > 0.001). T. cruzi seroprevalence decreased in San Salvador, Santa Ana, Sonsonate, and Cuscatlán. In contrast, seroprevalence remained high with no decrease in Ahuachapán and San Vicente, and consistently low in the remainder of the country. CONCLUSIONS: Although the national prevalence of T. cruzi among blood donors has decreased, it remains high in the provinces of Ahuachapán and San Vicente. Strengthening vector control activities and developing an approach for the systematic follow-up of prospective blood donors with positive serology for T. cruzi are required, especially in areas with high seropositivity.

Acute Chagas disease in El Salvador 2000-2012 - need for surveillance and control.

Several parasitological studies carried out in El Salvador between 2000-2012 showed a higher frequency of acute cases of Chagas disease than that in other Central American countries. There is an urgent need for improved Chagas disease surveillance and vector control programs in the provinces where acute Chagas disease occurs and throughout El Salvador as a whole.

Elimination of Rhodnius prolixus in El Salvador, Central America

Epidemiological studies performed in El Salvador between 1955-1972 demonstrated a high frequency of two triatomine vectors (Triatoma dimidiata and Rhodnius prolixus). However, the frequency of R. prolixus decreased by 1976 and this species has not been found since 1995. The main factors influencing the elimination of R. prolixus in El Salvador are discussed in this paper.

Elimination of Rhodnius prolixus in El Salvador, Central America.

Epidemiological studies performed in El Salvador between 1955-1972 demonstrated a high frequency of two triatomine vectors (Triatoma dimidiata and Rhodnius prolixus). However, the frequency of R. prolixus decreased by 1976 and this species has not been found since 1995. The main factors influencing the elimination of R. prolixus in El Salvador are discussed in this paper.

Planning and implementation of an infection control training program for healthcare providers in Latin America.

OBJECTIVE: The lack of well-trained, dedicated infection control personnel prevents optimal control of nosocomial infections in Latin American pediatric oncology centers. We collaboratively planned and implemented a multinational training course in San Salvador, El Salvador, to address this need. METHODS: The course relied on its organizers' experience in training international healthcare providers, the availability of the International Training Center for Nurses, previous infection control collaboration with the Hospital Nacional de Ninos Benjamin Bloom, and resources available at the University of El Salvador. The 4-week course consisted of lecture sessions combined with practical laboratory and hospital experience. RESULTS: Two courses, one conducted in 2005 and one in 2006, trained 44 professionals from 15 Latin American countries. Evaluations showed that course content and teacher performance met the trainees' needs and that all trainees acquired the necessary knowledge and skills. CONCLUSIONS: The course met the need for the training of Latin American infection control practitioners. Our experience can serve as a model for other organizations interested in strengthening infection control and prevention at international sites.

The onchocerciasis elimination program for the Americas: a history of partnership

The decision in 1987 by the pharmaceutical firm Merck & Co. to provide Mectizan (ivermectin) free of charge to river blindness control programs has challenged the international public health community to find effective ways to distribute the drug to rural populations most affected by onchocerciasis. In the Americas, PAHO responded to that challenge by calling for the elimination of all morbidity from onchocerciasis from the Region by the year 2007 through mass distribution of ivermectin. Since 1991, a multinational, multiagency partnership (consisting of PAHO, the endemic countries, nongovernmental development organizations, the Centers for Disease Control and Prevention in Atlanta, Georgia, as well as academic institutions and funding agencies) has developed the political, financial, and technical support needed to move toward the realization of that goal. This partnership is embodied in the Onchocerciasis Elimination Program for the Americas (OEPA), which is supported by the River Blindness Foundation (RBF) and now by the Carter Center. OEPA was conceived as a means of maintaining a regional initiative to eliminate what is otherwise a low priority disease. Since its inception in 1993, the OEPA has provided more than US$2 million in financial, managerial, and technical assistance to stimulate and/or support programs in Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela, so as to take full advantage of the Merck donation. Now halfway into a five-year, US$ 4 million grant provided through the Inter-American Development Bank, the OEPA's capacity to support the regional initiative is assured through 1999

Comparación de dos métodos de laboratorio para examinar xenodiagnósticos / Comparison of two laboratories methods in xenodiagnosis

El presente trabajo ha tenido por objetivo comparar la efectividad de dos métodos, el examen individual del contenido intestinal de los triatomíneos y el examen por homogeneización de todas las ninfas usadas, que resultaron igualmente sensibles para descubrir Trypanosoma cruzi y T. rangeli en xenodiagnósticos tomados al azar y por duplicado (AU)

Comparacion de dos metodos de laboratorio para examinar xenodiagnosticos. / Comparison of two laboratories methods in xenodiagnosis

El presente trabajo ha tenido por objetivo comparar la efectividad de dos metodos, el examen individual del contenido intestinal de los triatomineos y el examen por homogeneizacion de todas las ninfas usadas que resultaron igualmente sensibles para descubrir Trypanosoma cruzi y T. rangeli en xenodiagnosticos tomados al azar y por duplicado

Comparación de dos métodos de laboratorio para examinar xenodiagnósticos / Comparison of two laboratories methods in xenodiagnosis

El presente trabajo ha tenido por objetivo comparar la efectividad de dos métodos, el examen individual del contenido intestinal de los triatomíneos y el examen por homogeneización de todas las ninfas usadas, que resultaron igualmente sensibles para descubrir Trypanosoma cruzi y T. rangeli en xenodiagnósticos tomados al azar y por duplicado (AU)