Chagas Disease

It’s is an infection caused by a protozoon named

Trypanosoma cruzi. The main way of

transmission in endemic countries (Central and

South America) is trough the bite of an insect

(Triatominae), contaminated blood transfusions,

from mother to child during pregnancy and

delivery and trough ingestion of contaminated

food by infected stool. If untreated it may

become chronic infection and cause cardiac and

digestive problems.

Background

Migration has expanded the geographical limits

of Chagas disease (CD) beyond Latin America

(LA) [1]. Italy is thought to be one of the most

affected countries in Europe but a specific CD

programme has not been implemented at

national level [2].

With the aim of increasing awareness and testing

of CD, MSF strengthened an ongoing

programme of screening among the LA

Community (LAC) living in the Bergamo province

of northern Italy. The programme was started in

2009 by the NGO OIKOS and the Centre for

Tropical Diseases (CTD) Sacro Cuore Hospital

(Negrar). Bergamo province hosts the biggest

Bolivian community in Italy, as well as people

coming from other LA countries. A descriptive

prospective community-based sero-prevalence

survey was started in June 2012; ethics approval

was granted by the Research Ethics Board of

Verona province.

MethodHealth promotion was regularly carried out by health promoters selected from the LAC, focusing on young

people (<30 years), in order to encourage testing. Monthly serological screening for Trypanosoma cruzi

antibodies was carried out with two different ELISA tests, Biokit® and BiosChile®, in accordance with

international and World Health Organization guidelines. It was offered to all migrants from LA living in

Bergamo province, without any restrictions on age, sex or residence permit status. An epidemiological

questionnaire was used to assess the risk of having CD. Second-line diagnostics (disease staging) and

benznidazole (5 mg/kg/day for 60 days) were provided by CTD.

Results

From June to December 2012, over 2.000 people were approached during health promotion activities and 784

people were screened (67.5% females). 139 people tested positive (138 Bolivians and 1 child born in Italy to

a Bolivian mother). The overall sero-prevalence was 17.7%; the sero-prevalence among Bolivians was 19.8%.

Chart 1 shows the countries of origin of screened people. No positive cases were found among LA country

different from Bolivia, so far. Among total screened Bolivians, males and females had different sero-

prevalence (15.7% vs 22.6%) and different mean (SD) age distribution (33.7 years [±12.7] vs 36.8 [±12.6]),

respectively (Chart 2), but the mean (SD) age of positive Bolivian males and females did not differ (43.3 years

[±9.8] vs 44.2 [±10.8]).

Addressing the challenge of Chagas disease in a non-endemic country:

the collaboration between Médecins Sans Frontières (MSF), the NGO OIKOS and the

Center of Tropical Diseases of Sacro Cuore Hospital (Negrar) in Bergamo province (Northern Italy)

Ernestina Carla Repetto*1,6, Ada Maristella Egidi1, Andrea Angheben2,5, Mariella Anselmi3,5, Ahmad Al Rousan1, Gabriel Ledezma1, Rosita Ruiz1, Carlota Torrico1, Mariachiara Buoninsegna4,

Fabio Andreoni4, Barbara Maccagno1, Gianfranco De Maio1, Silvia Garelli1.

1 Médecins Sans Frontières 2 Center of Tropical Medicine of Sacro Cuore Don Calabria Hospital, Negrar, Verona (Italy) 3 Centro de Epidemiología Comunitaria y Medicina Tropical (CECOMET) Esmeraldas (Ecuador) 4 OIKOS Onlus, Bergamo (Italy) 5 COHEMI Project 6 PhD Fellow,

University of Brescia (Italy)

*Corresponding author: Ernestina Carla Repetto, msfocb-rome-med@brussels.msf.org, +39.342.3788813.

Chart 1. Country of origin distribution among

screened population (Jun-Dec 2012)

Chart 2. Age distribution among screened

Bolivians according to sex

ConclusionOur results predict that a large number of

Bolivians living in Bergamo could be affected by

CD (at least 3500 of the 18,000 total estimated

resident Bolivians).

In Italy the lack of screening protocols and the

difficulties in obtaining treatment in the public

health system are of particular concern, and

need to be quickly addressed by Italian health

authorities. Our model of intervention could

provide a possible way forward to tackle CD at

national level.

We need more data to confirm these results in

other Italian regions, however our observed sero-

prevalence is in line with that noted recently in

Spain [3]. We also need further work to

understand the difference in prevalence between

men and women, to better explore the burden of

CD in Italy and to expand the access to

diagnosis and treatment for this population in

need.

References1) Basile L, Jansà JM, Carlier Y, et al. Chagas disease in

European countries: the challenge of a surveillance system. Euro

Surveill 2011;16:pii=19968.

2) Angheben A, Anselmi M, Gobbi F, et al. Chagas disease in

Italy: breaking an epidemiological silence. Euro Surveill

2011;16(37):pii=19969.

3) Navarro M, Navaza B, Guionnet A, Lopez-Velez R. Chagas

Disease in Spain: Need for Further Public Health Measures.

PLoS Negl Trop Dis 2012;

6:e1962.doi:10.1371/journal.pntd.0001962.

Bolivia Ecuador

Peru Brazil

Born in Italy Italians travellers

Argentina Chile

El Salvador

From "Dossier Statistico Immigrazione 2012"

CARITAS e MIGRANTES (31/12/2011)

Regular migrants resident in Lombardia region:

974.134 (Morocco, Albania, Egypt, China, India)

Regular migrants resident in Bergamo province:

113.534, max estimated Bolivians: 18.000.

SPAIN 1.754.295

UNITES KINGDOM 497.517

ITALY 387.648

THE NETHERLANDS 237.572

FRANCE 168.870

PORTUGAL 121.124

GERMANY 85.313

SWITZERLAND 82.755

BELGIUM 43.810

TOTAL 3.378.814

3.378.814 PEOPLE FROM ENDEMIC AREA

123.078 POTENTIALLY INFECTED BY CHAGAS

From Eurosurveillance 2011 (Basile L et al).

Estimates of CD in Europe, 2009.

From Eurosurveillance 2011 (Basile L et al).

Estimates of migrants from CD endemic countries residents in

Europe, 2009.