13 minute read
La enfermedad de Chagas de transmisión oral desde un enfoque One Health
Alejandra López García y Juan Antonio Gilabert Santos
Facultad de Veterinaria, Universidad Complutense de Madrid
Correspondencia
Juan Antonio Gilabert Santos
Dpto. de Farmacología y Toxicología
Facultad de Veterinaria. Universidad Complutense de Madrid
Avda. Puerta de Hierro, s/n. 28040 Madrid, España
Teléfono: +34 913944036
E-mail: jagilabe@ucm.es
Financiación
Este trabajo no ha contado con ayudas específicas para su realización. Los autores declaran no tener ningún conflicto de intereses.
Palabras clave
Enfermedad de Chagas, transmisión de infección, One Health Chagas disease, infection transmission, One Health
Introducción / Objetivo
La enfermedad de Chagas es una zoonosis endémica en América Central y del Sur, causada por el protozoo Trypanosoma cruzi, que se transmite principalmente por vectores triatominos. A pesar de que la vectorial es la forma clásica de transmisión, en las últimas décadas, el número de casos asociados con la transmisión oral ha aumentado y está causada principalmente por la ingestión de alimentos contaminados con heces de los vectores o con secreciones de los reservorios infectados. El objetivo de este estudio es realizar un análisis con un enfoque One Health de los brotes agudos de la enfermedad de Chagas a partir de una revisión sistemática cualitativa.
Métodos
La revisión sistemática siguió un procedimiento estandarizado establecido por PRISMA (prisma-statement.org) aplicando criterios de inclusión y de exclusión resultó en un total de 30 publicaciones con 32 brotes descritos entre 1965 y 2022. Sólo se han incluido estudios en los que se han confirmado casos clínicos de Chagas oral agudo mediante pruebas parasitológicas y/o serológicas y en los que se realizó una investigación epidemiológica de las fuentes de infección, de los vectores y de los reservorios implicados.
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Resultados
Los principales alimentos involucrados en los brotes de transmisión oral fueron zumos caseros de frutas tropicales (como açaí o guayaba) o el jugo de caña de azúcar. Las principales especies de vectores identificadas fueron Panstrongylus geniculatus, Rhodnius pallescens y Triatoma brasiliensis relacionados con el ciclo salvaje del parásito. Como reservorios salvajes se encontraron principalmente mamíferos didélfidos (Didelphis marsupialis y D. albiventris) y como reservorios domésticos y peridomésticos, perros y ratas.
Conclusiones
El análisis ha identificado que los cambios ambientales han llevado al aumento de los casos y revela la dificultad de erradicar la enfermedad dado que el ciclo salvaje permite la circulación del parásito por transmisión oral al entrar en contacto con ambientes domésticos o peridomésticos. Se evidencia la necesidad de implementar medidas de vigilancia entomológica y control de los reservorios silvestres y domésticos, así como medidas de higiene para garantizar el control sanitario de los alimentos elaborados a nivel casero, como principales transmisores de la enfermedad.
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Impact of the interventions of the Association of People Affected with Chagas in Japan (ANACHA) after the first year of the foundation
Impacto de las intervenciones de la Asociación Nipona de Afectados de Chagas en Japón (ANACHA) tras el primer año de fundación
Iglesias Rodríguez IM (CA) (1,2), Kobashikawa I (3), de Ogo Vargas O (4), Erguez D (5), Melgar Escalante J (6), Bejarano Algarañaz T (7), Yoshioka K (8,9), Miura S (10,11)
(1) Visiting researcher, Nagasaki University, Japan
(2) Founder & general coordinator of the Asociación Nipona de Afectados de CHAgas, Japón (ANACHA)
(3) President of the Asociación Nipona de Afectados de CHAgas, Japón (ANACHA)
(4) Secretary of the Asociación Nipona de Afectados de CHAgas, Japón (ANACHA)
(5) Vocal of the Asociación Nipona de Afectados de CHAgas, Japón (ANACHA)
(6) Vocal of the Asociación Nipona de Afectados de CHAgas, Japón (ANACHA)
(7) Vicepresident of the Asociación Nipona de Afectados de CHAgas, Japón (ANACHA)
(8) Associate Professor of Nagasaki University, Japan
(9) Treasurer of the Asociación Nipona de Afectados de CHAgas, Japón (ANACHA)
(10) President of the NPO-MAIKEN, Japan
(11) Coordinator of the Asociación Nipona de Afectados de CHAgas, Japón (ANACHA).
Corresponding author
Inés María Iglesias Rodríguez
1-12-4 Sakamoto Nagasaki, Japan 852-8523
Phone: +34-682037034
Email: inesmiglesias@hotmail.com
Funding
No fundings were required. No conflicts of interest.
Keywords
Chagas disease, migration, Japan
Enfermedad de Chagas, migración, Japón
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Background
Japan is estimated to host 3,000 cases of Chagas disease (CD). (1,2) However, there is a lack of policies for prevention and care. (2,3) To contribute to the improvement of the current situation, in 2021 the people affected by CD associated. Our aim is to summarise the impact of the activities of the Association of People Affected with CD in Japan (ANACHA). (4)
Methods
Descriptive analysis of the ANACHA interventions from September 2021 until January 2023. ANACHA is composed of eight members: five people affected by CD, two CD physicians, and one CD specialist from academia. The members are originally from: Bolivia, Brazil, Spain, and Japan. During monthly virtual meetings, ANACHA identifies the needs and barriers in the health care system and in the community, and designs strategies to overcome them.
Results
A total of 20 interventions were conducted during 16 months. They are summarised as follows:
1. Information, communication, and education (ICE) and screening activities.
1. ICE & screening. Four different events were organised with the collaboration of NPO MAIKEN in Tsu (Mie), Kawasaki (Kanagawa) and Tokyo. Six out of 40 participants were identified as infected with Trypanosoma cruzi.
2. Distribution of information by brochures in the community, by the Japanese radio program Latin-a, and by social media in the Chagas-Japón platform.(5)
3. Conference participation. FINDECHAGAS assembly, to which it belongs, the II Webinar for the CD International Day in Japan, and the Neglected Tropical Diseases International Day in Japan.
4. ANACHA participated in a research that aims to identify the difficulties in the access of CD treatment in Japan.
2. Interventions to improve the Japanese health care system.
1. Support, ICE and referral of the CD affected people and their families. 2. ICE resources for health professionals.
2. Translation of documents for patients.
3. Facilitate access to benznidazole in Japan.
4. Identification of protocols in need of update.
Conclusiones
ANACHA has a positive impact on the situation of CD in Japan and contributes to the visualisation of CD at the national and international level. We believe that the diverse backgrounds, skills, and networks of the ANACHA members contribute to the effectiveness of the interventions implemented.
Póster References
1. Nara TA, Miura SA. Current Situation of Chagas Disease in Non - Endemic Countries. 2015;61(4):389–95
2. Iglesias Rodríguez IM, Miura S, Maeda T, Imai K, Smith C, Vasquez Velasquez C, et al. Analysis of the Chagas disease situation in Japan: A cross sectional study and cost-effectiveness analysis of a Chagas disease screening program. Lancet Reg Health West Pac [Internet]. 2022 [cited 2023 Feb 5];0(0). Available from: http://www.thelancet.com/article/S2666606522001894/ fulltext
3. Imai K, Misawa K, Osa M, Tarumoto N, Sakai J, Mikita K, et al. Chagas disease: a report of 17 suspected cases in Japan, 2012–2017. Trop Med Health [Internet]. 2019;47(1):38. Available from: https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-019-0168- 3
4. Asociación | Chagas Japón [Internet]. [cited 2023 Feb 5]. Available from: https://chagasjapon.wixsite.com/website/acerca-de
5. Japón | 日本 | Chagas en Japón [Internet]. [cited 2023 Feb 5]. Available from: https://chagasjapon.wixsite.com/website
Diagnóstico molecular temprano de Chagas vertical por LAMP a partir de muestras de sangre líquida y en soporte sólido:
Transferencia a instituciones de salud pública en América Latina
María Cristina Parada-Barba (1,2), Elena Montesinos Sanchis (3), Silvia A. Longhi (1), Lady García-Casares (1) , Arturo Muñoz-Calderón (1), Julio Alonso-Padilla (2, 3), Alejandro G. Schijman (1)
(1) Laboratorio de Biología Molecular de la Enfermedad de Chagas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular “Dr Héctor Torres”, INGEBI-CONICET
(2) Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - University of Barcelona, Barcelona, Spain
(3) CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
Correspondencia
Alejandro Schijman
Teléfono: 00541147832871
E-mail: schijman@dna.uba.ar
Financiación
Proyecto Chagas-LAMP (Consorcio Público-Privado internacional financiado por GHIT y Fundación Mundo Sano) y programa de Pequeñas Subvenciones del TDR – OPS. Sin conflicto de intereses.
Palabras clave
Enfermedad de Chagas, transmisión vertical, diagnóstico en el punto de atención, LAMP, FTA Chagas disease, vertical transmission, point-of-care diagnosis, LAMP, FTA
Introducción / Objetivos
El control de la transmisión materno-fetal del Trypanosoma cruzi, causante de Chagas vertical (ChV), es prioridad en salud pública, pues esta forma de transmisión es más frecuente en donde se ha logrado el control vectorial o en regiones no-endémicas, siendo identificable al nacimiento y tratable con alta eficiencia y probabilidad de demostración de cura en el corto plazo. Se planteó la validación analítica y transferencia de la amplificación isotérmica mediada por asas (LAMP) para diagnóstico molecular temprano de ChV en centros de salud pública en áreas endémicas.
Métodos
Se optimizó la metodología evaluando combinaciones de métodos rápidos de extracción de ADN acoplados al LAMP, adaptables a laboratorios ubicados en maternidades en áreas endémicas:
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Póster
1. PURE (Eiken Chemical Co, Japón) y 2. PrinterLab (impresora 3D modificada, AI BioSciences, EEUU). Se emplearon muestras de sangre humana seronegativa inoculada con T. cruzi de cultivo (cepas TcI, TcII y TcVI) en heparina como anticoagulante (30 µls) o en porciones de sacabocados de 3- y 6-mm de spots de 125 µl en tarjetas FTA® (Qiagen, UK) o 30 µls en Whatman 903™ (GE Healthcare, UK). Se comparó la amplificación empleando baños térmicos AccuBlock TM (LabNet, EEUU) o incubador Loopamp LF-160 (Eiken) y visualización a ojo desnudo, usando el dispositivo LF-160 o visor fluorescente P51(minipcr bio ®,EEUU).
Resultados
Las mejores condiciones mostraron un límite de detección (LoD95) en al menos 20 réplicas de 5 y 20 parásitos/mL, para sangre-heparina y FTA, respectivamente. El papel Whatman fue descartado por arrojar resultados falsos positivos. Se realizó la transferencia del LAMP y capacitó personal de 11 maternidades del sistema público de salud: Combinación PURE-LAMP (LF-160) a 5 sitios de Bolivia, 2 Paraguay y 2 Argentina y PURE-LAMP (AccuBlock – P51) a 2 maternidades argentinas. Se construyeron paneles de aptitud como sistema de control externo de calidad del LAMP para laboratorios participantes.
Conclusión
Se transfirió la metodología LAMP para diagnóstico de ChV a maternidades de área endémica, en proceso de validación clínica. De demostrarse una certeza diagnóstica similar a la PCR podría considerarse método rápido de diagnóstico molecular en puntos de atención e incorporarse al algoritmo diagnóstico de ChV.
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Trypanosoma to
Chagas disease case detection in Bolivia Evaluación comparativa de pruebas de ensayo de flujo lateral (pruebas rápidas) que detectan anticuerpos humanos específicos de Trypanosoma cruzi para apoyar la detección de casos de Enfermedad de Chagas en Bolivia
(1) Instituto Nacional de Laboratorios de Salud (INLASA), La Paz, Bolivia
(2) FIND, Campus Biotech. Chemin des Mines 9. 1202. Geneva, Switzerland
Corresponding author
Laura Bohorquez
FIND, Bogotá, Colombia
Phone: +573194860360
Email: laura.bohorquez@finddx.org
Keywords
Chagas disease, diagnostic performance, rapid test for chronic infection
Enfermedad de Chagas, desempeño diagnóstico, prueba rápida para infección crónica
Background
Bolivia is the country with the highest incidence of Chagas disease (CD) worldwide, and the fourth with the highest prevalence relative to its population1. It is estimated that more than 600,000 people are infected, 8,000 new cases occur annually due to vectorial transmission, and 600 cases due to congenital transmission2. In 2015, a total of 30,454 people were diagnosed with CD, but only 10% started the treatment2,3. Great efforts have been exerted in Bolivia in the fight against CD, especially in vector control operating protocols and guidelines for diagnosis and treatment of congenital transmission and CD in children. However, CD is mainly a chronic condition and it is a long-lasting challenge to prevent and control the non-vectorial transmission. This study was designed to independently evaluate immunoassay tests for T. cruzi infection to generate unbiased performance data to help inform test intended use and utility, for policy making in public health for CD.
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Methods
This was a retrospective, laboratory-based, diagnostic evaluation study of immunoassay tests for T. cruzi infection, to estimate the clinical sensitivity and specificity of the index tests, 10 commercially available T. cruzi LFAs, using the current CD diagnostic algorithm as the reference test method, performed at study site (INLASA), i.e. agreement of at least two serological tests, including two commercial ELISA tests, plus HAI. A total of 470 serum samples collected in 2019 - 2021; as part of CD routine diagnosis in Bolivia were used in this study, including 221 and 249 characterised as CD positive and CD negative, respectively, at study site.
The agreement between each T. cruzi LFA and the current CD diagnostic algorithm in Bolivia was also estimated. In addition to measuring individual clinical performances, the 10 LFAs were scored according to their relative importance in a decision tree-based algorithm, using the mean decrease in Gini index as scoring metrics, to evaluate their relevance for the next evaluation in prospective on field studies).
Results
A total of 4 LFAs had sensitivities above 90%, and 6 LFAs showed a performance above 95%. A total of 4 LFAs had the best performance given their high sensitivity and specificity. These tests had a value of balanced accuracy greater than 90%. The antibody levels subgroups analysis showed that for the challenging samples classified as “weakly positive subgroup”, only 1 LFA displayed a sensitivity >90%. All LFAs had an agreement with the reference tests ranging from moderate to almost perfect agreement (Kappa score from 0.6 to 0.94).
Conclusions
The optimal performance of the LFAs evaluated in this study allowed to inform to the national authorities in Bolivia about the use of LFAs in the detection of chronic CD cases in regions with limited resources and point of care (POC) settings. The best performant RDTs will be evaluated in prospective on field studies to compare RDT-based diagnostic algorithms against the current lab-based diagnostic algorithms in the real environment.
References
1. WHO. Chagas disease in Latin America: an epidemiological update based on 2010 estimates. Wkly. Epidemiol. Rec. 90, 33–44 (2015)
2. PAHO. EMTCT Plus. New generations free of HIV, syphilis, hepatitis B and Chagas disease in the Americas. (2018)
3. Doctors without borders. Manual De Atención Integral De Chagas En Zona Rural. Bolivia. 2016. Médicos Sin Fronteras España. https://www.doctorswithoutborders.ca/sites/default/ files/manual_de_atencion_integral_de_chagas_en_zona_rural_de_msf_en_bolivia.pdf (2016).
Póster
Chagas Express XXI Course: online training of popular health agents for endemic areas and implementation of this social technology in Brazil
Curso Expresso Chagas XXI: formación en línea de agentes de salud popular para áreas endémicas e implementación de esta tecnología social en Brasil
(1) Oswaldo Cruz Institute- Fiocruz, Laboratory of Innovations in Therapies, Education and Bioproducts/ Post-graduation Program in Education in Biosciences and Health
Corresponding authors
Email: ritamachado86@gmail.com
Email: tania.araujojorge@gmail.com
Keywords
Education, health promotion, citizenship
Educación, promoción de la salud, ciudadanía
Introduction
Chagas Express XXI (EC21) is a ArtScience participatory exhibition which brings an imaginary train to cities, with a station and six thematic “wagons” – in allusion to the wagon in which the scientist Carlos Chagas lived and worked, from 1907 to 1909, discovering Chagas Disease (CD) in the north of Minas Gerais. EC21 is an educational social technology that aims to translate CD discoveries into education/information practices and training of affected people and health professionals, as previously described.1
Objectives
To develop and test an EC 21 Course aiming at forming local interdisciplinary and intersectoral teams, qualified to adapt, to mediate and to implement EC21 social technology in different urban and rural contexts in CD endemic areas.
Methodology
We used the ArtScience active methodology 2 applying synchronous virtual classes via Zoom platform and asynchronous periods to explore materials available on the Fiocruz virtual education platform (https://campusvirtual.fiocruz.br/gestordecursos/hotsite/cvf-node-30225-submission-6097),
Póster and created an environment on WhatsApp groups by region where the participants came from: North (N), Northeast (NE), Southeast (SE), Midwest (MW) and South (S) of Brazil. Results: We developed the course in 2022 and presented two online editions (August and October). The First Edition was composed of 10 classes, and enrolled 200 participants; 145 attended and completed all the activities (45 SE, 2 S, 43 N, 33 NE, 17 MW, reaching 5568 municipalities that were vulnerable to chronic CD in Brazil. The second Edition proposed an intensive course of two theoretical classes (6 hours) coupled with a practical application in the Posse/Goiás state, Belém/Pará state and Arraial/Piauí state, with 110 participants (29 from Goiás, 60 from Pará, 7 from Piauí; with other persons coming from the states of Rio de Janeiro (11), Acre (1) and Ceará (1). Each wagon was adapted for implementation according to the regional demands.
Conclusion
The course disseminated knowledge about CD global and regional characteristics, treatment, and clinical guidelines. Three implementations of EC21 were carried out: Posse/Goiás, Belém and Arraial/Piauí, leaving legacies for the local team and future articulations in research, teaching and extension in Chagas.
References
1. Araujo-Jorge TC, Ferreira RR, Rocha RCM, Vieira TM, Costa ND, Santos LL, et al. (2021) “Chagas Express XXI”: A new ArtScience social technology for health and science education—A case study in Brazilian endemic areas of Chagas disease with an active search of chronic cases. PLoS Negl Trop Dis 15(7): e0009534. https://doi.org/10.1371/journal.pntd.0009534
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Chagas Express XXI: implementation of this social technology an endemic municipality of Goiás, Brazil
Expresso Chagas XXI: implementación de la tecnología social en un municipio endémico de Goiás, Brasil
(1) Oswaldo Cruz Institute- Fiocruz
(2) Posse Health Services
(3) Goiás Health Service
Corresponding authors
Email: betemanieri@gmail.com
Email: tania.araujojorge@gmail.com
Keywords
Education, health promotion, citizenship
Educación, promoción de la salud, ciudadanía
Introduction
“Expresso Chagas XXI” (EC21) is a participatory ArtScience exhibition to talk about Chagas disease (CD) in cities where people with the disease live or where there is a risk of contamination by the Trypanosoma cruzi parasite, with the “kissing bug” as the main vector. EC21 is a social technology engaging health professionals, CD patients and scientists. Posse, a municipality in the Northeast of Goiás (GO), Brazil, has a population of around 37,100 inhabitants, and is an endemic region for CD in GO. After two online training courses for popular health agents, Posse held and implemented EC21, during 3 days on November 2022, in partnership with the Oswaldo Cruz Institute (IOC-Fiocruz), Posse Municipal Health Department, State Health Secretary, involving health professionals, researchers, collaborators and volunteers.
Objectives
To implement the EC21 social technology in Posse with local teams and expanding local knowledge about CD, treatment, and diagnosis as well as CD official Protocol. Methodology: We used the quali-quantitative approach previously described (doi.org/10.1371/journal.pntd.0009534) and presented seven activity stations (the entry station and six thematic “wagons”) in a non-formal education space in the public sports gym equipment “Leonidas Augusto Figueredo”.
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Results
935 people participated in EC21, coming from urban and rural areas; 238 were students from local elementary, high schools and university campi. The local team engaged 11 nurses, 02 biomedicals, 01 primary care coordinator and her 15 agents (ACS), 02 nursing technicians, 01 epidemiological surveillance coordinator, 01 Combating Endemic Diseases Agents Coordinator and her 15 agents (ACE), 09 Social Assistance professionals, 01 technology information professional, and some other workers from the municipality of Posse (with the relevant support of the Mayor), in addition to the 15 IOC-Fiocruz scientists/students. After carrying out the rapid test on 563 participants, we obtained 259 positive tests which (46%); confirmatory serology at the reference laboratory in the state capital, showed 168 positive ones.
Conclusion
The organisation and implementation of EC21 highlighted the relevance of attention and care for people with CD and the inter-sector articulation in research, teaching and extension. A CD mobile consultation post was introduced as a legacy for rural areas.
References
1. Araujo-Jorge TC, Ferreira RR, Rocha RCM, Vieira TM, Costa ND, Santos LL, et al. (2021) “Chagas Express XXI”: A new ArtScience social technology for health and science education—A case study in Brazilian endemic areas of Chagas disease with an active search of chronic cases. PLoS Negl Trop Dis 15(7): e0009534. https://doi.org/10.1371/journal.pntd.0009534
