title: Prevalence, clinical staging and risk for blood-borne transmission of Chagas disease among Latin American migrants in Geneva, Switzerland.
abstract: BACKGROUND
  Migration of Latin Americans to the USA, Canada and Europe has modified Chagas disease distribution, but data on imported cases and on risks of local transmission remain scarce. We assessed the prevalence and risk factors for Chagas disease, staged the disease and evaluated attitudes towards blood transfusion and organ transplant among Latin American migrants in Geneva, Switzerland.
  
  
  RESULTS
  This cross-sectional study included all consecutive Latin American migrants seeking medical care at a primary care facility or attending two Latino churches. After completing a questionnaire, they were screened for Chagas disease with two serological tests (Biomérieux ELISA cruzi; Biokit Bioelisa Chagas). Infected subjects underwent a complete medical work-up. Predictive factors for infection were assessed by univariate and multivariate logistic regression analysis.1012 persons (females: 83%; mean age: 37.2 [SD 11.3] years, Bolivians: 48% [n = 485]) were recruited. 96% had no residency permit. Chagas disease was diagnosed with two positive serological tests in 130 patients (12.8%; 95%CI 10.8%-14.9%), including 127 Bolivians (26.2%; 95%CI 22.3%-30.1%). All patients were in the chronic phase, including 11.3% with cardiac and 0.8% with digestive complications. Predictive factors for infection were Bolivian origin (OR 33.2; 95%CI 7.5-147.5), reported maternal infection with T. cruzi (OR 6.9; 95%CI 1.9-24.3), and age older than 35 years (OR 6.7; 95%CI 2.4-18.8). While 22 (16.9%) infected subjects had already donated blood, 24 (18.5%) and 34 (26.2%) considered donating blood and organs outside Latin America, respectively.
  
  
  CONCLUSIONS
  Chagas disease is highly prevalent among Bolivian migrants in Switzerland. Chronic cardiac and digestive complications were substantial. Screening of individuals at risk should be implemented in nonendemic countries and must include undocumented migrants.
authors.affiliation: Division of Primary Care Medicine, Department of Community Medicine And Primary Care, University Hospitals of Geneva and Faculty of Medicine, Geneva University, Geneva, Switzerland. yves.jackson@hcuge.ch
authors.forename: Yves
authors.initials: Y
authors.lastname: Jackson
authors.forename: Laurent
authors.initials: L
authors.lastname: Gétaz
authors.forename: Hans
authors.initials: H
authors.lastname: Wolff
authors.forename: Marylise
authors.initials: M
authors.lastname: Holst
authors.forename: Anne
authors.initials: A
authors.lastname: Mauris
authors.forename: Aglaé
authors.initials: A
authors.lastname: Tardin
authors.forename: Juan
authors.initials: J
authors.lastname: Sztajzel
authors.forename: Valérie
authors.initials: V
authors.lastname: Besse
authors.forename: Louis
authors.initials: L
authors.lastname: Loutan
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gaspoz
authors.forename: Jean
authors.initials: J
authors.lastname: Jannin
authors.forename: Pedro
authors.initials: P
authors.lastname: Albajar Vinas
authors.forename: Alejandro
authors.initials: A
authors.lastname: Luquetti
authors.forename: François
authors.initials: F
authors.lastname: Chappuis
mesh_terms: D000328:Adult; D001782:Blood Donors / Q000706:statistics & numerical data; D014355:Chagas Disease / Q000453:epidemiology* / Q000473:pathology / Q000635:transmission*; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D007843:Latin America; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data