Prevalence, clinical staging and risk for blood-borne transmission of Chagas disease among Latin American migrants in Geneva, Switzerland.
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.
Jackson
Yves
Y
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
Gétaz
Laurent
L
Wolff
Hans
H
Holst
Marylise
M
Mauris
Anne
A
Tardin
Aglaé
A
Sztajzel
Juan
J
Besse
Valérie
V
Loutan
Louis
L
Gaspoz
Jean-Michel
JM
Jannin
Jean
J
Albajar Vinas
Pedro
P
Luquetti
Alejandro
A
Chappuis
François
F
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