title: Cross-sectional, descriptive study of Chagas disease among citizens of Bolivian origin living in Munich, Germany.
abstract: Chagas disease (CD) has become a global health issue mainly due to migration. Germany lacks surveillance data and is home to a large Latin American immigrant population. Recognising that Bolivia is the country with the highest CD prevalence in Latin America, this cross-sectional, descriptive pilot study investigated CD and associated factors among citizens of Bolivian origin living in Munich, Germany.
  
  
  
  Participants completed a questionnaire in order to collect socioeconomic and health-related data. In addition, serology was performed. In case of positive serological tests, PCR diagnostic and clinical staging together with disease management was initiated. Qualitative research was conducted to identify personal and community barriers as well as strategies to increase CD awareness among the population at risk.
  
  
  
  Between June 2013 and June 2014, 43 people from Bolivia (or descendants) were enrolled. A total of 9.3% (4/43), of whom two women were of childbearing age, tested seropositive (ELISA and IFAT), and one also by PCR. For 2/4 positive participants, clinical evaluation was performed and the indeterminate form of CD was diagnosed. Knowledge about CD symptoms and ways of transmission were completely absent among 55.8% (24/43, 2/4 with CD) and 30.2% (13/43, 1/4 with CD) of participants, respectively. A total of 27.9% (12/43, 0/4 with CD) of participants had donated blood prior to the study, whereas 62.8% (27/43, 3/4 with CD) were motivated to donate blood in the future. The qualitative research identified lack of knowledge as well as stigma and fears related to CD.
  
  
  
  Despite the small number of participants, the prevalence of CD as well as the potential risk of non-vectorial transmission was alarming. Campaigns adapted for Latin American migrants as well as control strategies should be developed and put in place in order to prevent non-vectorial transmission and actively detect cases of CD in Germany.
authors.affiliation: Fundación Mundo Sano, Madrid, Spain.
authors.forename: Miriam
authors.initials: M
authors.lastname: Navarro
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Berens-Riha
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hohnerlein
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.|German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Seiringer
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: von Saldern
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Garcia
authors.affiliation: Centro Nacional de Medicina Tropical (Instituto de Salud Carlos III), Madrid, Spain.|Red de investigación Cooperativa en Enfermedades Tropicales, Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Blasco-Hernández
authors.affiliation: Fundación Mundo Sano, Madrid, Spain.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Navaza
authors.affiliation: The Laboratory for Quantum Gravity & Strings, Department of Mathematics and Applied Mathematics, University of Cape Town, Cape Town, South Africa.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shock
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.
authors.forename: Gisela
authors.initials: G
authors.lastname: Bretzel
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.|German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoelscher
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Löscher
authors.affiliation: Department of Control of Neglected Tropical Diseases, World Health Organization (WHO), Geneva, Switzerland.
authors.forename: Pedro
authors.initials: P
authors.lastname: Albajar-Viñas
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.|German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Pritsch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001838:Bolivia / Q000208:ethnology; D014355:Chagas Disease / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Chagas Disease; Germany; Migration; Trypanosoma cruzi