Prevalence of Chagas disease among Latin American immigrants in non-endemic countries: an updated systematic review and meta-analysis
Gisele Nepomuceno de Andrade, Pau Bosch‐Nicolau, Bruno Ramos Nascimento, Francisco Rogerlândio Martins‐Melo, Pablo Perel, Yvonne Geissbühler, Caroline Demacq, Monica Quijano, Jonathan F Mosser, Ewerton Cousin, Ísis Eloah Machado, Matheus Lucca A.C. Rodrigues, Antônio Luiz Pinho Ribeiro, Israel Molina
Abstract
Background Chagas disease (CD), endemic in 21 Latin American countries, has gradually spread beyond its traditional borders due to migratory movements and emerging as a global health concern. We conducted a systematic review and meta-analysis of available data to establish updated prevalence estimates of CD in Latin American migrants residing in non-endemic countries. Methods A systematic search was conducted in MEDLINE/PubMed, Embase, Cochrane Library, Scopus, Web of Science, and LILACS via Virtual Health Library ( Biblioteca Virtual em Saúde - BVS ), including references published until November 1st, 2023. Pooled prevalence estimates and 95% confidence intervals (CI) were calculated using random effect models. Heterogeneity was assessed by the chi-square test and the I 2 statistic. Subgroup analyses were performed to explore potential sources of heterogeneity among studies. The study was registered in the PROSPERO database (CRD42022354237). Findings From a total of 1474 articles screened, 51 studies were included. Studies were conducted in eight non-endemic countries (most in Spain), between 2006 and 2023, and involving 82,369 screened individuals. The estimated pooled prevalence of CD in Latin American migrants living in non-endemic countries was 3.5% (95% CI: 2.5–4.7; I 2 : 97.7%), considering studies in which screening was indicated simply because the person was Latin American. Per subgroups, the pooled CD prevalence was 11.0% (95% CI: 7.7–15.5) in non-targeted screening (unselected population in reference centers) (27 studies); in blood donors (4 studies), the pooled prevalence was 0.8% (95% CI: 0.2–3.4); among people living with HIV Latin American immigrants (4 studies) 2.4% (95% CI: 1.4–4.3) and for Latin American pregnant and postpartum women (14 studies) 3.7% (95 CI: 2.4–5.6). The pooled proportion of congenital transmission was 4.4% (95% CI: 3.3–5.8). Regarding the participants' country of origin, 7964 were from Bolivia, of which 1715 (21,5%) were diagnosed with CD, and 21,304 were from other Latin American countries of which 154 (0,72%) were affected. Interpretation CD poses a significant burden of disease in Latin American immigrants in non-endemic countries, suggesting that CD is no longer a problem limited to the American continent and must be considered as a global health challenge. Funding This study was funded by the World Heart Federation, through a research collaboration with Novartis Pharma AG.