Congenital Chagas Disease in the Ecuadorian Amazon: Maternal Screening at Delivery and Evaluation of Risk Factors Associated with Vector Exposure

Marion Restrepo Zambrano Public Health, Epidemiology and Development Institute (ISPED), University of Bordeaux, Bordeaux, France;
Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Pontificia Universidad Católica del Ecuador, Quito, Ecuador;

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Faustine Rouset Public Health, Epidemiology and Development Institute (ISPED), University of Bordeaux, Bordeaux, France;
Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Pontificia Universidad Católica del Ecuador, Quito, Ecuador;

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Otita F. Carrasco Hospital General Francisco de Orellana, Francisco de Orellana, Ecuador;

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Diana Echeverría Murillo Dirección Distrital 22D02, Orellana-Loreto-SALUD, Ministerio de Salud Pública, Francisco de Orellana, Ecuador;

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Jaime A. Costales Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Pontificia Universidad Católica del Ecuador, Quito, Ecuador;

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Simone Frédérique Brenière Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Pontificia Universidad Católica del Ecuador, Quito, Ecuador;
Interactions Hôtes-Vecteurs-Parasites-Environnement dans les Maladies Tropicales Négligées dues aux Trypanosomatidés (INTERTRYP), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD), Institut de Recherche pour le Développement (IRD), Université de Montpellier, TA A-17/G, International Campus in Baillarguet, Montpellier, France

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Congenital infection with Trypanosoma cruzi remains a major route for Chagas disease transmission in endemic and non-endemic regions. We evaluated an intervention strategy aimed to detect congenital Chagas disease cases at a major hospital in the Ecuadorian Amazon via cord blood analysis at the time of delivery. All women giving birth at the hospital during the study period (191) were invited to participate. Among them, two (1.0%) did not adjust to the inclusion criteria and four (2.1%) declined to participate in the study, showing the intervention had good acceptability among the mothers. It was possible to obtain cord blood samples during 146 of the deliveries, and only one woman was found to be seropositive, without evidence of transmission to the newborn at delivery or 8 months later. In addition, sociodemographic and economic characterization of the study population revealed that few women had previous knowledge about Chagas disease (16.1%) whereas more than half (62.5%) recognized the vector. Recognizing the vector and having seen it indoors were associated with women from rural families, involved in agriculture, and hunting in the forest. Interestingly, most women (87.3%) reported having easy access to Ecuador’s national health system, suggesting serological screening during prenatal visits would be of value in this province. With a proper prenatal screening system in place, cord blood screening would allow for timely detection of T. cruzi infection in newborns from both seropositive women and the minority (2.1%) of women who do not comply with prenatal care visits.

Author Notes

Address correspondence to Jaime A. Costales, Centro de Investigación para la Salud en América Latina, Escuela de Ciencias Biológicas, Pontificia Universidad Católica del Ecuador, Av. 12 de Octubre 1076 y Roca, Apartado 17-01-2184, Quito 170143, Ecuador, E-mail: jacostalesc@puce.edu.ec or Simone Frédérique Brenière, INTERTRYP, CIRAD, IRD, Université de Montpellier, Montpellier, France, E-mail: frederique.breniere@ird.fr.

Financial support: This work received funding from the Institut de Recherche pour le Développement (IRD), France, and IdEx International 2015–2016 from the University of Bordeaux, France.

Authors’ addresses: Marion Restrepo Zambrano and Faustine Rouset, Public Health, Epidemiology and Development Institute (ISPED), University of Bordeaux, Bordeaux, France and Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Pontificia Universidad Católica del Ecuador, Quito, Ecuador, E-mails: marionrestrepo85@gmail.com and faustine.rouset@hotmail.fr. Otita F. Carrasco, Hospital General Francisco de Orellana, Francisco de Orellana, Ecuador, E-mail: otita.carrasco@hfo.gob.ec. Diana Echeverría Murillo, Dirección Distrital 22D02, Orellana-Loreto-SALUD, Ministerio de Salud Pública, Francisco de Orellana, Ecuador, E-mail: diana_em55@hotmail.com. Jaime A. Costales, Centro de Investigación para la Salud en América Latina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador, E-mail: jacostalesc@puce.edu.ec. Simone Frédérique Brenière, INTERTRYP, CIRAD, IRD, Université de Montpellier, Montpellier, France, E-mail: frederique.breniere@ird.fr.

These authors contributed equally to this work.

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