Geographic Variation in the Sensitivity of Recombinant Antigen-based Rapid Tests for Chronic Trypanosoma cruzi Infection

Jennifer R. Verani Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Amy Seitz Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Robert H. Gilman Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Carlos LaFuente Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Gerson Galdos-Cardenas Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Vivian Kawai Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Elizabeth de LaFuente Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Lisbeth Ferrufino Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Natalie M. Bowman Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Viviana Pinedo-Cancino Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Michael Z. Levy Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Francis Steurer Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Charles W. Todd Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Louis V. Kirchhoff Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Lilia Cabrera Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Manuela Verastegui Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Caryn Bern Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Emory University, Atlanta, Georgia; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Asociación Benéfica PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Unversitario Japonés, Santa Cruz, Bolivia; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Chagas disease affects 8–11 million people throughout the Americas. Early detection is crucial for timely treatment and to prevent non-vectorial transmission. Recombinant antigen-based rapid tests had high sensitivity and specificity in laboratory evaluations, but no Peruvian specimens were included in previous studies. We evaluated Stat-Pak and Trypanosoma Detect rapid tests in specimens from Bolivia and Peru. Specimens positive by three conventional assays were confirmed positives; specimens negative by two or more assays were confirmed negatives. In Bolivian specimens, Stat-Pak and Trypanosoma Detect tests were 87.5% and 90.7% sensitive, respectively; both showed 100% specificity. Sensitivity in Peruvian specimens was much lower: 26.6–33.0% (Stat-Pak) and 54.3–55.2% (Trypanosoma Detect); both had specificities > 98%. Even in Bolivian specimens, these sensitivities are inadequate for stand-alone screening. The low sensitivity in Peru may be related to parasite strain differences. Chagas disease rapid tests should be field tested in each geographic site before widespread implementation for screening.

Author Notes

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