Chagas Disease: Seroprevalence and Associated Factors in Indigenous Communities of the Southern Limit of Argentine Chaco.

Chagas disease is more prevalent in socially vulnerable communities in the Gran Chaco Eco-region. The study evaluated the seroprevalence of Chagas disease and associated factors between May 2014 and September 2015, in indigenous communities of Santa Fe, Argentina, in the southern Chaco. Lysate ELISA and indirect hemagglutination tests were used to detect antibodies against Trypanosoma cruzi, and recombinant ELISA was used in the case of disagreement. Household surveys were conducted with the head of household about risk factors for the disease. Serological tests were conducted on 298 people from three indigenous communities, 127 male and 171 female. Seroprevalence was 18.5%. A total of 64 surveys were conducted; 82.8% of the heads of household were male, with a median age of 39 years, and 61.0% had not completed primary school. In 35.9% of the households, there was at least one member of the cohabiting group infected with T. cruzi. The level of education of the head of household showed a statistically significant association with Chagas disease (OR = 3.43), among all the risk factors studied. The prevalence of infection is lower than that of other indigenous communities of the Gran Chaco, probably because environmental conditions are moderating and disfavoring the establishment of the insect vector in homes, but also because of socioeconomic differences with the rest of the eco-region. Beyond this, serological controls are needed to prevent vertical transmission.

Chagas disease in children from the Gran Chaco region: A bibliographic appraisal.

In the Gran Chaco region, the Pan American Health Organization (PAHO) declared the interruption of vector transmission of Chagas Disease in Paraguay and some district of Argentina.After a bibliographic search, by using the words "Chagas, prevalence, children, Chaco", on scientiphic articles indexed in Pubmed and Lilacs during the 2010-2021 period, we found nine studies which dealt with entomological data seroprevalence surveys of Chagas Disease in Argentine children and three studies in Bolivian children.More field studies need to be published to better understand the epidemiological situation in children from the region. Due to its social and ecological characteristics, the Gran Chaco region remains a hotspot for Chagas Disease affecting disproportionally rural communities and certain vulnerable ethnics groups.

Seroprevalence of Chagas disease in urban and rural indigenous populations of the south of Gran Chaco.

BACKGROUND: In Latin America, Chagas disease is endemic, with a high prevalence in rural indigenous communities and an increasing prevalence in urban areas owing to migration from rural areas with active vector transmission. This study aimed to assess differences in the prevalence of Chagas disease in urban and rural moqoit communities, one of the main ethnic indigenous groups in the south of Gran Chaco. METHODS: A seroprevalence study was conducted in six moqoit populations in the Santa Fe province, Argentina. The variables studied were serology results for Chagas disease, residents of urban or rural areas, age, and sex. RESULTS: The results showed that 9.26% of the 702 volunteers evaluated and 18.32% of the 131women of childbearing potential were seropositive. According to the calculated prevalence ratio, the prevalence of Chagas disease in urban communities was6.41 (95% confidence inverval: 3.73-11.02) times higher than that in rural communities: 21.59% in urban communities vs. 3.37%in rural communities. CONCLUSIONS: The seroprevalence found in the moqoit community was higher than the estimated level for the general population of the same region, with a greater impact in urban areas than in rural areas. The urbanization of groups of people with poor socio-sanitary conditions in the second half of the 20th century could have caused this higher seroprevalence of Chagas disease.

Seroprevalence of Chagas disease in urban and rural indigenous populations of the south of Gran Chaco

ABSTRACT Background: In Latin America, Chagas disease is endemic, with a high prevalence in rural indigenous communities and an increasing prevalence in urban areas owing to migration from rural areas with active vector transmission. This study aimed to assess differences in the prevalence of Chagas disease in urban and rural moqoit communities, one of the main ethnic indigenous groups in the south of Gran Chaco. Methods: A seroprevalence study was conducted in six moqoit populations in the Santa Fe province, Argentina. The variables studied were serology results for Chagas disease, residents of urban or rural areas, age, and sex. Results: The results showed that 9.26% of the 702 volunteers evaluated and 18.32% of the 131women of childbearing potential were seropositive. According to the calculated prevalence ratio, the prevalence of Chagas disease in urban communities was6.41 (95% confidence inverval: 3.73-11.02) times higher than that in rural communities: 21.59% in urban communities vs. 3.37%in rural communities. Conclusions: The seroprevalence found in the moqoit community was higher than the estimated level for the general population of the same region, with a greater impact in urban areas than in rural areas. The urbanization of groups of people with poor socio-sanitary conditions in the second half of the 20th century could have caused this higher seroprevalence of Chagas disease.

Dengue emergence in the temperate Argentinian province of Santa Fe, 2009-2020.

Dengue virus (DENV) transmission occurs primarily in tropical and subtropical climates, but within the last decade it has extended to temperate regions. Santa Fe, a temperate province in Argentina, has experienced an increase in dengue cases and virus circulation since 2009, with the recent 2020 outbreak being the largest in the province to date. The aim of this work is to describe spatio-temporal fluctuations of dengue cases from 2009 to 2020 in Santa Fe Province. The data presented in this work provide a detailed description of DENV transmission for Santa Fe Province by department. These data are useful to assist in investigating drivers of dengue emergence in Santa Fe Province and for developing a better understanding of the drivers and the impacts of ongoing dengue emergence in temperate regions across the world. This work provides data useful for future studies including those investigating socio-ecological, climatic, and environmental factors associated with DENV transmission, as well as those investigating other variables related to the biology and the ecology of vector-borne diseases.

Conservación de las formas de alimentación ancestrales en comunidades moqoit del Chaco Argentino. Diferencias urbano rural / Conservation of ancestral feeding forms in moqoit communities in Argentinian Chaco

FUNDAMENTOS: En una población, una multiplicidad de factores influye en el estilo de vida y en los patrones de consumo alimentario. La alimentación es una de las actividades humanas más vulnerable a la transculturación. El objetivo de esta investigación fue evaluar la conservación de tradiciones alimentarias en comunidades de etnia moqoit del Norte de la provincia de Santa Fe, en el Chaco Argentino. MÉTODOS: Se realizó un estudio cuantitativo, descriptivo de corte transversal. Se aplicaron encuestas sobre hábitos alimentarios y características socioeconómicas a las personas que habitualmente cocinaban en una comunidad moqoit rural y una urbana, mediante visitas domiciliarias. RESULTADOS: Aceptaron participar personas de 73 de los 130 hogares. Un alto porcentaje de la población moqoit conserva formas tradicionales de obtención y preparación de alimentos, siendo esto más marcado en la comunidad rural. CONCLUSIONES: La situación general en la que viven denota un alto grado de carencia y exclusión. Sin embargo, la conservación de tradiciones ancestrales de alimentación y su relación con la soberanía alimentaria y la conservación de su ambiente natural, podría contribuir a subsanar estas carencias

BACKGROUND: A multiplicity of factors influences lifestyle and patterns of food consumption in a population. Food is one of the human activities most vulnerable to transculturation.The objective of this research was to evaluate the conservation of food traditions in communities of the moqoit ethnic group of the North of the province of Santa Fe, in the Argentine Chaco. METHODS: A quantitative, descriptive cross-sectional study was carried out. Surveys on food habits and socioeconomic characteristics were applied to people who habitually cooked in a rural moqoit community and an urban one, through home visits. RESULTS: People from73 of the 130 households agreed to participate. A high percentage of the moqoit population conserves traditional ways of obtaining and preparing food, this being more marked in the rural community. CONCLUSIONS: The general situation in which they live denotes a high degree of deprivation and exclusion. However, the conservation of ancestral food traditions and their relationship with food sovereignty and the conservation of their natural environment, could contribute to correcting these deficiencies

[Seroprevalence of Chagas´Disease in older than 14 years old in rural Chaco areas of Santa Fe Province.] / Seroprevalencia de Chagas en mayores de 14 años de áreas rurales del Chaco Santafesino.

Introduction: Chagas´Disease (CD) is endemic en Chaco Región. It is unknown the seroprevalence in population older than 14 years old from rural Chaco areas of Santa Fe Province. This study aimed to determine the seroprevalence of and socio-environmental factors associated with CD in inhabitants >14 years old of rural Chaco areas of Santa Fe, Argentina. Methods: A cross-sectional study was conducted between 2010 and 2015, in people over 14 years old, in the rural districts of the Chaco region, in the North of Santa Fe Province, Argentina. Blood serology for Trypanosoma cruzi antibodies based on two serological tests, and a third in case of discordance, were analized. Semi-structured survey was administered. Association between CD and socio-environmental variables were analyzed using prevalence ratios with 95% confidence intervals. Results: A total of 749 individual were analyzed, with an average of 29.5 years. The seroprevalence was 24.70% (26.69% in women and 20.26% in men). Socio-environmental variables showed association with Trypanosoma cruzi seropositive. The seroprevalence was 7.83 times higher in the children of mothers who had not reached secondary education. Conclusions: Chaco region of Santa Fe is endemic for CD, as well as other provinces of the Region. The low level of education is the more important conditioning for this endemic disease.

Introducción: Introducción. La Enfermedad de Chagas (ECh) es endémica en la Región del Chaco. Se desconoce su seroprevalencia en mayores de 14 años de áreas rurales del Chaco Santafesino. El objetivo del trabajo fue determinar la seroprevalencia de ECh en mayores de 14 años de áreas rurales del Chaco Santafesino, Argentina, y su asociación con factores de riesgo epidemiológico. Métodos: Se realizó un estudio transversal entre 2010 y 2015, en personas mayores de 14 años, los distritos rurales de la región del Chaco, en el Norte de la Provincia de Santa Fe, Argentina. Se determinó la prevalencia de anticuerpos contra Trypanosoma cruzi mediante dos pruebas serológicas, realizando una tercera en caso de discordancia. Se realizaron encuestas semiestructuradas sobre variables socioambientales. Se analizó la asociación entre ECh y variables socioambientales mediante la razón de prevalencias con un intervalo de confianza del 95%. Resultados: Se estudió una muestra de 749 personas, con una media de edad de 29,5 años. La seroprevalencia fue de 24,70% (26,69% en mujeres y 20,26% en hombres). Se halló asociación estadísticamente significativa entre las variables socioambientales y la seroprevalencia. La seroprevalencia fue 7,83 veces mayor en los hijos de madres que no habían alcanzado la educación secundaria. Conclusiones: La región del Chaco Santafesino es endémica para Chagas, al igual que otras provincias de la Región. El bajo nivel de instrucción materno es el condicionante más importante para esta endemia

Conocimientos sobre la enfermedad de Chagas en estudiantes de Enfermería de Argentina

Introducción: La enfermedad de Chagas es uno de principales problemas de Salud Pública de Latinoamérica. La deficiencia en la formación de los profesionales de la salud es un factor que contribuye a su persistencia y dificulta su prevención y control. Objetivos: Valorar el nivel de conocimientos sobre los distintos aspectos de la enfermedad de Chagas, con que se gradúan en enfermería en una región endémica con transmisión vectorial controlada. Métodos: Se realizó un estudio descriptivo transversal, mediante una encuesta anónima y voluntaria sobre diferentes aspectos del Chagas, a 133 estudiantes del último año de la Escuela de Enfermería de Santa Fe, Argentina, en el año 2015. Se calcularon la media, valores mínimos y máximos para las variables cuantitativas, y frecuencias absolutas y relativas para las cualitativas. Resultados: Todos los alumnos aceptaron participar de la encuesta (133/133). El promedio de edad fue de 28 años. El 83,5 % fueron mujeres y el 16,5 % varones. El 82,7 % identificaron a los vectores y 100 % conocieron como transmiten, 7,5 % conocieron otras vías de transmisión. El 92,5 % reconoció el área de riesgo vectorial, pero minimizaron la prevalencia en el país y fuera del área de riesgo vectorial. Los conocimientos sobre clínica y tratamiento fueron 38,3 % y 27,1 % respectivamente. Conclusiones: Los estudiantes de enfermería se encuentran capacitados para la prevención de la Enfermedad de Chagas por vía vectorial, pero se deben reforzar los conocimientos en otros aspectos para colaborar en el control de la endemia.

Introduction: Chagas disease is one of the main public health problems in Latin America. The deficiency in the training of health professionals is a factor that contributes to its persistence and hinders its prevention and control. Objectives: To assess the level of knowledge about the different aspects of Chagas disease, with which graduate complete the Nursing major in an endemic region with controlled vector transmission. Methods: A cross-sectional, descriptive study was carried out, using an anonymous and voluntary survey about different aspects of Chagas disease, conducted on 133 students of the last academic year at the School of Nursing of Santa Fe, Argentina, in 2015. We calculated the mean, the minimum and maximum values ​​for quantitative variables, and the absolute and relative frequencies for qualitative ones. Results: All students agreed to participate in the survey (133/133). The average age was 28 years. 83.5% were women and 16.5% were men. 82.7% identified the vectors and 100% knew the transmission way, 7.5% knew other transmission routes. 92.5% recognized the vector risk area, but they minimized the prevalence in the country and outside the vector risk area. Their knowledge about clinical aspects and treatment were 38.3% and 27.1%, respectively. Conclusions: Nursing students are trained to prevent vector-borne Chagas disease, but knowledge in other aspects must be strengthened to help control the endemic disease.

Simultaneous use of two rapid diagnostic tests for the diagnosis of Chagas disease.

The sensitivity of rapid diagnostic tests (RDT) for Chagas disease is not great enough for their single use. The aim of this paper was to evaluate the performance of two RDTs for Chagas disease, used simultaneously. Two different RDTs (A and B) were performed in 64 and 42 serum samples that were negative and positive, respectively, by conventional serological techniques. Validity and reliability of both tests were evaluated individually and simultaneously. Sensitivity was 90.5% and 97.6%, and specificity was 100% and 93.8%, for RDT A and B, respectively. The κ statistic was 0.96. When both RDTs were used simultaneously, sensitivity was 97.4%, specificity was 100% and the discordance percentage 6.6%. The combined use of two RDTs with serum samples is an acceptable application in healthcare centres.

Development and assessment of an improved recombinant multiepitope antigen-based immunoassay to diagnose chronic Chagas disease.

The use of chimeric molecules fusing several antigenic determinants is a promising strategy for the development of low-cost, standardized and reliable kits to determine specific antibodies. In this study, we designed and assessed a novel recombinant chimera that complements the performance of our previously developed chimera, CP1 [FRA and SAPA antigens (Ags)], to diagnose chronic Chagas disease. The new chimeric protein, named CP3, is composed of MAP, TcD and TSSAII/V/VI antigenic determinants. We compared the performance of both chimeric Ags using a panel of 67 Trypanosoma cruzi-reactive sera and 67 non-reactive ones. The sensitivity of CP3 vs CP1 was 100 and 90.2%, and specificity was 92.5 and 100%, respectively. The mixture of CP1 + CP3 achieved 100% of sensitivity and specificity. More importantly, an additional subset of 17 sera from patients with discordant results of conventional serological methods was analysed; the CP1 + CP3 mixture allowed us to accurately classify 14 of them with respect to IIF, the usual technique used in most of the reference centres. These results show an improved performance of the CP1 + CP3 mixture in comparison with enzyme-linked immunosorbent assay and indirect haemagglutination commercial assays.

Chagas pediátrico en áreas rurales de la provincia de Santa Fe / Pediatric chagas disease in rural areas of Santa Fe province

INTRODUCCIÓN: la enfermedad de Chagas continúa siendo un importante problema de salud pública en la ecoregión del Gran Chaco. El norte de la provincia de Santa Fe, correspondiente al Sur de dicha región, se encuentra bajo control entomológico. Dado que se trata de una infección crónica, la seroprevalencia de esta endemia enniños es un marcador de la situación actual de la infección. OBJETIVOS:Determinar la seroprevalencia de infección chagásica en poblaciónpediátrica del Chaco santafesino. MÉTODOS: Se realizó un estudiodescriptivo de corte transversal sobre seroprevalencia de infección chagásica en niños de 5 a 14 años de edad. Comprendió un área aproximada de 38 000 km2 de distritos rurales de los departamentos 9 de Julio y Vera en la provincia de Santa Fe, y se llevó a cabo entre noviembre de 2010 y abril de 2013. RESULTADOS: Se muestreó al71,5% de los niños de la región (3765/5266). La prevalencia fue de1,8% (67/3765). Varió de 5,5% a 0% entre los distintos distritos. De5 a 9 años, fue 1,2% (21/1769); de 10 a 14 años, 2,3% (46/1996).CONCLUSIONES: La seroprevalencia hallada fue inferior a la de otrosestudios en el Gran Chaco. Se observa una gran heterogeneidad en laprevalencia entre los distritos, aun entre los vecinos. La distribución noobedecería a factores climáticos, sino a factores sociales y a la influenciade la actividad antrópica en cada localidad.

INTRODUCTION: chagas disease remains a major public health problem in the Gran Chaco region. The north of Santa Fe province, being the south of this region, is under entomologicalsurveillance. Being a chronic infection, the seroprevalence of this endemic disease in children serves as a marker of the current status. OBJECTIVES: To determine the seroprevalence of Chagasdisease in the pediatric population of Chaco region in Santa Fe. METHODS: A descriptive, cross-sectional seroprevalence study on Chagas infection was conducted for children aged 5-14 years old. It considered an area of 38 000 km2 belonging to ruraldistricts of 9 de Julio and Vera departments in Santa Fe province,between November 2010 and April 2013. RESULTS: The sampling included 71.5% of the children in the region (3765/5266). There was a prevalence of 1.8% (67/3765), ranged from 5.5% to 0% among districts. For 5-9 years, it was 1.2% (21/1769); for 10-14 years, 2.3% (46/1996). CONCLUSIONS: The seroprevalence was lower than in other studies performed in the Gran Chaco. A large heterogeneity is observed in the prevalence among districts, even among neighboring districts. The distribution does not seem to be due to climatic factors, but to social factors and the influence of human activity in each location.

Diagnostic reliability of an immunochromatographic test for Chagas disease screening at a primary health care centre in a rural endemic area.

Many patients with Chagas disease live in remote communities that lack both equipment and trained personnel to perform a diagnosis by conventional serology (CS). Thus, reliable tests suitable for use under difficult conditions are required. In this study, we evaluated the ability of personnel with and without laboratory skills to perform immunochromatographic (IC) tests to detect Chagas disease at a primary health care centre (PHCC). We examined whole blood samples from 241 patients and serum samples from 238 patients. Then, we calculated the percentage of overall agreement (POA) between the two groups of operators for the sensitivity (S), specificity (Sp) and positive (PPV) and negative (NPV) predictive values of IC tests compared to CS tests. We also evaluated the level of agreement between ELISAs and indirect haemagglutination (IHA) tests. The readings of the IC test results showed 100% agreement (POA = 1). The IC test on whole blood showed the following values: S = 87.3%; Sp = 98.8%; PPV = 96.9% and NPV = 95.9%. Additionally, the IC test on serum displayed the following results: S = 95.7%; Sp = 100%; PPV = 100% and NPV = 98.2%. Using whole blood, the agreement with ELISA was 96.3% and the agreement with IHA was 94.1%. Using serum, the agreement with ELISA was 97.8% and the agreement with IHA was 96.6%. The IC test performance with serum samples was excellent and demonstrated its usefulness in a PHCC with minimal equipment. If the IC test S value and NPV with whole blood are improved, then this test could also be used in areas lacking laboratories or specialised personnel.

Diagnostic reliability of an immunochromatographic test for Chagas disease screening at a primary health care centre in a rural endemic area

Many patients with Chagas disease live in remote communities that lack both equipment and trained personnel to perform a diagnosis by conventional serology (CS). Thus, reliable tests suitable for use under difficult conditions are required. In this study, we evaluated the ability of personnel with and without laboratory skills to perform immunochromatographic (IC) tests to detect Chagas disease at a primary health care centre (PHCC). We examined whole blood samples from 241 patients and serum samples from 238 patients. Then, we calculated the percentage of overall agreement (POA) between the two groups of operators for the sensitivity (S), specificity (Sp) and positive (PPV) and negative (NPV) predictive values of IC tests compared to CS tests. We also evaluated the level of agreement between ELISAs and indirect haemagglutination (IHA) tests. The readings of the IC test results showed 100% agreement (POA = 1). The IC test on whole blood showed the following values: S = 87.3%; Sp = 98.8%; PPV = 96.9% and NPV = 95.9%. Additionally, the IC test on serum displayed the following results: S = 95.7%; Sp = 100%; PPV = 100% and NPV = 98.2%. Using whole blood, the agreement with ELISA was 96.3% and the agreement with IHA was 94.1%. Using serum, the agreement with ELISA was 97.8% and the agreement with IHA was 96.6%. The IC test performance with serum samples was excellent and demonstrated its usefulness in a PHCC with minimal equipment. If the IC test S value and NPV with whole blood are improved, then this test could also be used in areas lacking laboratories or specialised personnel.