##common.pageHeaderLogo.altText##

Review article: Biomedical intelligence

Vol. 154 No. 12 (2024)

Chagas disease in Switzerland: current situation, challenges and opportunities

Cite this as:
Swiss Med Wkly. 2024;154:3719
Published
19.12.2024

Summary

Chagas disease is a parasitic infection found mainly in continental Latin America. However, it is now present globally due to increasing international mobility and its lifelong persistence in the absence of timely treatment. In Switzerland, this neglected tropical disease presents a significant challenge because of its high potential for transmission, severe clinical manifestations and complications, and a lack of medical and public health programs at both the cantonal and national levels. This paper reviews the medical and public health interventions addressing Chagas disease in countries outside Latin America. It provides a specific perspective on the challenges, opportunities, and strategies for the elimination of Chagas disease as a public health problem within the Swiss context. This article concludes with the introduction of the newly created Swiss Chagas Network, which aims to develop strategies for improving the management of Chagas disease in Switzerland.

References

  1. Chagas disease (also known as American trypanosomiasis). https://www.who.int/news-room/fact-sheets/detail/chagas-disease-(american-trypanosomiasis)
  2. Federal Statistical Office. Federal Statistical Office. https://www.bfs.admin.ch/bfs/en/home.html
  3. Morlok M, Meier H, Oswald A, Efionayi-Mäder D. Les sans-papiers en Suisse en 2015, rapport final à l’attention du Secrétariat d’Etat aux migrations (SEM). https://www.sem.admin.ch/dam/sem/fr/data/internationales/illegale-migration/sans_papiers/ber-sanspapiers-2015-f.pdf.download.pdf/ber-sanspapiers-2015-f.pdf
  4. Garrett CM, Altman R. Vulnerabilized: revisiting the language of the vulnerable populations framework. Am J Public Health. 2024 Feb;114(2):177–9. doi: https://doi.org/10.2105/AJPH.2023.307532
  5. Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030. World Health Organization; 2021. 196.
  6. Jackson Y, Varcher Herrera M, Gascon J. Economic crisis and increased immigrant mobility: new challenges in managing Chagas disease in Europe. Bull World Health Organ. 2014 Oct;92(10):771–2. doi: https://doi.org/10.2471/BLT.13.134072
  7. de Sousa AS, Vermeij D, Ramos AN Jr, Luquetti AO. Chagas disease. Lancet. 2024 Jan;403(10422):203–18. doi: https://doi.org/10.1016/S0140-6736(23)01787-7
  8. Jackson Y, Basile L, Chappuis F. Chagas Disease in Europe. Neglected Tropical Diseases - Europe and Central Asia; 2021. pp. 101–22.
  9. Basile L, Jansa JM, Carlier Y, Salamanca DD, Angheben A, Bartoloni A, et al.; Working Group on Chagas Disease. Chagas disease in European countries: the challenge of a surveillance system. Euro Surveill. 2011 Sep;16(37):19968. doi: https://doi.org/10.2807/ese.16.37.19968-en
  10. Navarro M, Reguero L, Subirà C, Blázquez-Pérez A, Requena-Méndez A. Estimating chagas disease prevalence and number of underdiagnosed, and undertreated individuals in Spain. Travel Med Infect Dis. 2022;47:102284. doi: https://doi.org/10.1016/j.tmaid.2022.102284
  11. Liechti M, Baur HR, Gurtner HP, Straub PW. [Cardiac complications of American trypanosomiasis (Chagas disease). Various case reports and general observations]. Schweiz Med Wochenschr. 1990 Oct;120(41):1493–6.
  12. Jackson Y, Chappuis F, Loutan L. [Chagas disease in Switzerland: managing an emerging infection and interrupting its transmission]. Rev Med Suisse. 2008 May;4(157):1212–4.
  13. Jackson Y, Chappuis F. Chagas disease in Switzerland: history and challenges. Euro Surveill. 2011 Sep;16(37):19963. doi: https://doi.org/10.2807/ese.16.37.19963-en
  14. Da Costa-Demaurex C, Cárdenas MT, Aparicio H, Bodenmann P, Genton B, D’Acremont V. Screening strategy for Chagas disease in a non-endemic country (Switzerland): a prospective evaluation. Swiss Med Wkly. 2019 Apr;149:w20050. doi: https://doi.org/10.4414/smw.2019.20050
  15. Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030. World Health Organization; 2021. 196 pp.
  16. Justi SA, Galvão C. The Evolutionary Origin of Diversity in Chagas Disease Vectors. Trends Parasitol. 2017 Jan;33(1):42–52. doi: https://doi.org/10.1016/j.pt.2016.11.002
  17. Guidelines for the diagnosis and treatment of Chagas disease. World Health Organization; 2018.
  18. Chagas disease (American trypanosomiasis). https://www.who.int/health-topics/chagas-disease#tab=tab_1
  19. Jan 27. Factsheet: Chagas Disease in the Americas for Public Health Workers. https://www.paho.org/en/documents/factsheet-chagas-disease-americas-public-health-workers
  20. Pérez-Molina JA, Molina I. Chagas disease. Lancet. 2018 Jan;391(10115):82–94. doi: https://doi.org/10.1016/S0140-6736(17)31612-4
  21. de Noya B, González O, Robertson LJ. Trypanosoma cruzi as a Foodborne Pathogen. Springer; 2015. 92 pp. doi: https://doi.org/10.1007/978-3-319-23410-6
  22. Klein MD, Proaño A, Noazin S, Sciaudone M, Gilman RH, Bowman NM. Risk factors for vertical transmission of Chagas disease: A systematic review and meta-analysis. Int J Infect Dis. 2021 Apr;105:357–73. doi: https://doi.org/10.1016/j.ijid.2021.02.074
  23. Herwaldt BL. Laboratory-acquired parasitic infections from accidental exposures. Clin Microbiol Rev. 2001 Oct;14(4):659–88. doi: https://doi.org/10.1128/CMR.14.3.659-688.2001
  24. Bern C. Chagas’ Disease. N Engl J Med. 2015 Jul;373(5):456–66. doi: https://doi.org/10.1056/NEJMra1410150
  25. Pinto AY, Valente SA, Valente VC, Ferreira Junior AG, Coura JR. [Acute phase of Chagas disease in the Brazilian Amazon region: study of 233 cases from Pará, Amapá and Maranhão observed between 1988 and 2005]. Rev Soc Bras Med Trop. 2008;41(6):602–14. doi: https://doi.org/10.1590/S0037-86822008000600011
  26. Laranja FS, Dias E, Nobrega G, Miranda A. Chagas’ Disease. Circulation. 1956. https://www.ahajournals.org/doi/abs/10.1161/01.cir.14.6.1035
  27. Alba Soto CD, Cappa SM. Trypanosoma cruzi Journey from the Insect Vector to the Host Cell. Chagas Disease; 2019. pp. 25–59. doi: https://doi.org/10.1007/978-3-030-00054-7_2
  28. Francolino SS, Antunes AF, Talice R, Rosa R, Selanikio J, de Rezende JM, et al. New evidence of spontaneous cure in human Chagas’ disease. Rev Soc Bras Med Trop. 2003;36(1):103–7. doi: https://doi.org/10.1590/S0037-86822003000100014
  29. Dias JC, Dias E, Martins-Filho OA, Vitelli-Avelar D, Correia D, Lages E, et al. Further evidence of spontaneous cure in human Chagas disease. Rev Soc Bras Med Trop. 2008;41(5):505–6. doi: https://doi.org/10.1590/S0037-86822008000500014
  30. Bittencourt AL, Sadigursky M, Barbosa HS. [Congenital Chagas’ disease. Study of 29 cases]. Rev Inst Med Trop São Paulo. 1975;17(3):146–59.
  31. Coura JR, de Abreu LL, Pereira JB, Willcox HP. Morbidade da doenĉa de Chagas. IV. Estudo longitudinal de dez anos emPains e Iguatama, Minas Gerais, Brasil. Mem Inst Oswaldo Cruz. 1985;80(1):73–80. doi: https://doi.org/10.1590/S0074-02761985000100011
  32. Rassi A Jr, Rassi A, Marcondes de Rezende J. American trypanosomiasis (Chagas disease). Infect Dis Clin North Am. 2012 Jun;26(2):275–91. doi: https://doi.org/10.1016/j.idc.2012.03.002
  33. Sabino EC, Ribeiro AL, Salemi VM, Di Lorenzo Oliveira C, Antunes AP, Menezes MM, et al.; National Heart, Lung, and Blood Institute Retrovirus Epidemiology Donor Study-II (REDS-II), International Component. Ten-year incidence of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi-seropositive former blood donors. Circulation. 2013 Mar;127(10):1105–15. doi: https://doi.org/10.1161/CIRCULATIONAHA.112.123612
  34. Viotti R, Vigliano C, Lococo B, Bertocchi G, Petti M, Alvarez MG, et al. Long-term cardiac outcomes of treating chronic Chagas disease with benznidazole versus no treatment: a nonrandomized trial. Ann Intern Med. 2006 May;144(10):724–34. doi: https://doi.org/10.7326/0003-4819-144-10-200605160-00006
  35. Machado-de-Assis GF, Diniz GA, Montoya RA, Dias JC, Coura JR, Machado-Coelho GL, et al. A serological, parasitological and clinical evaluation of untreated Chagas disease patients and those treated with benznidazole before and thirteen years after intervention. Mem Inst Oswaldo Cruz. 2013 Nov;108(7):873–80. doi: https://doi.org/10.1590/0074-0276130122
  36. Dias JC. The indeterminate form of human chronic Chagas’ disease A clinical epidemiological review. Rev Soc Bras Med Trop. 1989;22(3):147–56. doi: https://doi.org/10.1590/S0037-86821989000300007
  37. Coura JR, de Abreu LL, Pereira JB, Willcox HP. [Morbidity in Chagas’ disease. IV. Longitudinal study of 10 years in Pains and Iguatama, Minas Gerais, Brazil]. Mem Inst Oswaldo Cruz. 1985;80(1):73–80. doi: https://doi.org/10.1590/S0074-02761985000100011
  38. Salvador F, Treviño B, Sulleiro E, Pou D, Sánchez-Montalvá A, Cabezos J, et al. Trypanosoma cruzi infection in a non-endemic country: epidemiological and clinical profile. Clin Microbiol Infect. 2014 Jul;20(7):706–12. doi: https://doi.org/10.1111/1469-0691.12443
  39. de Oliveira RB, Troncon LE, Dantas RO, Menghelli UG. Gastrointestinal manifestations of Chagas’ disease. Am J Gastroenterol. 1998 Jun;93(6):884–9. doi: https://doi.org/10.1111/j.1572-0241.1998.270_r.x
  40. Echeverría LE, Marcus R, Novick G, Sosa-Estani S, Ralston K, Zaidel EJ, et al. WHF IASC Roadmap on Chagas Disease. Glob Heart. 2020 Mar;15(1):26. doi: https://doi.org/10.5334/gh.484
  41. Sica RE, Gonzalez Cappa SM, Sanz OP, Mirkin G. Peripheral nervous system involvement in human and experimental chronic American trypanosomiasis. Bull Soc Pathol Exot. 1995 Mar;88(4):156–63.
  42. Bern C. Chagas disease in the immunosuppressed host. Curr Opin Infect Dis. 2012 Aug;25(4):450–7. doi: https://doi.org/10.1097/QCO.0b013e328354f179
  43. Martinez-Perez A, Norman FF, Monge-Maillo B, Perez-Molina JA, Lopez-Velez R. An approach to the management of Trypanosoma cruzi infection (Chagas’ disease) in immunocompromised patients. Expert Rev Anti Infect Ther. 2014 Mar;12(3):357–73. doi: https://doi.org/10.1586/14787210.2014.880652
  44. Cardoso RN, Macedo FY, Garcia MN, Garcia DC, Benjo AM, Aguilar D, et al. Chagas cardiomyopathy is associated with higher incidence of stroke: a meta-analysis of observational studies. J Card Fail. 2014 Dec;20(12):931–8. doi: https://doi.org/10.1016/j.cardfail.2014.09.003
  45. Bestetti RB, Restini CB. Precordial chest pain in patients with chronic Chagas disease. Int J Cardiol. 2014 Sep;176(2):309–14. doi: https://doi.org/10.1016/j.ijcard.2014.07.112
  46. Saraiva RM, Mediano MF, Mendes FS, Sperandio da Silva GM, Veloso HH, Sangenis LH, et al. Chagas heart disease: an overview of diagnosis, manifestations, treatment, and care. World J Cardiol. 2021 Dec;13(12):654–75. doi: https://doi.org/10.4330/wjc.v13.i12.654
  47. Swett MC, Rayes DL, Campos SV, Kumar RN. Chagas Disease: Epidemiology, Diagnosis, and Treatment. Curr Cardiol Rep. 2024 Oct;26(10):1105–12. doi: https://doi.org/10.1007/s11886-024-02113-7
  48. Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010 Apr;375(9723):1388–402. doi: https://doi.org/10.1016/S0140-6736(10)60061-X
  49. Requena-Méndez A, Bussion S, Aldasoro E, Jackson Y, Angheben A, Moore D, et al. Cost-effectiveness of Chagas disease screening in Latin American migrants at primary health-care centres in Europe: a Markov model analysis. Lancet Glob Health. 2017 Apr;5(4):e439–47. doi: https://doi.org/10.1016/S2214-109X(17)30073-6
  50. Gascón J, Albajar P, Cañas E, Flores M, Gómez i Prat J, Herrera RN, et al.; Working Group of the second workshop on “Imported Chagas’ Disease, a New Challenge in Public Health”; Spanish Society of Tropical Medicine and International Health. [Diagnosis, management and treatment of chronic Chagas’ heart disease in areas where Trypanosoma cruzi infection is not endemic]. Enferm Infecc Microbiol Clin. 2008 Feb;26(2):99–106.
  51. Carlier Y, Altcheh J, Angheben A, Freilij H, Luquetti AO, Schijman AG, et al. Congenital Chagas disease: updated recommendations for prevention, diagnosis, treatment, and follow-up of newborns and siblings, girls, women of childbearing age, and pregnant women. PLoS Negl Trop Dis. 2019 Oct;13(10):e0007694. doi: https://doi.org/10.1371/journal.pntd.0007694
  52. Moraes FC, Souza ME, Dal Moro L, Donadon IB, da Silva ER, de Souza DD, et al. Prevention of congenital chagas disease by trypanocide treatment in women of reproductive age: A meta-analysis of observational studies. PLoS Negl Trop Dis. 2024 Sep;18(9):e0012407. doi: https://doi.org/10.1371/journal.pntd.0012407
  53. Edwards MS, Montgomery SP. Congenital Chagas disease: progress toward implementation of pregnancy-based screening. Curr Opin Infect Dis. 2021 Oct;34(5):538–45. doi: https://doi.org/10.1097/QCO.0000000000000769
  54. Howard EJ, Xiong X, Carlier Y, Sosa-Estani S, Buekens P. Frequency of the congenital transmission of Trypanosoma cruzi: a systematic review and meta-analysis. BJOG. 2014 Jan;121(1):22–33. doi: https://doi.org/10.1111/1471-0528.12396
  55. Altcheh JM. Congenital Chagas Disease. Chagas Disease; 2019. pp. 179–98. doi: https://doi.org/10.1007/978-3-030-00054-7_9
  56. Wagner N, Jackson Y, Posfay Barbe C. Maladie de Chagas: le point pour le praticien. Paediatrica. 2015;23(3):25–8.
  57. Moscatelli G, Moroni S, García Bournissen F, González N, Ballering G, Schijman A, et al. Longitudinal follow up of serological response in children treated for Chagas disease. PLoS Negl Trop Dis. 2019 Aug;13(8):e0007668. doi: https://doi.org/10.1371/journal.pntd.0007668
  58. Requena-Méndez A, Aldasoro E, de Lazzari E, Sicuri E, Brown M, Moore DA, et al. Prevalence of Chagas disease in Latin-American migrants living in Europe: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2015 Feb;9(2):e0003540. doi: https://doi.org/10.1371/journal.pntd.0003540
  59. Eperon G, Bühler S, Enriquez N, Vaudaux B. [The immunosuppressed traveler : vaccination guidelines]. Rev Med Suisse. 2018 May;14(605):922–33.
  60. Sánchez-Camargo CL, Albajar-Viñas P, Wilkins PP, Nieto J, Leiby DA, Paris L, et al. Comparative evaluation of 11 commercialized rapid diagnostic tests for detecting Trypanosoma cruzi antibodies in serum banks in areas of endemicity and nonendemicity. J Clin Microbiol. 2014 Jul;52(7):2506–12. doi: https://doi.org/10.1128/JCM.00144-14
  61. Chappuis F, Mauris A, Holst M, Albajar-Vinas P, Jannin J, Luquetti AO, et al. Validation of a rapid immunochromatographic assay for diagnosis of Trypanosoma cruzi infection among Latin-American Migrants in Geneva, Switzerland. J Clin Microbiol. 2010 Aug;48(8):2948–52. doi: https://doi.org/10.1128/JCM.00774-10
  62. D’Acremont V, Greub G, Genton B. [Rapid diagnostic tests (RDT): the cure-all for the practitioner?]. Rev Med Suisse. 2011 May;7(294):984–6.
  63. Yun O, Lima MA, Ellman T, Chambi W, Castillo S, Flevaud L, et al. Feasibility, drug safety, and effectiveness of etiological treatment programs for Chagas disease in Honduras, Guatemala, and Bolivia: 10-year experience of Médecins Sans Frontières. PLoS Negl Trop Dis. 2009 Jul;3(7):e488. doi: https://doi.org/10.1371/journal.pntd.0000488
  64. Pérez-Molina JA, Crespillo-Andújar C, Bosch-Nicolau P, Molina I. Trypanocidal treatment of Chagas disease. Enferm Infecc Microbiol Clin (Engl Ed). 2021 Nov;39(9):458–70. doi: https://doi.org/10.1016/j.eimce.2020.04.012
  65. De Salazar PM, Sosa-Estani S, Salvador F, Sulleiro E, Sánchez-Montalvá A, Ribeiro I, et al. Human Trypanosoma cruzi chronic infection leads to individual level steady-state parasitemia: implications for drug-trial optimization in Chagas disease. PLoS Negl Trop Dis. 2022 Nov;16(11):e0010828. doi: https://doi.org/10.1371/journal.pntd.0010828
  66. Grossmann U, Rodriguez ML. Chagas disease treatment efficacy markers: experiences from a Phase III study with nifurtimox in children. Front Parasitol. 2023 Sep;2:1229467. doi: https://doi.org/10.3389/fpara.2023.1229467
  67. Parrado R, Ramirez JC, de la Barra A, Alonso-Vega C, Juiz N, Ortiz L, et al. Usefulness of Serial Blood Sampling and PCR Replicates for Treatment Monitoring of Patients with Chronic Chagas Disease. Antimicrob Agents Chemother. 2019 Jan;63(2):e01191-18. doi: https://doi.org/10.1128/AAC.01191-18
  68. Basquiera AL, Sembaj A, Aguerri AM, Omelianiuk M, Guzmán S, Moreno Barral J, et al. Risk progression to chronic Chagas cardiomyopathy: influence of male sex and of parasitaemia detected by polymerase chain reaction. Heart. 2003 Oct;89(10):1186–90. doi: https://doi.org/10.1136/heart.89.10.1186
  69. Morillo CA, Marin-Neto JA, Avezum A, Sosa-Estani S, Rassi A Jr, Rosas F, et al.; BENEFIT Investigators. Randomized Trial of Benznidazole for Chronic Chagas’ Cardiomyopathy. N Engl J Med. 2015 Oct;373(14):1295–306. doi: https://doi.org/10.1056/NEJMoa1507574
  70. Jackson Y, Wyssa B, Chappuis F. Tolerance to nifurtimox and benznidazole in adult patients with chronic Chagas’ disease. J Antimicrob Chemother. 2020 Mar;75(3):690–6. doi: https://doi.org/10.1093/jac/dkz473
  71. Silva S, Barros MV, Nunes MD, Silva L, Edvardsen T, Araujo F, et al. Abstract 11768: Regression of Inflammation by Cardiac Magnetic Resonance in Chronic Chagasic Patients Treated With Benznidazole. Circulation. 2023; https://www.ahajournals.org/doi/10.1161/circ.148.suppl_1.11768
  72. Rapp E. Chagas Congenital Screening in Switzerland: Processes of Recognition and Knowledge-Sharing. Med Anthropol. 2021;40(6):557–71. doi: https://doi.org/10.1080/01459740.2021.1922900
  73. Romay-Barja M, Iglesias-Rus L, Boquete T, Benito A, Blasco-Hernández T. Key Chagas disease missing knowledge among at-risk population in Spain affecting diagnosis and treatment. Infect Dis Poverty. 2021 Apr;10(1):55. doi: https://doi.org/10.1186/s40249-021-00841-4
  74. Ventura-Garcia L, Roura M, Pell C, Posada E, Gascón J, Aldasoro E, et al. Socio-cultural aspects of Chagas disease: a systematic review of qualitative research. PLoS Negl Trop Dis. 2013 Sep;7(9):e2410. doi: https://doi.org/10.1371/journal.pntd.0002410
  75. Swissmedic: https://www.swissmedic.ch/swissmedic/en/home.html
  76. Swissmedic. Hémovigilance Rapport Annuel 2013.
  77. Requena-Méndez A, Albajar-Viñas P, Angheben A, Chiodini P, Gascón J, Muñoz J; Chagas Disease COHEMI Working Group. Health policies to control Chagas disease transmission in European countries. PLoS Negl Trop Dis. 2014 Oct;8(10):e3245. doi: https://doi.org/10.1371/journal.pntd.0003245
  78. Colombo V, Giacomelli A, Casazza G, Galimberti L, Bonazzetti C, Sabaini F, et al. Trypanosoma cruzi infection in Latin American pregnant women living outside endemic countries and frequency of congenital transmission: a systematic review and meta-analysis. J Travel Med. 2021 Jan;28(1):taaa170. doi: https://doi.org/10.1093/jtm/taaa170
  79. Bilger V, Hollomey C, Efionayi-Mäder D, Wyssmüller C. Health care for undocumented migrants in Switzerland : policies, people, practices. 2011.
  80. Jackson Y, Paignon A, Wolff H, Delicado N. Health of undocumented migrants in primary care in Switzerland. PLoS One. 2018 Jul;13(7):e0201313. doi: https://doi.org/10.1371/journal.pone.0201313
  81. Piccoli L, Wanner P. The political determinants of the health of undocumented immigrants: a comparative analysis of mortality patterns in Switzerland. BMC Public Health. 2022 Apr;22(1):804. doi: https://doi.org/10.1186/s12889-022-13188-8
  82. Ending the neglect to attain the sustainable development goals. One Health: approach for action against neglected tropical diseases 2021-2030. Executive summary. World Health Organization; 2022. 4 pp.