Large Urban Outbreak of Orally Acquired Acute Chagas Disease at a School in Caracas, Venezuela

• Published in: The Journal of infectious diseases 2010-05, Vol.201 (9), p.1308-1315
• Main Authors: Alarcón de Noya, Belkisyolé, Díaz-Bello, Zoraida, Colmenares, Cecilia, Ruiz-Guevara, Raiza, Mauriello, Luciano, Zavala-Jaspe, Reinaldo, Suarez, José Antonio, Abate, Teresa, Naranjo, Laura, Paiva, Manuel, Rivas, Lavinia, Castro, Julio, Márques, Juan, Mendoza, Iván, Acquatella, Harry, Torres, Jaime, Noya, Oscar
• Format: Article
• Language: English
• Subjects: Adolescent; Age Factors; Beverages - parasitology; Blood; Case-Control Studies; Chagas disease; Chagas Disease - epidemiology; Chagas Disease - etiology; Chagas Disease - physiopathology; Child; Disease Outbreaks; Disease transmission; Electrocardiography; Enzyme linked immunosorbent assay; Epidemiology; Female; Foodborne Diseases - epidemiology; Foodborne Diseases - etiology; Hemagglutination Tests; Humans; Infections; Juices; Logistic Models; Male; Parasitemia; PARASITES; Polymerase Chain Reaction; Psidium - parasitology; Risk Factors; Schools; Symptoms; Trypanosoma cruzi; Urban Population; Venezuela - epidemiology; Young Adult
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/651608

(See the editorial commentary by Miles, on pages 1282–1284.) Background. Trypanosoma cruzi oral transmission is possible through food contamination by vector's feces. Little is known about the epidemiology and clinical features of microepidemics of orally acquired acute Chagas disease (CD). Methods. A case-control, cohort-nested, epidemiological study was conducted during an outbreak of acute CD that affected a school community. Structured interviews were designed to identify symptoms and sources of infection. Electrocardiograms were obtained for all patients. Specific serum antibodies were assessed by immunoenzimatic and indirect hemagglutination tests. In some cases, parasitemia was tested directly or by culture, animal inoculation, and/or a polymerase chain reaction technique. Results. Infection was confirmed in 103 of 1000 exposed individuals. Of those infected, 75% were symptomatic, 20.3% required hospitalization, 59% showed ECG abnormalities, parasitemia was documented in 44, and 1 child died. Clinical features differed from those seen in vectorial transmission. The infection rate was significantly higher among younger children. An epidemiological investigation incriminated contaminated fresh guava juice as the sole source of infection. Conclusions. This outbreak was unique, because it affected a large, urban, predominantly young, middle-class, otherwise healthy population and resulted in an unprecedented public health emergency. Rapid diagnosis and treatment avoided higher lethality. Food-borne transmission of T. cruzi may occur more often than is currently recognized.