Prenatal Chagas disease screening in Latin America: the current policy landscape and potential utility of an expanded maternal-familial Trypanosoma cruzi testing framework

In 2018, revised World Health Organization guidance moved toward eliminating congenital Chagas disease (Trypanosoma cruzi)—a traditionally vector-borne parasitic disease that can chronically infect persons and be vertically transmitted from untreated mothers to their fetuses during pregnancy. Several endemic countries have since adopted risk-based or universal prenatal screening policies with high variation among strategies, implementation, coverage, and reporting. This article describes a collaborative investigation between researchers and the Salvadoran Ministry of Health, where expanded infant and family follow-up testing was executed after mothers tested T. cruzi positive during parturition. In this pilot study, we found 16% (n = 5/32) of familial members tested positive for previously undiagnosed infection. This manuscript highlights lessons learned from a familial follow-up testing initiative, provides rationale in support of expanding the maternal-familial T. cruzi screening framework in endemic countries, and describes updates on international progress towards implementation of prenatal screening as indicated by updated World Health Organization guidance.