Economic crisis and increased immigrant mobility: new challenges in managing Chagas disease in Europe

In Europe, there is evidence of the effect of the global financial crisis and austerity measures on vulnerable people's health: increasing risky health behaviours, difficulties accessing health care and poorer mental, maternal and child health. 1 There are little data on the extent to which communicable diseases are affected by the economic crisis in developed countries. However, a meta-analysis suggests worse health outcomes affecting the whole population, with infants, elderly, poor and/or homeless people, prisoners and immigrants carrying the main burden. 2 Europe has a substantial burden of infectious diseases in vulnerable groups with social and economic disadvantages. In the past two decades this region has received more than 3.5 million Latin American immigrants, with a predominance of young-to-middle aged women, many of whom are undocumented. 3 Chagas disease, a potential life-threating parasitic infection endemic in Latin America, has recently emerged in Eu-rope, affecting an estimated 80 000 to 120 000 Latin American immigrants. In European countries, Chagas disease costs 16 million United States dollars (US$) for health care and US$ 137 million as a result of lost productivity annually. 4 Chagas disease transmission through congenital and unscreened blood and organ donations has been identified in several European countries. Italy and Spain, two countries severely hit by the economic crisis, host the largest Latin American communities at risk and have reported the highest number of Chagas cases. 5 Undetected and untreated , 20–40% of infected people develop severe cardiac, digestive or neurologic complications requiring complex, costly and long-term medical attention. Despite evidence of the economic and health benefits of introducing targeted screening and treatment strategies among risk groups, Chagas disease-related health needs remain largely unmet in Europe. It is estimated that 90% of infected persons living in Europe have yet to be identified. 5 The recommended transmission-control strategies include screening pregnant women, their babies and other family members, and testing blood and organ donors at risk. But the identification of infected individuals is particularly hindered by the long clinically-silent phase, the poor specificity and high diversity of possible symptoms, the need for specific diagnostic procedures and the lack of awareness among health professionals. Moreover, infected immigrants at risk in Europe often face administrative and economic barriers preventing them from obtaining access to care. Europe's current economic crisis and subsequent austerity measures have been significantly affecting the management of Chagas disease. Since 2008, several European countries have been cutting health and …