Intestinal parasitic infections in a community from Pampa del Indio, Chaco (Argentina) and their association with socioeconomic and environmental factors

Neglected tropical diseases are a group of 20 disabling diseases, which, in particular, are the most common chronic infections in the most vulnerable people. This study aimed to characterize the infection by intestinal parasites (IPs) in dwellings from a peri-urban neighborhood in Pampa del Indio, Chaco (Argentina), and its association with socioeconomic and environmental variables. Single stool samples were collected from all individuals older than 1 year through household visits and processed using coprological sedimentation and flotation techniques. Standardized questionnaires were used at the household level to collect socio-economic information. Environmental variables were obtained from the Planetscope image, Landsat 8 images and remote sensors, while land-use layers were obtained through the use of a maximum likelihood algorithm. Stool samples were provided by 314 individuals. The prevalence of IPs found was 30.6% (n = 96), with a predominance of Giardia lamblia (12.7%, n = 40) and Hymenolepis nana (7.6%, n = 24). The only soil-transmitted helminth found was Strongyloides stercoralis with a 2.5% prevalence (n = 8). Individuals of adult age (> 18 years) were 0.65 times less likely to present parasitic infections with respect to children and adolescents. The only environmental variable that was closely associated with the presence of IPs, was the Normalized Difference Water Index (NDWI), a measure of humidity; being higher around houses with positive individuals. Most of the IPs found in this study were of water-borne transmission and those transmitted directly from person-to-person, therefore fecal contamination is present. We believe that the low prevalence of STH in this area, which requires a passage through the soil, is related to the environmental characteristics, which are unsuitable for the development/permanence of the infective stages of these parasites. The geospatial data and tools used herein proved to be useful for the study of the relationship between the different factors that influence the presence of IPs in a community, from an eco-health approach.Fil: Scavuzzo, Carlos Matias. Comision Nacional de Actividades Espaciales. Instituto de Altos Estudios Espaciales "Mario Gulich"; Argentina. Fundación Mundo Sano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Delgado, Cintia. Fundación Mundo Sano; ArgentinaFil: Goy, Marcia. Hospital Dr. Dante Tardelli; ArgentinaFil: Crudo, Favio. Fundación Mundo Sano; ArgentinaFil: Porcasi, Ximena. Comision Nacional de Actividades Espaciales. Instituto de Altos Estudios Espaciales "Mario Gulich"; ArgentinaFil: Periago, Maria Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Mundo Sano; Argentin

Rickettsia parkeri Rickettsiosis, Argentina

Rickettsia parkeri, a recently identified cause of spotted fever rickettsiosis in the United States, has been found in Amblyomma triste ticks in several countries of South America, including Argentina, where it is believed to cause disease in humans. We describe the clinical and epidemiologic characteristics of 2 patients in Argentina with confirmed R. parkeri infection and 7 additional patients with suspected R. parkeri rickettsiosis identified at 1 hospital during 2004–2009. The frequency and character of clinical signs and symptoms among these 9 patients closely resembled those described for patients in the United States (presence of an inoculation eschar, maculopapular rash often associated with pustules or vesicles, infrequent gastrointestinal manifestations, and relatively benign clinical course). Many R. parkeri infections in South America are likely to be misdiagnosed as other infectious diseases, including Rocky Mountain spotted fever, dengue, or leptospirosis

Impact of a public health intervention for active surveillance and mitigation of SARS-CoV-2 in a district from Buenos Aires province, Argentina: a descriptive epidemiological study

Background The first case of SARS-CoV-2 was reported in Argentina on 3 March 2020. Measures to limit the spread of the virus were implemented, including complete lockdown (26 March). Nonetheless, the virus spread throughout the country, with a first peak of almost a million cases in October. On 30 November, the government's recommendation switched from social, preventive and compulsory isolation, to social, preventive and compulsory distancing. Objectives To describe a tailored public health strategy to mitigate the spread of SARS-CoV-2 and determine its behaviour in San Antonio de Areco district from Buenos Aires province (Argentina) through a private-public association. Design, setting and participants Surveillance of the virus was performed with the local healthcare system, through early identification of cases and the systematic study of each infected individual and contact, regardless of symptomatology, using telemedicine and a COVID-19-specific outpatient clinic. Real-time PCR was used for detection using both individual and pooled samples, with a 12-hour turnaround time. Results Up to 30 November, a total of 2426 suspected cases were analysed and 578 were confirmed. Surveillance of health personnel and at-risk populations proved effective, mitigating viral spread. Pooling samples allowed reduction of operator time, helped reduce costs, and allowed detection of both symptomatic and asymptomatic cases. Conclusion After 8 months of protocol implementation, the strategy to intensively survey groups at higher epidemiological risk and the systematic search for asymptomatic cases with the incorporation of pooled PCR for diagnosis, in combination with individual testing, is an efficient and viable option in populations with similar characteristics, in the frame of social isolation.Fil: Crudo, Favio. Fundación Mundo Sano; ArgentinaFil: Fernández, Mariana. Fundación Mundo Sano; ArgentinaFil: Rodríguez Fermepín, Marcelo. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Fisiopatología y Bioquímica Clínica; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Entrocassi, Andrea Carolina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Fisiopatología y Bioquímica Clínica; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Cardone, Karina Angela. No especifíca;Fil: Spina Markmann, Fernando. No especifíca;Fil: Periago, Maria Victoria. Fundación Mundo Sano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Chuit, Roberto. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Abril, Marcelo Claudio. Fundación Mundo Sano; Argentin

A public health response against Strongyloides stercoralis : time to look at soil-transmitted helminthiasis in full

Strongyloides stercoralis infections have a worldwide distribution with a global burden in terms of prevalence and morbidity that is largely ignored. A public health response against soil-transmitted helminth (STH) infections should broaden the strategy to include S. stercoralis and overcome the epidemiological, diagnostic, and therapeutic challenges that this parasite poses in comparison to Ascaris lumbricoides, Trichuris trichiura, and hookworms. The relatively poor sensitivity of single stool evaluations, which is further lowered when quantitative techniques aimed at detecting eggs are used, also complicates morbidity evaluations and adequate drug efficacy measurements, since S. stercoralis is eliminated in stools in a larval stage. Specific stool techniques for the detection of larvae of S. stercoralis, like Baermann's and Koga's agar plate, despite superiority over direct techniques are still suboptimal. New serologies using recombinant antigens and molecular-based techniques offer new hopes in those areas. The use of ivermectin rather than benzimidazoles for its treatment and the need to have curative regimens rather than lowering the parasite burden are also unique for S. stercoralis in comparison to the other STH due to its life cycle, which allows reproduction and amplification of the worm burden within the human host. The potential impact on STH of the benzimidazoles/ivermectin combinations, already used for control/elimination of lymphatic filariasis, should be further evaluated in public health settings. While waiting for more effective single-dose drug regimens and new sensitive diagnostics, the evidence and the tools already available warrant the planning of a common platform for STH and S. stercoralis control

Strongyloides stercoralis and Trypanosoma cruzi coinfections in a highly endemic area in Argentina

Background Strongyloidiasis and Chagas disease are endemic in northern Argentina. In this study we evaluate the association between S. stercoralis and T. cruzi infections in villages with diverse prevalence levels for these parasites. Further understanding in the relationship between these Neglected Tropical Diseases of South America is relevant for the design of integrated control measures as well as exploring potential biologic interactions. Methodology Community based cross-sectional studies were carried in different villages of the Chaco and Yungas regions in Argentina. Individuals were diagnosed by serology for S. stercoralis and T. cruzi. The association between S. stercoralis and T. cruzi, and between anemia and the two parasites was evaluated using two approaches: marginal (Ma) and multilevel regression (Mu). Results A total of 706 individuals from six villages of northern Argentina were included. A total of 37% were positive for S. stercoralis, 14% were positive for T. cruzi and 5% were positive for both. No association was found between infection with S. stercoralis and T. cruzi in any of the models, but we found a negative correlation between the prevalence of these species in the different villages (r =-0.91). Adults (> 15 years) presented association with S. stercoralis (Ma OR = 2.72; Mu OR = 2.84) and T. cruzi (Ma OR = 5.12; Mu OR = 5.48). Also, 12% and 2% of the variance of infection with S. stercoralis and T. cruzi, respectively, could be explained by differences among villages. On the other hand, anemia was associated with infection with S. stercoralis (Ma OR = 1.73; Mu OR = 1.78) and was more prevalent in adults (Ma OR = 2.59; Mu OR = 2.69). Conclusion We found that coinfection between S. stercoralis and T. cruzi is not more frequent than chance in endemic areas. However, the high prevalence for both parasites, raises the need for an integrated strategy for the control of STH and Chagas disease.Fil: Fleitas, Pedro Emanuel. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; ArgentinaFil: Floridia Yapur, Noelia Aldana del Rosario. Universidad Nacional de Salta. Facultad de Ciencias Naturales. Escuela de Biología. Cátedra de Química Biológica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Patología Experimental. Universidad Nacional de Salta. Facultad de Ciencias de la Salud. Instituto de Patología Experimental; ArgentinaFil: Nieves, Elvia Ester. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentina. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Echazú, Adriana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentina. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Vargas, Paola Anahí. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Caro, Reynaldo Nicolás. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Aveldaño, Ramiro. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Lopez, Walter. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Fernandez, Mariana. Asociación para el Desarrollo Sanitario Regional; ArgentinaFil: Crudo, Favio. Asociación para el Desarrollo Sanitario Regional; ArgentinaFil: Cimino, Rubén Oscar. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentina. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Krolewiecki, Alejandro Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentina. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentin

Seroprevalence of the strongyloides stercoralis infection in humans from yungas rainforest and gran chaco region from Argentina and Bolivia

The threadworm, Strongyloides stercoralis, is endemic in tropical and subtropical areas. Data on the prevalence and distribution of infection with this parasite species is scarce in many critical regions. We conducted a seroprevalence study of S. stercoralis infection in 13 locations in the Gran Chaco and Yungas regions of Argentina and Bolivia during the period 2010–2016. A total of 2803 human serum samples were analyzed by ELISA-NIE which has a sensitivity of 75% and specificity of 95%. Results showed that 551 (19.6%) of those samples were positive. The adjusted prevalence was 20.9%, (95% confidence interval (CI) 19.4%–22.4%). The distribution of cases was similar between females and males with an increase of prevalence with age. The prevalence in the different locations ranged from 7.75% in Pampa del Indio to 44.55% in Santa Victoria Este in the triple border between Argentina, Bolivia, and Paraguay in the Chaco region. Our results show that S. stercoralis is highly prevalent in the Chaco and Yungas regions, which should prompt prospective surveys to confirm our findings and the design and deployment of control measures.Fil: Cimino, Rubén Oscar. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina. Universidad Nacional de Salta. Facultad de Ciencias Naturales. Escuela de Biología. Cátedra de Química Biológica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; ArgentinaFil: Fleitas, Pedro Emanuel. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina. Universidad Nacional de Salta. Facultad de Ciencias Naturales. Escuela de Biología. Cátedra de Química Biológica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; ArgentinaFil: Fernández, Mariana. Asociación para el desarrollo sanitario regional; ArgentinaFil: Echazú, Adriana. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; ArgentinaFil: Juarez, Marisa del Valle. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Floridia Yapur, Noelia Aldana del Rosario. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina. Universidad Nacional de Salta. Facultad de Ciencias Naturales. Escuela de Biología. Cátedra de Química Biológica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Patología Experimental. Universidad Nacional de Salta. Facultad de Ciencias de la Salud. Instituto de Patología Experimental; ArgentinaFil: Cajal, Silvana Pamela. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Seijo, Alfredo. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Abril, Marcelo. Fundación Mundo Sano; ArgentinaFil: Weinberg, Diego. Fundación Mundo Sano; ArgentinaFil: Piorno, Pablo Emiliano. Asociación para el desarrollo sanitario regional; ArgentinaFil: Caro, Nicolás. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Vargas, Paola. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Gil, José Fernando. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Investigaciones en Energía no Convencional. Grupo Vinculado al INENCO - Instituto de Investigaciones y Políticas del Ambiente Constituido | Universidad Nacional de Salta. Facultad de Cienicas Exactas. Departamento de Física. Instituto de Investigaciones en Energía no Convencional. Grupo Vinculado al INENCO - Instituto de Investigaciones y Políticas del Ambiente Constituido; ArgentinaFil: Crudo, Favio. Asociación para el desarrollo sanitario regional; ArgentinaFil: Krolewiecki, Alejandro Javier. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentin

RBD-specific polyclonal F(ab´)2 fragments of equine antibodies in patients with moderate to severe COVID-19 disease: A randomized, multicenter, double-blind, placebo-controlled, adaptive phase 2/3 clinical trial

Background: passive immunotherapy is a therapeutic alternative for patients with COVID-19. Equine polyclonal antibodies (EpAbs) could represent a source of scalable neutralizing antibodies against SARS-CoV-2. Methods: we conducted a double-blind, randomized, placebo-controlled trial to assess efficacy and safety of EpAbs (INM005) in hospitalized adult patients with moderate and severe COVID-19 pneumonia in 19 hospitals of Argentina. Primary endpoint was improvement in at least two categories in WHO ordinal clinical scale at day 28 or hospital discharge (ClinicalTrials.gov number NCT04494984). Findings: between August 1st and October 26th, 2020, a total of 245 patients were enrolled. Enrolled patients were assigned to receive two blinded doses of INM005 (n = 118) or placebo (n = 123). Median age was 54 years old, 65 1% were male and 61% had moderate disease at baseline. Median time from symptoms onset to study treatment was 6 days (interquartile range 5 to 8). No statistically significant difference was noted between study groups on primary endpoint (risk difference [95% IC]: 5 28% [-3 95; 14 50]; p = 0 15). Rate of improvement in at least two categories was statistically significantly higher for INM005 at days 14 and 21 of follow-up. Time to improvement in two ordinal categories or hospital discharge was 14 2 (§ 0 7) days in the INM005 group and 16 3 (§ 0 7) days in the placebo group, hazard ratio 1 31 (95% CI 1 0 to 1 74). Subgroup analyses showed a beneficial effect of INM005 over severe patients and in those with negative baseline antibodies. Overall mortality was 6 9% the INM005 group and 11 4% in the placebo group (risk difference [95% IC]: 0 57 [0 24 to 1 37]). Adverse events of special interest were mild or moderate; no anaphylaxis was reported. Interpretation: Albeit not having reached the primary endpoint, we found clinical improvement of hospitalized patients with SARS-CoV-2 pneumonia, particularly those with severe disease.Fil: Lopardo, Gustavo. Municipalidad de Vicente Lopez (buenos Aires). Hospital Municipal Doctor Bernardo Houssay.; ArgentinaFil: Belloso, Waldo H.. Hospital Italiano; ArgentinaFil: Nannini, Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Colonna, Mariana. Inmunova; ArgentinaFil: Sanguineti, Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Inmunova; ArgentinaFil: Zylberman, Vanesa. Inmunova; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Muñoz, Luciana. Inmunova; ArgentinaFil: Dobarro, Martín. Sanatorio Sagrado Corazón; ArgentinaFil: Lebersztein, Gabriel. Sanatorio Sagrado Corazón; ArgentinaFil: Farina, Javier. Gobierno de la Provincia de Buenos Aires. Hospital de Alta Complejidad Cuenca Alta Doctor Nestor Carlos Kirchner.; ArgentinaFil: Vidiella, Gabriela. Sanatorio Agote. Dr. Luis Agote; ArgentinaFil: Bertetti, Anselmo. Sanatorio Guemes Sociedad Anonima.; ArgentinaFil: Crudo, Favio. Universidad Nacional de San Antonio de Areco; ArgentinaFil: Alzogaray, Maria Fernanda. Instituto Medico Platense.; ArgentinaFil: Barcelona, Laura. Municipalidad de Vicente Lopez (buenos Aires). Hospital Municipal Doctor Bernardo Houssay.; ArgentinaFil: Teijeiro, Ricardo. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Doctor Ignacio Pirovano; ArgentinaFil: Lambert, Sandra. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Scublinsky, Darío. Clinica Zabala.; ArgentinaFil: Iacono, Marisa. Provincia del Neuquen. Hospital Provincial Neuquen "dr. E. Castro Rendon"; ArgentinaFil: Stanek, Vanina. Hospital Italiano; ArgentinaFil: Solari, Rubén. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Cruz, Pablo. No especifíca;Fil: Casas, Marcelo Martín. Clinica Adventista Belgrano; ArgentinaFil: Abusamra, Lorena. Hospital Municipal Dr. Diego Thompson; ArgentinaFil: Luciardi, Héctor Lucas. Provincia de Tucuman. Ministerio de Salud. Sistema Provincial de Salud. Hosp. Centro de Salud "zenon Santillan"; ArgentinaFil: Cremona, Alberto. Hospital Italiano de La Plata; ArgentinaFil: Caruso, Diego. Hospital Español; ArgentinaFil: de Miguel, Bernardo. No especifíca;Fil: Perez Lloret, Santiago. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires"; Argentina. Universidad Abierta Interamericana. Secretaría de Investigación. Centro de Altos Estudios En Ciencias Humanas y de la Salud - Sede Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Millán, Susana. No especifíca;Fil: Kilstein, Yael. No especifíca;Fil: Pereiro, Ana. Fundación Mundo Sano; ArgentinaFil: Sued, Omar. Fundación Huésped; ArgentinaFil: Cahn, Pedro. Fundación Huésped; ArgentinaFil: Spatz, Linus. Inmunova; ArgentinaFil: Goldbaum, Fernando Alberto. Inmunova; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquímicas de Buenos Aires. Fundación Instituto Leloir. Instituto de Investigaciones Bioquímicas de Buenos Aires; Argentina. Universidad Nacional de San Martin. Centro de Rediseño E Ingenieria de Proteinas.; Argentin

Rapid Diagnostic Tests for Trypanosoma cruzi Infection: Field Evaluation of Two Registered Kits in a Region of Endemicity and a Region of Nonendemicity in Argentina

Fil: Lopez-Albizu, Constanza. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Parasitología; Argentina.Fil: Danesi, Emmaría. ANLIS Dr.C.G.Malbrán. Centro Nacional de Diagnóstico e Investigación de Endemo-Epidemias; ArgentinaFil: Piorno, Pablo. Asociación para Desarrollo Sanitario Regional (ADESAR); Argentina.Fil: Fernandez, Mariana. Asociación para Desarrollo Sanitario Regional (ADESAR); Argentina.Fil: García Campos, Francisco. Ministerio de Salud Pública de Salta; Argentina.Fil: Scollo, Karenina. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Parasitología; Argentina.Fil: Crudo, Favio. Asociación para Desarrollo Sanitario Regional (ADESAR); Argentina.Infection by Trypanosoma cruzi (Chagas disease [ChD]) affects around 7 million people in the Americas, most of whom are unaware of their status due to lack of clinical manifestations and poor access to diagnosis. Rapid diagnostic tests (RDTs) are widely used for screening for different infections (HIV, hepatitis B, and syphilis), and their application for ChD would facilitate access to diagnosis, especially in remote areas where health services have scarce resources. We conducted a prospective intervention study in 2018 to evaluate in the field two in vitro RDTs for ChD, authorized by the National Administration of Medicaments, Aliments, and Medical Technologies of Argentina (ANMAT), in areas of endemicity and nonendemicity in Argentina. We recruited 607 volunteers older than 18 years in Salta province and the city of Buenos Aires. The RDTs Ab Standard Diagnostics SD Bioline (SD) and Check Chagas Wiener Lab (WL) were performed in situ with whole-blood samples, and confirmatory serology was done at a reference center. The rate of infection with T. cruzi was 17.8% (108/607). The SD test showed 97.2% sensitivity (95% confidence interval [CI], 93.5 to 100) and 91.7% specificity (95% CI, 96.2 to 99.2%), and the WL test showed 93.4% sensitivity (95% CI, 88.2 to 98.6%) and 99.1% specificity (95% CI, 91.9 to 100%). The sensitivity and specificity for the two RDTs tested were higher than previously reported. These results encourage the use of the tested RDTs in Salta province and for further field studies for the implementation of these RDTs in other epidemiological scenarios. This will be very important to improve access to diagnosis of Chagas and its clinical management as a neglected disease, especially in remote areas with health access barriers

How to implement the framework for the elimination of mother-to-child transmission of HIV, syphilis, hepatitis B and Chagas (EMTCT Plus) in a disperse rural population from the Gran Chaco region: A tailor-made program focused on pregnant women.

The framework for the elimination of mother-to-child transmission (EMTCT Plus) was proposed by the Pan American Health Organization in 2017 to all member states in order to widen the already existing framework for HIV and syphilis to include elimination of the infection with hepatitis B virus (HBV) and Chagas disease (ChD), now called EMTCT Plus. The objective of this wider initiative is to achieve and maintain the elimination of mother-to-child transmission (MTCT) of the infection with HIV, syphilis, ChD, and the perinatal infection by HBV as a public health problem, in line with the Strategy for Universal Access to Health and Universal Health Coverage. The EMTCT Plus framework represents an interesting challenge for member states, since it requires adequate implementation strategies to overcome health system diversities. Additionally, each country implements this framework in a different manner and according to their own national administrative structure, which can even vary within each country in federal administrations. Moreover, available data from each country constitute global national figures that do not necessarily reflect regional variations. This is the case of many intervention areas with dispersed rural populations like the Tri-Border Area between Argentina, Bolivia, and Paraguay located in the Gran Chaco region. Moreover, this region is a hotspot for neglected tropical diseases, not only for intestinal helminth infections but also for ChD. This is the area that will be used as an example in the current tutorial to aid others in the implementation of the framework. For this purpose, we have posed a series of statements that aim to describe the different components, based on our experience, that should be considered for implementation of this framework.Fil: Crudo, Favio. Asociación Para El Desarrollo Sanitario Regional; Argentina. Fundación Mundo Sano; ArgentinaFil: Piorno, Pablo Emiliano. Asociación Para El Desarrollo Sanitario Regional; ArgentinaFil: Krupitzki, Hugo Bernardo. Asociación Para El Desarrollo Sanitario Regional; Argentina. Centro de Educaciones Médicas e Investigación Clínica "Norberto Quirno"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Guilera, Analia. Asociación Para El Desarrollo Sanitario Regional; ArgentinaFil: López Albizu, Constanza. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud “Dr. C. G. Malbrán”. Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben”; Argentina. Asociación Para El Desarrollo Sanitario Regional; ArgentinaFil: Danesi, Emmaría. Centro Nacional de Diagnóstico E Investigaciones En End; Argentina. Asociación Para El Desarrollo Sanitario Regional; ArgentinaFil: Scollo, Karerina. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud “Dr. C. G. Malbrán”. Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben”; ArgentinaFil: Lloveras, Susana. Asociación Para El Desarrollo Sanitario Regional; ArgentinaFil: Mir, Sebastián. Universidad Nacional de San Antonio de Areco.; ArgentinaFil: Álvarez, Marisa. Provincia de Salta. Ministerio de Salud Pública; ArgentinaFil: Yudis, Silvio. Gobierno de la Provincia de Salta. Ministerio de la Primera Infancia.; ArgentinaFil: Cayo Fernández, Miguel Angel. Dirección de Salud, Gobierno Regional Gran Chaco; BoliviaFil: Cipri, Diego. Ministerio de Salud Pública y Bienestar Social; ParaguayFil: Krolewiecki, Alejandro Javier. Fundación Mundo Sano; Argentina. Asociación Para El Desarrollo Sanitario Regional; Argentina. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Pereiro, Ana Cristina. Fundación Mundo Sano; ArgentinaFil: Periago, Maria Victoria. Fundación Mundo Sano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Abril, Marcelo Claudio. Fundación Mundo Sano; ArgentinaFil: Fernandez, Mariana. Asociación Para El Desarrollo Sanitario Regional; Argentin