Epidemiological assessment of the first year of mandatory notification of chronic Chagas disease in Alagoas, Northeast Brazil

Chagas disease (CD), caused by the protozoan parasite Trypanosoma cruzi, affects >7 million individuals worldwide. The disease progresses from an acute phase to a chronic phase, which may manifest as indeterminate, cardiac, digestive or cardiodigestive forms. Although CD is endemic in Brazil, only acute cases were subject to mandatory notification. In 2020, Brazil expanded mandatory notifications to include chronic cases; however, implementation in the State of Alagoas (AL), Northeast of Brazil, began only in January 2023. Here, we performed an epidemiological assessment of the first year (January 2023 to January 2024) of the mandatory notification of chronic CD in AL. Our data show that most of the 104 reported cases occurred among Afro-Brazilian women aged 40-59 with no or low levels of formal education. Despite the chronic nature of the disease, most diagnoses were recent and based on serological methods, primarily ELISA in combination with immunofluorescence assays. The cardiac form was the most frequently documented clinical manifestation, and 12 individuals succumbed to cardiac complications associated with the disease. These findings highlight the significant prevalence of chronic CD among adults in the State of Alagoas (AL) and underscores its role in elevating mortality risk due to cardiac and cardiodigestive complications in this population.