Today on World Chagas Disease Day, the World Health Organization (WHO) has called for comprehensive and equitable access to health care and services to everyone affected by Chagas disease. An estimated 6 to 7 million people worldwide are infected by Trypanosoma cruzi – the parasite that causes the disease.
“It is sad to note that despite progress, millions of people still remain undiagnosed, with limited or no access to healthcare” said Dr Ren Minghui, Assistant Director-General, Division for Universal Health Coverage/Communicable and Non-Communicable Diseases. “We need to improve detection and diagnosis rates which currently are at unacceptably low levels1 and we need to provide equitable access to treatment and health services to everyone.”
Chagas disease remains a public health problem in several endemic areas of continental Latin America where the burden on the health system is high. Over the past decades, Chagas disease has been detected in several countries outside Latin America, including the United States, Canada and in many European and some African, Eastern Mediterranean and Western Pacific countries.
Chagas Disease is curable if treatment is initiated soon after infection. Left undiagnosed and untreated in its chronic phase Chagas disease can result in arrythmias, dilated cardiomyopathy, leading to sudden death or heart failure, with relatively frequent digestive clinical manifestations and thrombotic vascular accidents and neurological sequela.
“The NTD road map for 2021-2030 provides for a series of objectives to accelerate progress in the prevention and control of Chagas disease, including the elimination of its congenital form and providing 75% coverage of antiparasitic treatment to eligible populations everywhere” said Dr Mwelecele Ntuli Malecela, Director, Department of Control of Neglected Tropical Diseases. “We are confident that this day will boost activities that will help to improve visibility and awareness of the disease.”
Silent and silenced disease
Chagas disease is mostly asymptomatic, either in the acute phase after infection or in the life-lasting chronic phase, without a successful antiparasitic treatment.
It can take decades before an infected person develops chronic clinical manifestations.
More than ever, with the current pandemic and the risk of presenting severe COVID-19 clinical manifestations, detection of people with Chagas disease should be prioritized and provided with access to vaccination.
Potential of integrated interventions
Already, integrated interventions with malaria and other haemoparasites, maternal and child health programmes, HIV/AIDS and other communicable and noncommunicable health programmes are improving implementation in a cost-effective manner.
Monitoring and verification of achievements through data exchange and information sources2 have opened possibilities to share and make accessible information, monitor advances and verify achievements. Better research and diagnosis tools can accelerate the screening of patients (including blood transfusion, organ transplant, screening of girls and women of childbearing age, and pregnant women and their newborns and children).
In 2019, the 72nd World Health Assembly endorsed the designation of a World Chagas Disease Day to raise public awareness and information about what is often termed as a ‘silent and silenced disease’.
The disease
Chagas disease, also known as American trypanosomiasis, is a potentially life-threatening illness caused by the protozoan parasite Trypanosoma cruzi (T. cruzi).
It is found mainly in endemic areas of 21 continental Latin American countries and regions3
For centuries, the disease was strictly a Latin American problem of rural populations, but movement of people from rural to urban areas and to other continents expanded the reach of disease transmission channels towards non vectorial routes, such as blood transfusion, congenital and oral transmission, organ transplant and contaminated food.
There is no vaccine against Chagas disease. Domiciliary vectorial control and transfusional control, together with congenital transmission, remain the most effective methods of preventing transmission in Latin America.
Chagas disease was named after Carlos Ribeiro Justiniano Chagas, a Brazilian physician and researcher who discovered the disease in 1909.
1Depending on the areas, under-diagnosis of Chagas disease cases can be as high as 90% or even more, and this includes congenital and paediatric cases.
2The open-source WHO information system to control/eliminate Chagas disease and other NTDs is contributing to gather and analyze real-time data/information on Chagas disease.
3Argentina, Belize, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela (Bolivarian Republic of)