Integrated control of Chagas disease for its elimination as public health problem - A Review

Abstract

Chagas disease or American trypanosomiasis is, together with geohelminths, the neglected disease that causes more loss of years of healthy life due to disability in Latin America. Chagas disease, as determined by the factors and determinants, shows that different contexts require different actions, preventing new cases or reducing the burden of disease. Control strategies must combine two general courses of action including prevention of transmission to prevent the occurrence of new cases (these measures are cost effective), as well as opportune diagnosis and treatment of infected individuals in order to prevent the clinical evolution of the disease and to allow them to recuperate their health. All actions should be implemented as fully as possible and with an integrated way, to maximise the impact. Chagas disease cannot be eradicated due because of the demonstrated existence of infected wild triatomines in permanent contact with domestic cycles and it contributes to the occurrence of at least few new cases. However, it is possible to interrupt the transmission of Trypanosoma cruzi in a large territory and to eliminate Chagas disease as a public health problem with a dramatic reduction of burden of the disease.

Serological Diagnosis of Chronic Chagas Disease: Is It Time for a Change?

“…Several control measures exist for Chagas disease, according to the different transmission scenarios (7,14,53), some of which have been applied by health organizations or administrative governments (54)(55)(56)(57)(58). Previous studies on the cost-effectiveness of Chagas disease management have been undertaken (59)(60)(61)(62), but the costs of different diagnostic methods have not been compared.…”

“…The flagellated protozoan Trypanosoma cruzi is mainly transmitted in areas endemic for the disease through contact with the dejections of blood-feeding triatomine bugs (6,7) and more rarely by oral transmission through contaminated food (8,9). The infection may also occur in both areas that are endemic and nonendemic through blood transfusion (10), organ transplant (11), congenital transmission (12), and laboratory accidents (13), allowing the disease to spread to urbanized areas (14).…”

Developments in the management of Chagas cardiomyopathy

“…[162,163] In fact, most experts recommend the anti-trypanosomal treatment for most of patients with chronic T. cruzi infection, with or without cardiomyopathy, especially in those below 50 years of age. [152,163–165] However, there are many concerns related to the toxicity of the currently available drugs, the absence of evidence of benefit in those older than 50 years of age and the absence of a randomized clinical trial that documented the beneficial effect of the specific treatment. [127,166] There are only two drugs currently available for the treatment of Chagas disease, nifurtimox and benznidazole, both associated with significant toxicity, especially in adults.…”

The contemporary distribution of Trypanosoma cruzi infection in humans, alternative hosts and vectors

“…The parasite is primarily transmitted through the faeces of triatomine bugs contaminating their own bite wounds 9 . Congenital transmission and transmission through blood transfusion and organ donation also occur.…”