Surveillance, health promotion and control of Chagas disease in the Amazon Region - Medical attention in the Brazilian Amazon Region: a proposal

Abstract

We refer to Oswaldo Cruz's reports dating from 1913 about the necessities of a healthcare system for the Brazilian Amazon Region and about the journey of Carlos Chagas to 27 locations in this region and the measures that would need to be adopted. We discuss the risks of endemicity of Chagas disease in the Amazon Region. We recommend that epidemiological surveillance of Chagas disease in the Brazilian Amazon Region and Pan-Amazon region should be implemented through continuous monitoring of the human population that lives in the area, their housing, the environment and the presence of triatomines. The monitoring should be performed with periodic seroepidemiological surveys, semi-annual visits to homes by health agents and the training of malaria microscopists and healthcare technicians to identify Trypanosoma cruzi from patients' samples and T. cruzi infection rates among the triatomines caught. We recommend health promotion and control of Chagas disease through public health policies, especially through sanitary education regarding the risk factors for Chagas disease. Finally, we propose a healthcare system through base hospitals, intermediate-level units in the areas of the Brazilian Amazon Region and air transportation, considering the distances to be covered for medical care.

Performance of TcI/TcVI/TcII Chagas-Flow ATE-IgG2a for universal and genotype-specific serodiagnosis of Trypanosoma cruzi infection

“…cruzi has been related to biological characteristics (infectivity, parasitemia, tissue tropism, mortality during the acute phase of infection [13,26–30] and susceptibility/resistance to drugs [5,8,31–34] in murine model and infectivity, replication and differentiation in vector o) [35], epidemiological characteristics [4,36,37] and clinical manifestations [38–40] of Chagas disease. Therefore, the knowledge of parasite genetics may offer insights about the biology of the parasite, patient’s treatment outcome, clinical aspects of human disease, as well as how to establish epidemiological surveillance and control of Chagas disease [41, 42]. So, the genetic diversity of T .…”

Epidemiological overview of chagas disease in the state of Amazonas, from 2004 to 2014

“…Today, however, due to the high rates of oral transmission through the ingestion of contaminated food, such as sugarcane juice and açaí, the vast triatomine fauna and reservoirs found naturally infected by trypanosomatids alerts the public health system of this region, increasing substantially the endemicity indicators of this disease. [9][10][11][12] The risks of CD transmission in the Amazon Region are a cause for concern, due to the great diversity of infected vectors and increasing human migrations, where the disease is directly linked to the degradation of the natural environment and to the exodus of tria-tomines from their wild biotopes to the urban region. 13 This concern is even greater with the recent outbreaks of oral transmission, mainly related to the consumption of açaí.…”

Dissecting the phyloepidemiology of Trypanosoma cruzi I (TcI) in Brazil by the use of high resolution genetic markers

“…Annual outbreaks have occurred, particulary in the northern Brazilian Amazon region during the past decade. Here, some local products derived from fruit juice have been contaminated with infected feces of triatomine bugs of different genera [ 9 , 11 , 12 ].…”