Last week, the Pan American Health Organization (PAHO) met in Washington, DC to discuss the current status of Chagas, as well as future management of the disease. Progress has been made with vector transmission of Chagas interrupted in 17 out of 21 affected countries in the Americas, and screening for the disease in blood banks universalized.
“The region has made considerable advances in addressing Chagas since the 1990s, and this meeting has marked a point of inflection at a time when the dynamics and epidemiology of the disease has changed,” said Luis Gerardo Castellanos, Head of the Neglected, Tropical and Vector-borne diseases Unit at PAHO/WHO.
“The occurrence of new cases has reduced in all countries, but around six million people still live with the disease, many of whom are unaware of their status. The migration of people from endemic areas to urban areas also means that we must take measures to detect and treat everyone affected, including those in cities,” he said.
So what’s next?
Those present at the meeting agreed that preventing the transmission of Chagas from mother to child should be a primary area of focus and resources. Mother to child transmission is now the main source of infection in countries that have controlled vector transmission and applied universal screening at blood banks. This is the case for Argentina, Brazil, Chile, Honduras, Paraguay, Nicaragua and Uruguay, among others.
Around 9,000 babies are born each year with Chagas in the Americas, accounting for 30% of all new infections. A baby born to a mother infected with Chagas has between a 2 to 8% chance of contracting the disease during gestation and birth.
In 2017, PAHO launched a new framework to prevent mother to child transmission of four diseases, including Chagas, by 2020. It is estimated that around 1.1 million women of child-bearing age in the region are infected with the T.cruzi parasite.
In order to prevent this type of transmission, PAHO recommends the implementation of universal screening of pregnant women and newborns in order to identify their status and, if necessary, start curative treatment. It is also advised that if a woman tests positive for Chagas, her other children should also be diagnosed and treated.
Improving access to the prevention, diagnosis and treatment of Chagas for women and children falls in line with the universal health strategy of PAHO, which aims to ensure health for all, with no one left behind.
Chagas is a parasitic, systemic, and chronic disease caused by the protozoan Trypanosoma cruzi. The parasites are mainly transmitted to humans by triatomine bugs, known as “kissing bugs,” but can also be transmitted via blood transfusions, organ transplants, the consumption of contaminated food, and from mother to child during gestation.
It is estimated that in the long term, 30% of chronic infections will develop complications that will have serious and irreversible consequences on the nervous system, the digestive system and the heart. If the disease is detected in time, however, it can be cured and prognosis improved. Even if diagnosed during the chronic phase, treatment can still prevent or delay its progress.