The New Epidemiological Scenario of Chagas Disease Involves New Challenges and Requires a Multidisciplinary Approach

Chagas disease, caused by the Trypanosoma cruzi parasite, was originally described as an endemic disease among poor populations living in rural areas of Latin America. However, two major factors have modified the epidemiology of the disease over the last decades: climate change and human migration. This new scenario brings new challenges in the prevention and control of the disease. In a review published in Acta Tropica, Dr. Quim Gascón and Dr. Maria Jesus Pinazo, researchers at ISGlobal, analyse the new epidemiological scenario of Chagas disease and how to deal with it.

In endemic countries, the disease vector (more than 100 species of triatomine bugs) has acquired a wider geographic distribution, and re-infestation of homes by non-domiciliary species as well as the emergence of insecticide resistance represent major challenges in these countries. The growing concentration of people in periurban areas with poor hygienic conditions and the oral infection caused by ingestion of drinks or food contaminated with bugs or their feces also favor T. cruzi transmission. In addition, vertical transmission of the disease from mother to child during pregnancy is responsible for more than 8,000 cases per year and remains one of the major public health challenges in endemic and non-endemic countries.

Migration flows have not only taken the disease to urban regions of Latin America, but also to non-endemic countries, where parasite transmission occurs mainly from mother to child during pregnancy and birth, but can also occur through blood transfusions and organ donations. An estimated 300,000 people live with T. cruzi in USA and 100,000 in Europe (most of which are in Spain), but despite this, few countries have established the necessary health public measures to screen for the parasite in pregnant women, blood banks and transplanted organs in order to prevent its transmission.

Despite the globalization and economic impact of the disease (estimated in 7 thousand million USD), the authors point out that Chagas remains a neglected disease and has become a silent and silenced public health crisis. A multidisciplinary approach at the national and international level is required in order to coordinate the different control programs (vector, blood and organ banks, vertical transmission). They conclude that the international community must concentrate resources and efforts in two main directions: a better management of the infection in affected people and more research to cover knowledge gaps in the phsysiopathology, diagnosis and treatment of the disease.

Reference

Pinazo MJ, Gascon J. The importance of the multidisciplinary approach to deal with the new epidemiological scenario of Chagas disease (global health). Acta Trop. 2015 Nov;151:16-20.

Image: Climate change and migration flows have contributed to the globalization of the disease