Chagas disease: a neglected emergency

Abstract

This year marks the 100th anniversary of the discovery of Chagas disease. The illness mainly affects the poor in remote areas and is endemic in rural Latin America, where an estimated 18 million people are infected with the causative parasite Trypanosoma cruzi, transmitted by Reduvid bug insect vectors. For decades, their confined location helped to make Chagas disease neglected and an unattractive candidate for drug development.Programmes so far have focused on disease prevention (via vector control) but 50 000 cases and 15 000 deaths are still reported annually. Nifurtimox and benznidazole treatments are effective only during the symptomatic stage of Chagas disease that is observed in fewer than 1% of individuals (mostly children). The drugs are old, toxic, and lack specificity. The chronic disease stage takes decades to develop and is associated with cardiac and gastrointestinal complications for which symptom management is the only treatment option. No vaccine or standardised diagnostic test is yet available.Because of increased human migration and mobility, Chagas disease now has the potential to become an international threat. Vector resistance, new carriers, novel transmission routes (contaminated food, transfused blood, transplanted organs), disease reactivation in HIV/AIDS individuals, and a raised number of cases in urban environments have all been observed. In 2007, WHO established The Global Network for Chagas Disease Elimination to raise global awareness of the disease.The control and treatment of Chagas disease urgently requires international cooperation between policy makers, donors, health-care providers, and researchers. The recent World Health Assembly wasted an opportunity in not discussing Chagas disease. The newly established 5-year, US$120 million US National Institutes of Health's Therapeutics for Rare and Neglected Diseases Program is a much needed initiative, and should ensure that Chagas disease drug development is included in the research agenda. This year marks the 100th anniversary of the discovery of Chagas disease. The illness mainly affects the poor in remote areas and is endemic in rural Latin America, where an estimated 18 million people are infected with the causative parasite Trypanosoma cruzi, transmitted by Reduvid bug insect vectors. For decades, their confined location helped to make Chagas disease neglected and an unattractive candidate for drug development. Programmes so far have focused on disease prevention (via vector control) but 50 000 cases and 15 000 deaths are still reported annually. Nifurtimox and benznidazole treatments are effective only during the symptomatic stage of Chagas disease that is observed in fewer than 1% of individuals (mostly children). The drugs are old, toxic, and lack specificity. The chronic disease stage takes decades to develop and is associated with cardiac and gastrointestinal complications for which symptom management is the only treatment option. No vaccine or standardised diagnostic test is yet available. Because of increased human migration and mobility, Chagas disease now has the potential to become an international threat. Vector resistance, new carriers, novel transmission routes (contaminated food, transfused blood, transplanted organs), disease reactivation in HIV/AIDS individuals, and a raised number of cases in urban environments have all been observed. In 2007, WHO established The Global Network for Chagas Disease Elimination to raise global awareness of the disease. The control and treatment of Chagas disease urgently requires international cooperation between policy makers, donors, health-care providers, and researchers. The recent World Health Assembly wasted an opportunity in not discussing Chagas disease. The newly established 5-year, US$120 million US National Institutes of Health's Therapeutics for Rare and Neglected Diseases Program is a much needed initiative, and should ensure that Chagas disease drug development is included in the research agenda. Chagas disease: still a neglected emergency?10 years after highlighting the health consequences for millions of people infected with Trypanosoma cruzi, a 2019 report from the Pan American Health Organization concluded that there has been little progress in the prevention and treatment of Chagas disease, a problem that now extends beyond Latin America.1 Full-Text PDF