Integrated control of Chagas disease for its elimination as public health problem--a review.

Sergio Sosa-Estani,Elsa Leonor Segura

doi:10.1590/0074-02760140408

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.

Highlights

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 (Hotez et al 2008)
Trypanosoma cruzi, its causative agent, can be transmitted by different ways: vector, blood or oral (WHO 2002)
The Pan American Health Organization (PAHO) has reviewed possibilities of different levels of control for several neglected diseases related with poverty

Summary

Epidemiologic components

Modes of transmission and distribution factors Various scenarios should be considered when trying to understand the transmission dynamics of T. cruzi. 290 Integrated control of Chagas disease Sergio Sosa-Estani, Elsa Leonor Segura haviours and biotopes (Fig. 1), there is diversity in the lineage of the parasite (Zingales et al 2012), diversity in its wild and human hosts, in their potential susceptibility to infection and in their response and there is diversity in the behaviours of the people infected and their social environment, generating a variety of risk or protection scenarios for the various forms of transmission. In areas where no conditions exist for vector transmission (absence of vectors), but where there is intense immigration of people from an area with vector transmission, there may be a risk of transmission by blood that requires the implementation of measures to control transmission through these routes, such as screening of blood and organ donors and monitoring of pregnant women and newborns from women infected with T. cruzi (Mallimaci et al 2001, 2010)

Prevention and control activities

Care of people and levels of prevention