Policy Implications of the Changing Epidemiology of Chagas Disease and Stroke

Abstract

American trypanosomiasis or Chagas disease (CD) is considered today a global health problem. This parasitic disease, endemic and once almost entirely confined in the Americas for thousands of years, has spread outside Latin America. Economic crisis and population mobility, mainly migration, has spread at first to United States and Canada and later to European countries.1 Since 2000, increasing numbers of CD cases have been reported in many European countries, including cases among travelers returning from Latin America.2,3 Neurologists should increase their awareness because CD is an important cause of ischemic stroke in endemic regions,2 which has been also reported among immigrants living in nonendemic countries. The objectives of this article are to review the changing epidemiology of CD in the field of stroke, and to propose some policy implications to raise the awareness, diagnosis, and prevention of this long-term neglected disease. ### Burden of CD in Endemic Countries CD, a parasitic disease caused by the protozoan Trypanosome cruzi , is spread from Chile, Argentine, Brazil, Bolivia, Colombia, Venezuela, Caribbean region, Mexico, and southern Texas in the United States. In Latin American endemic countries, CD has been linked to poverty and rural areas and was not considered a public health problem for many years.3 In fact, the disease is transmitted to humans by the feces of the blood-sucking triatomine bugs through the insect sting (wild vector transmission). Today, CD is endemic in 21 Latin American countries and has become a global health problem because of the emigration to developed countries of thousands of asymptomatic or paucisymptomatic T cruzi –infected people who are unaware of their condition.3 It is estimated that between 8 and 14 million people are infected with T cruzi in Latin America, including 2 million people infected women of fertile age. Only Brazil has ≥4 million people with the …