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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 10  |  Issue : 5  |  Page : 1367-1368
Aiming to achieve elimination of Chagas disease: Before it acquires a status of global public health concern


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India

Click here for correspondence address and email

Date of Web Publication6-Nov-2017
 

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Aiming to achieve elimination of Chagas disease: Before it acquires a status of global public health concern. Ann Trop Med Public Health 2017;10:1367-8

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Aiming to achieve elimination of Chagas disease: Before it acquires a status of global public health concern. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Dec 10];10:1367-8. Available from: http://www.atmph.org/text.asp?2017/10/5/1367/196623


Dear Sir,

Chagas disease is a potentially life-endangering disease attributed to the infection with the parasite Trypansosoma cruzi[1] The current global estimates suggest that almost 6 to 7 million people are infected with the disease, with the majority of the cases being reported across the Latin America nations.[1],[2] However, the disease no longer remains restricted to the American region and has spread to other continents as well owing to the population migration.[1],[2] Furthermore, the disease accounts for the deaths of 10,000 individuals every year because of the complications associated with cardiac, digestive, neurological, or multisystem involvement.[1],[3]

In addition, the disease has been associated with an enormous financial burden on the health care system (for management of the disease-associated complications such as arrhythmia, cardiac failure), catastrophic expenditure by individuals/households, enormous expenditure by the authorities on vector control measures, sickness absenteeism, reduced productivity, and impairment in the quality of life of the affected persons.[1],[2],[3]

Even though, vector-borne transmission is predominant in the Americas, the disease is even transmitted by intake of food contaminated with the parasite, blood transfusion, transplacental transmission or during childbirth, and organ transplantation.[2]

Furthermore, the disease clinically presents in either acute phase (parasites circulate in the blood and symptoms are mild) or chronic phase (organisms are hidden in the cardiac or digestive muscles and the patients present with serious complications).[1]

In the absence of a vaccine, vector control through spraying of residual insecticides in houses/surrounding areas and improvement in the housing standards has been identified as one of the most effective approaches for the prevention of the disease.[1],[4] In addition, measures such as motivating people to use bed nets; maintaining hygienic practices in different phases of food preparation, transportation, storage and consumption; screening of blood donors or organ donors for the disease; and ensuring that newborns and other children of infected mothers are uniformly screened to promote early detection and prompt treatment can significantly reduce the incidence of the disease.[1],[2]

From the treatment perspective, the infection is completely curable, provided the treatment (benznidazole or nifurtimox) is initiated immediately after infection, while in the chronic stages of the disease; subsequent progression of the infection can be halted by the drugs.[1],[5] Treatment has even been advocated for the reactivated cases or asymptomatic patients; nevertheless, the use of drugs is not recommended for pregnant women and patients with coexisting morbidity of hepatic or renal failure.[1],[5]

Moreover, the path to contain the infection is quite difficult, as the precise estimate of the prevalence of the disease cannot be ascertained due to the presence of spatial heterogeneity, rapid changes in trends of disease, prolonged lag period between acquisition of infection and development of the symptomatic disease, no clear-cut guidelines to conclusively establish the disease specific deaths, poor quality of surveillance about the sequel of disease, and no mechanism to obtain epidemiological information about the disease outside endemic nations.[2],[5] In addition, issues such as maintaining progress in the field of disease control, detecting the diseases in regions that were earlier disease free due to migration of infected people, and ensuring that diagnostic and treatment services are readily accessible to millions of infected people have made it difficult to reduce the disease prevalence.[1],[2],[5]

However, in the mission to attain the goal of elimination of disease, address the identified challenges, and extend desired health care for all persons, both in endemic and nonendemic nations, there is a great need to increase the networking at the global level and ensure improvement in the surveillance and information systems.[1],[4],[5] In addition, strategies such as promoting the use of diagnostic tests for screening and diagnosis of infections, preventing congenital or blood-borne or organ-borne transmission, and ensuring appropriate case management of all forms of infections can also improve the outcome.[1],[2],[4]

To conclude, Chagas disease, which was earlier restricted to a specific region, possesses a potential to spread to the entire world in the modern era. Thus, it is the responsibility of all the stakeholders to interrupt the transmission of the disease through concerted efforts before it becomes a global public health concern.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. Chagas disease (American trypanosomiasis)—Fact sheet; 2016. Available from: http://who.int/mediacentre/factsheets/fs340/en/. [Last accessed on 2016 Jun 5].  Back to cited text no. 1
    
2.
Stanaway JD, Roth G. The burden of Chagas disease: estimates and challenges. Glob Heart 2015;10:139-44.  Back to cited text no. 2
[PUBMED]    
3.
Cucunubá ZM, Okuwoga O, Basáñez MG, Nouvellet P. Increased mortality attributed to Chagas disease: A systematic review and meta-analysis. Parasit Vectors 2016;9:42.  Back to cited text no. 3
    
4.
Benziger CP, Ribeiro AL, Narula J. After 100 years, the diagnosis, treatment, and control of Chagas disease remains a challenge. Glob Heart 2015;10:137-8.  Back to cited text no. 4
[PUBMED]    
5.
Maguire JH. Treatment of Chagas' disease: Time is running out. N Engl J Med 2015;373:1369-70.  Back to cited text no. 5
[PUBMED]    

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Correspondence Address:
Saurabh R Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, 3rd Floor, Ammapettai Village, Thiruporur, Guduvancherry Main Road, Sembakkam Post, Kancheepuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.196623

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