Why in 9 years Chagas could cease to be a global public health concern

It is no longer a rural disease but of the cities. (Fernando Calzada)

The world today is shocked by the emergence of a new disease that started in China. But 102 years ago, Latin America also discovered another infection -caused by a parasite- that was silently advancing across the planet: Chagas disease. Today there is between 6 and 7 million people infected by the parasite in the world, but only 10% would be diagnosed. Now The World Health Organization set a plan to eliminate Chagas disease as a public health problem in 9 years. It is no longer a rural disease but of the cities.

The Chagas plan is part of the new 2021-2030 roadmap that the United Nations health agency developed for the 20 most neglected diseases. It’s known that, As a result of migrations, the infection is also present in the United States, Canada, in many of the European countries, such as Spain, and in some Africans, the Eastern Mediterranean and the Western Pacific. The parasite is transmitted mainly by insect bites, from mother to child, by contaminated blood transfusions, or from receiving donated organs from people who had the infection.

“The new roadmap for neglected diseases such as Chagas was made from the global consultation that began in 2018, with public institutions from different countries, researchers, non-governmental organizations, and culminated with the approval of the document during the World Assembly of Health last November. It will be a challenge to develop the actions to achieve the goals that are proposed because we still do not know exactly what the impact of the COVID-19 pandemic will be.“, said to Infobae the doctor Pedro Albajar Viñas, who is part of the WHO Department of Control of Neglected Tropical Diseases.

The plan is built on pillars that drive more action. It includes doing more structured research on communities affected by disease and putting measures in place that are based on scientific evidence. “In addition to introducing gradual modifications in the programmatic actions, a more radical change will also be needed to incorporate and integrate the interventions in the national health systems and coordinate the actions between the various sectors. These cross-cutting approaches are not new, as they are already present in several NTD-related plans, but their practical application has proven difficult in some circumstances, ”the roadmap states.

(Shutterstock.com)

(Shutterstock.com)

According to Albajar Viñas, during the last nine years there was another roadmap, but it was necessary to rethink what is missing. They are the most neglected patients in the world. In many cases, effective treatment is not yet available. But in other cases, people -such as those living with Chagas- do not have access to diagnosis and treatment. What is being sought now is for there to be more intersectoral work.

“These diseases do not only have to involve health personnel. If silos are avoided within the health system and in its interaction with other sectors, there is a greater chance of improving the disease situation. In the case of Chagas, many patients already have the infection and can live for decades, but they need care “, he warned. What they call “intersectoral work” means Recognize that to better control diseases, it will be tried that 100% of the affected people also have access to the water supply, sanitation, and hygiene.

Regarding the goal of eliminating Chagas as a public health concern, Dr. Albajar Viñas explained that the infection could be controlled through more tests in women and children, blood transfusions and organ donations in regions of the world where there are still no insect vectors of the parasite. “Eradicating it is impossible: species of insects will always live in environments that can transmit the parasite,” he clarified. In addition, the Chagas plan aims to achieve antiparasitic treatment coverage of 75% of the eligible population by 2030, and for 15 countries to be able to interrupt transmission through four transmission routes (vector, transfusion, transplantation and congenital).

Can WHO’s new plan for Chagas and other neglected diseases really be carried out? “It is a plan with ambitious goals that will make it possible to measure concrete progress. If they are not achieved, it will be possible to evaluate what worked and reformulate it for the following years ”, valued the doctor. Silvia Gold, President of the Fundación Mundo Sano of Argentina and member of the Board of Directors of the WHO Foundation in dialogue with Infobae.

The plan is built on pillars that drive more action.  It includes doing more structured research on the communities affected by the diseases and implementing measures that are based on scientific evidence (EFE / David de la Paz)

The plan is built on pillars that drive more action. It includes doing more structured research on the communities affected by the diseases and implementing measures that are based on scientific evidence (EFE / David de la Paz)

According to Gold, The plan reduces the verticality of previous years by allowing each country to implement actions according to its characteristics, and includes an approach from education and infrastructure. “Chagas disease is on the world public agenda today. That was a major change. The roadmap was a collective construction by counting on the global public consultation, and this would lead to more commitment by all the sectors involved ”, estimated Gold.

“The WHO roadmap will involve several changes based on the experiences learned. It encourages the scientific community to seek solutions that meet the needs of people with simplified, efficient, and high-quality solutions. That they be feasible to be implemented at the first level of medical care, close to homes, “Sergio Sosa Estani, researcher at Conicet and in charge of the Chagas program of the Drugs for Neglected Diseases Initiative (DNDi) in Latin America, commented to Infobae. . It will not be just a question of epidemiologists and doctors. The new approach will include the contribution of experts in “social psychology, anthropology, that allow integrating approaches related to nutrition, mental health, among others,” he said. Sosa Estani. That approach is key to breaking down the stigma and discrimination experienced by people with Chagas disease or other neglected diseases.

Sosa Estani also stressed that now it is intended to broaden the perspective of “One Health”. Human health is not disconnected from what happens to the health of other species that inhabit the world. “Deforestation affects and contributes to the risk of neglected diseases. Understanding the environment, intervening or not intervening can make a difference, increase risk factors, generating more damage and more cases of diseases ”, Sosa Estani said.

As a result of migrations, the infection is also present in the United States, Canada, in many of the European countries, such as Spain, and in some Africans, the Eastern Mediterranean and the Western Pacific (Shutterstock.com)

As a result of migrations, the infection is also present in the United States, Canada, in many of the European countries, such as Spain, and in some Africans, the Eastern Mediterranean and the Western Pacific (Shutterstock.com)

In the case of Chagas, there is a lot to do. In areas with insects that transmit the parasite, work must be done to improve the environment to avoid refuge for the vectors, and apply insecticides in accordance with control programs, said Sosa Estani. “Pregnant women should be tested in endemic countries for vector transmission, and in non-endemic countries with intense population migration from endemic countries”, he claimed.

“There is evidence that timely treatment with benznidazole and nifurtimox in women of childbearing age controls the infection. It has a secondary prevention effect on women because it cures the infection and prevents the progression to heart disease. It also contributes to primary prevention by avoiding congenital transmission of children born to post-treatment pregnancies ”, he pointed out. The Pan American Health Organization is promoting the EMTCT Plus Program for the control of congenitally transmitted infections, integrating the control of Syphilis, HIV, Hepatitis B and Chagas.

Testing of girls and boys at birth will be further promoted, said Sosa Estani. “Argentina has had it compulsory since the eighties. Its incorporation is being promoted in all the countries of the region. There are examples such as non-endemic countries, such as Spain, that now consider these tests on children ”.

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