Chagas disease is a parasitic infection often caused by contact with the faeces of infected blood-sucking insects (called kissing bugs) which infest people’s homes. The illness can also be passed on by eating food contaminated by the insects, through blood transfusions or organ transplants, or to children at birth.
Estimated number of people with the Trypanosoma cruzi infection – Chagas disease (2010)
Total number of chronic cases of Chagas disease detected through medical health care systems in endemic countries of the Americas
WHO roadmap target:
Control by 2020
- By 2015, interrupted transmission by blood transfusion in the Americas, European and Western Pacific regions
- By 2020, interrupted transmission by intradomiciliary vectors in Latin America
Progress in controlling Chagas disease has been most impressive in endemic settings in Latin America. Good progress was made towards interrupting transmission from both blood transfusions and bites from the vector. Almost all countries (41 of 42) conducted compulsory screening to interrupt transmission during blood transfusion however, verification of interruption is lengthy and costly and will take longer to complete. Similarly, progress in halting household transmission from triatomine bugs by 2020 is on track, 9 of 21 countries having halted transmission and a further 8 having achieved partial interruption by 2015. Three areas that present particular challenges for reaching vector control targets are the Amazon basin and Gran Chaco regions of South America and the Guatemala– El Salvador border. Conducting activities is logistically challenging and expensive and requires more support.
Individual diagnosis and treatment are integral components of the global programme. Support has increased but is still far short of that needed. It has been reported that less than 1% of patients globally can access treatment. Recent commitments by endemic countries to scale- up diagnosis and treatment are promising but will require resources. NGOs have increased their support in this area, approximately doubling the number of patients diagnosed and treated between 2015 and 2016, and have extended their support to 10 countries. Coordination with WHO and the WHO Regional Office for the Americas has increased and should continue. Global requests have been made for nifurtimox, and benznidazole is now approved for use in the USA; more detection and treatment in the USA is therefore anticipated. A commitment from Mundo Sano and Elea to donate treatment for Chagas disease for congenital cases in Latin America (in agreement with the WHO Regional Office for the Americas) and for children under 18 in countries outside of the Americas (in agreement with WHO) is a significant advance.
The urgent unmet research needs in the global Chagas disease programme include monitoring of and research on insecticide resistance; new diagnostic tools more appropriate for the programme, such as rapid tests for inaccessible areas; better tools for diagnosis in newborns; improved access to diagnosis and treatment; and alternative drugs for patients with long-term Chagas infection or other conditions that cannot be treated with current therapy.