Control strategy

Overview

There is no vaccine for Chagas disease.

Vector control remained the most effective method of preventing transmission in Latin America. Blood screening has become increasingly more important to prevent infection through transfusion and organ transplantation.

The activities of the Programme on the Control of Chagas disease are based on a two-pillar strategy, which does not directly involve vector control.

This strategy determines the way to the reduction of Chagas disease burden through transmission stop and care of patients. Despite being logical and apparently simple, this strategy implies to overcome the logistics challenge of combining different activities with different length and chronogram of implementation.

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Intergovernmental Initiatives and current challenges

Since the 90s, national and international successes in controlling the parasite and its vector have been achieved by Member States in the frame of four Intergovernmental Initiatives in Latin America (the Southern cone, Central American, Andean Past and Amazonian Intergovernmental Initiatives with the Pan American Health Organization secretariat).

In addition, the risk of transmission by blood transfusion has been substantially reduced throughout Latin America. These advances have been made possible thanks to the strong commitment by Member States where the disease is endemic, the strength of their research and control organizations and the support from many international partners.

Nevertheless, despite the remarkable progress made by the above control Initiatives, key challenges are still to be addressed, namely: sustainability of control successes, Chagas disease emergence, re-emergence or dissemination in different world areas and detection and care of patients, including their co-infections and co-morbidities.

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The initiative of the disease non-endemic countries and the Technical Groups

Faced with the spread and globalization of the disease, WHO and PAHO organized a joint meeting in July 2007, in Geneva: 'Revisiting Chagas disease: from a Latin American Health perspective to a Global Health perspective' to move towards the goal of providing more support and reinforce national and regional capacities to reach the objective of complete elimination of Chagas disease transmission and provide health care to infected and ill patients.

The meeting recommended the establishment of an Initiative of Non-Endemic Countries and a better global networking to tackle Chagas disease.

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A renewed framework, specific objectives and a mandate to control and eliminate Chagas disease was established through the Resolution of the World Health Assembly WHA 63.20, approved in May 2010. Regular reporting to Member States on the control and elimination progress in the successive WHA was requested, starting in May 2012, during the 65 WHA.

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Achievements

Key achievements have been registered in the last four years, among others:

Interruption of the vectorial transmission of Trypanosoma cruzi by Rhodnius prolixus(introduced and intradomiciliary species) in Central America (Belize, Costa Rica, El Salvador, Guatemala, Nicaragua, Honduras) and Mexico, with the key support of JICA.

Interruption of the vectorial transmission by Triatoma infestans, the principal intradomiciliary vector species in five Argentinean provinces (Entre Rios, Jujuy, La Pampa, Neuquen and Rio Negro), Oriental Region of Paraguay, two departments in Southern Peru (Moquegua and Tacna), additionally to Brazil, Chile and Uruguay.

Progressive implementation of universal blood screening to stop transfusional transmission, with 20 out of the 21 disease endemic countries with universal screening for T. cruzi infection in blood banks.

Progressive awareness and improvement of the implementation, coverage and quality of the health care for Chagas disease patients, including early diagnosis and treatment of congenital Chagas disease; better coverage of Chagas disease training in universities and other education centres and the increased detection of oral transmission outbreaks through contaminated food by T. cruzi in different endemic countries,