Monday, June 3, 2019

Breaking the silence on Chagas disease

On 22 May, World Heart Federation (WHF) held a WHA side event, in collaboration with the Chagas Coalition and the Drugs for Neglected Diseases initiative (DNDi), titled Chagas Disease: Breaking the Silence.

The event aimed to raise awareness of Chagas Disease, especially in light of the upcoming WHO Roadmap on neglected tropical diseases (NTDs), and to support the campaign for an official WHO World Chagas Day, which was approved just a few days later by the World Health Assembly.

Here are some key facts about Chagas disease.

·         Chagas disease is caused by infection with the protozoan parasite Trypanosoma cruzi transmitted by triatomine bugs.
·         Vector-borne transmission in poor housing conditions occurs exclusively in the Americas, where an estimated 6 to 8 million people are infected.
·         The epidemiology of the disease is changing due to successful reduction of transmission in endemic areas as well as migration of individuals within and outside of endemic areas.
·         Thousands of infected individuals live in cities across Latin America and in the United States, Spain, and other European countries.
·         The infective trypomastigote form of the T. cruzi parasite is present in large numbers in the feces of infected triatomine bugs.
·         During or immediately after a blood meal, the triatomine bug defecates on the skin of the host, allowing the organism to enter through the bite wound or via intact conjunctiva or mucous membranes.
·         The risk of infection in the setting of short-term exposure is low.
·         On average, 900 to 4000 contacts with infected vectors are needed to result in infection.
·         In endemic areas, T. cruzi infection is usually acquired in childhood and persists for life.
·         About 70-80% of infected individuals have lifelong asymptomatic infection.
·         The prevalence of clinical disease increases with age, reflecting onset of cardiac and gastrointestinal manifestations in early adulthood with progression over a period of years to decades.
·         Disease transmission can also occur vertically from mother to fetus, via transfusion of infected blood components, via organ transplantation from an infected donor, via ingestion of contaminated food or drink, or via laboratory exposure.
·         Most congenitally infected infants are asymptomatic or have nonspecific signs; specific laboratory screening is needed to detect congenital infections in infants.
·         Transmission by domestic vectors has been reduced via residual application of long-lasting insecticides in human dwellings and peridomestic structures.
WHA72 key outcomes

·         Member states agreed on a new global strategy on health, environment and climate change: the transformation needed to improve lives and well-being sustainably through healthy environments
·         Member States agreed on a decision to accelerate and scale up action to prevent and treat noncommunicable diseases (NCDs), primarily cancer, diabetes, and heart and lung diseases, and to meet global targets to reduce the number of people dying prematurely from these diseases
·         Member States also expressed wide support for the WHO Access Roadmap for Medicines, Vaccines and other health products, which will determine WHO’s work on this issue for the next five years.
·         The World Health Assembly adopted a resolution on improving the transparency of markets for medicines, vaccines and other health products in an effort to expand access. The resolution urges Member States to enhance public sharing of information on actual prices paid by governments and other buyers for health products, but stops short of compelling pharmaceutical companies to disclose R&D costs.
·         Member States agreed to establish World Chagas Day, to be celebrated each year on 14 April. Chagas is a neglected tropical disease which currently affects between 6 and 7 million people, mostly in Latin America.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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