Category Archives: Chagas

Sharing Best Practices from JICA’s Chagas Disease Control Efforts in Central America

Asia, Chagas, Latin America and the Caribbean

 

Photo courtesy of JICA

Photo courtesy of JICA

According to recent estimates, about 45 percent of Central America’s population is at risk for Chagas Disease –one of the 17 neglected tropical diseases recognized by the World Health Organization (WHO). However, the Japan International Cooperation Agency (JICA) has made large strides in controlling and halting the transmission of Chagas within several countries of the region.

On Thursday, May 29th, JICA members shared success stories and best practices from their 14 years of experience controlling Chagas Disease in Central America. During the event, Dr. Ken Hashimoto, JICA’s Central American Regional Advisor for Chagas, noted that the best practices developed by his team were designed to aid the broader global health community in their efforts to rid the Americas of this deadly disease.

Beginning with an overview, Dr. Hashimoto explained that Chagas disease is most-often transmitted by small insects (triatomine bugs) which frequently hide in the cracks of mud walls. This is problematic because the majority of Chagas victims are poor and live in mud houses.

Dr. Hashimoto noted that JICA’s Chagas control strategy involved a variety of activities – including surveying, training national officials and community health workers, securing financial support, raising awareness and establishing a surveillance system to prevent new outbreaks of the disease.

More specifically, Dr. Hashimoto said the control strategy consisted of an attack phase and a surveillance phase. As part of the attack phase, JICA conducted initial surveys on the scope of the problem, dispatching dozes of long-term and short-term experts and volunteers to the region. Once this initial task had been completed, the team sprayed houses in at-risk communities with insecticide. In addition, JICA members educated communities on ways to prevent the disease. Lastly, the JICA team evaluated the success of their efforts – often times needing to repeat the steps until finally halting transmission of the disease in several areas.

Why was JICA so successful? Their latest report, “Best Practices” from JICA’s Chagas Disease Control Efforts in Central America, provides insight into their best practices.

Through workshops, interviews and analysis, JICA developed 23 different best practices: 13 at the national level, 5 at the departmental level and 5 at the operational level. According to JICA, the term best practices is defined as “a set of coherent actions that generate favorable changes in sustainability, impact, and the ability to be replicated.”

Some examples of best practices at the national level include the following:

  • Projecting a vision for a national plan to control Chagas
  • The strategic design of national plan
  • Creating a diploma course on vector borne diseases
  • Applying GIS (Geographic Information Systems)
  • Establishing connections between the Ministries of Health and the Ministries of Education

 

At the departmental level, Dr. Hashimoto notes that establishing community participation on the control efforts was important. In addition, deworming was provided at the same time that surveys were conducted to assess the burden of Chagas disease. This is because children found positive for Chagas are often not able to receive treatment for the disease because they are malnourished and will react poorly to the treatment. To help with this issue, the children are dewormed before treatment and their bodies are rid of the nutrient-sucking intestinal worms. In addition to deworming medicine, many children also need better nutrients depending on how malnourished they are.

Lastly, Dr. Hashimoto noted that strong commitment from governments were key to sustaining the program’s success long-term.

For more information and best practices from JICA’s Chagas control efforts, click here.

Calling Attention to a Silent NTD – Chagas Disease

Chagas, Latin America and the Caribbean,

 

Mother and Child in Guatemala_1

By Raquel Corona-Parra

Chagas disease, or American Trypanosomiasis, is one of the 17 neglected tropical diseases (NTDs) recognized by the World Health Organization (WHO). It is primarily found in the Americas and it affects millions of people – however, like all NTDs, Chagas disease is a disease of poverty and its toll on the most vulnerable populations goes largely unnoticed.

It is estimated that around 10 million people are infected with Chagas disease worldwide, with more than 99% of the cases occurring in Latin America. The Pan American Health Organization (PAHO) estimates that around 100 million people are at risk for infection. Most of the endemic countries in the region are in Central and South America; however, according to the WHO, the disease is now also affecting communities in the United States, Canada, and some areas of Europe and the Western Pacific.

Increased political attention is needed, particularly in Mexico and the United States, to put an end to this NTD. in its declaration, The Global Chagas Disease Coalition calls for access to existing health tools, innovation and a global R&D agenda, transmission control to prevent Chagas in endemic and non-endemic countries, and advocacy to ensure public and policy awareness of this NTD.

In addition, Sabin Vaccine Institute and other partners are working tirelessly to combat and draw attention to Chagas disease. As part of this effort, a group of partners including the Global Chagas Disease Coalition, Sabin Vaccine Institute, the National School of Tropical Medicine at Baylor College of Medicine, Drugs for Neglected Diseases initiative (DNDi), Doctors Without Borders/Médecins Sans Frontières (MSF), Research!America, the American Society of Tropical Medicine and Hygiene (ASTMH), and PAHO, will host an event tomorrow titled “Advancing Life-Saving R&D Innovations for People Living with Chagas Disease – The Silent Killer.” To catch the live stream of the event, click here.

It starts with a kissing bug

Chagas disease is caused by the protozoan parasite Trypanosoma cruzi (T. cruzi) and it is transmitted most commonly by triatomine bugs, better known as “kissing bugs.” These bugs, which live in the cracks of mud, adobe, and palm thatch houses, bite humans at night as they sleep, usually in the face. The bug defecates close to the bite, and the parasite T. cruzi enters the body when the person scratches at the bite. Chagas disease can also be transmitted through blood transfusion, congenital transmission, organ transplantation and consumption of contaminated foods.

Symptoms and treatment

Chagas disease presents itself in two stages. During the first stage, the acute phase, the parasites cause mild symptoms such as fever, headache, and enlarged lymph glands. The second stage is a chronic phase when the parasites are in the heart and digestive muscle, causing symptoms such as cardiac disorders, digestive and neurological disorders, and can lead to sudden death or heart failure. Treatment for the disease includes benznidazole and nifurtimox, which are most effective in curing Chagas soon after infection occurs. The Sabin Vaccine Institute’s Product Development Partnership is currently developing a vaccine for Chagas in collaboration with Baylor College of Medicine and Texas Children’s Hospital, with support from the Slim Initiative for the Development of Neglected Tropical Disease Vaccines.

Recent Chagas efforts

In July, a group of experts gathered in El Salvador for the country’s first National Conference for the Prevention and Control of Chagas Disease. The event – organized by government ministries in El Salvador, Japan International Cooperation Agency (JICA), and PAHO – was convened to promote the scientific exchange of the advances in Chagas disease monitoring, control, diagnosis and treatment. JICA has been present in Central America since 2000, supporting the governments in their Chagas disease prevention efforts, particularly the IPCA initiative for Chagas disease control (Iniciativa de los Países de Centro América para la Interrupción de la Transmisión Vectorial, Transfusional y Atención Médica de la Enfermedad de Chagas). Minister of Health María Isabel Rodríguez stressed that although disease incidence has reduced, there are still a considerable amount of people who die from the effects of this NTD. To address this, a new technical surveillance group was formed during the conference to expand upon the efforts to control Chagas disease in El Salvador. In Guatemala, the recently launched National Plan to control and eliminate NTDs includes Chagas control activities.

PAHO and WHO have also supported Chagas control efforts in affected subregions of Latin America, through the following cooperation initiatives: the Southern Cone Initiative (Argentina, Bolivia, Brazil, Chile, Paraguay, and Uruguay), the Central America Initiative/IPCA (Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama), the Andean Initiative (Colombia, Ecuador, Peru, and Venezuela), and the Amazon Initiative (Bolivia, Brazil, Colombia, Ecuador, Guyana, French Guiana, Peru, Suriname, and Venezuela). The Mundo Sano Foundation, a Global Network partner, works on entomological surveillance and home improvement activities to combat Chagas in rural areas of Argentina.

Efforts to draw increased attention to Chagas disease continue to push forward. Remember to tune into the live stream of “Advancing Life-Saving R&D Innovations for People Living with Chagas Disease – The Silent Killer” here, and stay-tuned for an update from the event.

Artfully Bringing Stories of Neglected Tropical Diseases to Life

Chagas, hookworm, Latin America and the Caribbean, NTDs, PAHO, ,

 

Update: We’re happy to share the news that Shelly Xie was recently awarded the 2013 ASTMH Communications Award

There are several ways to describe the impact of neglected tropical diseases (NTDs) on millions of families worldwide. But this may be one of the most artful and poetic we’ve seen.

Last week, medical student and artist Shelly Xie showcased two sand animations that thoughtfully illustrated stories of families infected with hookworm and Chagas disease at the Pan American Health Organization’s (PAHO) 52nd Directing Council. Shelly’s poetic narration, mixed with moving music and sand drawings, gave these complex stories life.

Shelly’s first animation tells the story of a Brazilian family. Maria, Antonio and their daughter Francisca contract hookworm – a parasitic disease which leaves them sick, tired and unable to work, go to school or take care of their crops.  This story is illustrative of the broader burden NTDs have on millions of Latin American and Caribbean families. Over 13.8 million preschool and 31 million school age children are at risk of hookworm and other parasitic intestinal worms.

Shelly’s second animation tells the story of a young couple in Argentina who contracts Chagas disease. After being bit by the Triatomine bug, both the husband and wife become too sick to work and take care of their livestock. Even worse, the mother is expecting a child who now has a chance of contracting Chagas disease as well. After a week, the couple begins to feel better – but what they don’t know is the side-effects of Chagas disease could lead to an enlarged colon and esophagus, or even heart failure in the years to come. It is estimated that 10 to 11 million people in Latin America and the Caribbean are living with Chagas, Shelly explains.

Shelly’s animations are part of PAHO’s Art Research Project – a program that works with different sectors of society to show how we can all have an impact on global health efforts. Her unique and artistic messaging has the power to include an even wider audience in NTD advocacy and awareness efforts worldwide.

Neglected Tropical Diseases in… Texas?

Chagas


By Agustin Caceres

At the end of last year, I attended the conference “Lives in the Balance”, organized by DNDi and Doctors Without Borders in New York City. Specialists from all over the world debated the situation of NTDs, particularly TB and Chagas disease: the existing challenges in research and development, the creation of new drugs and the need for better coordination among governments, donors, academia and NGOs.

The surprise for me was hearing Dr. Peter J. Hotez, dean of the National School of Tropical Medicine at Baylor College and president of the Sabin Vaccine Institute, talk about the situation of NTDs in a country that would not come to my mind when I think about Chagas disease: the United States.

According to his research, Texas has an increasing number of cases of Chagas. You might think that these statistics could be due to the high volume of immigrants that reside in the State, but research shows that in many cases, patients infected with the parasite that causes the disease were born and raised in Texas.

Image: A composite risk map for Chagas disease in Texas. Source: University of Texas in Austin

These cases are, like in many other countries, usually neglected. Chagas remains invisible to the public eye, since cases are found mostly in the poorest and most vulnerable populations of Southern Texas and the metropolitan area of Houston, particularly among African Americans.

The situation of Chagas in Texas has drawn the attention of institutions like the Centers for Disease Control and Prevention (CDC). After three dogs died from acute Chagas cardiomyopathy in one location, an investigation was conducted in the home, garage and grounds of the owner of these pets. A serologic study was conducted on stray dogs, and an ecologic niche model was developed to predict areas where the vector Triatoma gerstaeckeri might be expected.

This study demonstrated the existence of a domestic transmission cycle for an insect species that is typically considered a zoonotic vector. However, according to CDC it is not clear whether this observation represents an isolated case or whether it actually indicates an emerging public health problem.

Some estimate that 300,000 people live with Chagas disease in the United States, and in many cases they do not have access to testing or free treatment. The research conducted in Texas is a good reminder that we must remain vigilant –NTDs are not just a problem of the developing world. These diseases affect the neglected everywhere.

Agustin Caceres is Communications and Outreach Officer at the Social Protection and Health Division of the Inter-American Development Bank (IDB) in Washington DC.