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Global Health Matters

July - August, 2008  |  Volume 7, Issue 4

Burden of Chagas disease still high after a century effort

Closer links between Chagas disease research and public health practices are necessary, say two Fogarty grantees and a colleague, commenting on the 100th anniversary of the infection's discovery.

Panstrongylus megistus. Photo:
Instituto de Cinecias Biomedicas,
University of Sao Paulo.

A commentary in the International Journal of Epidemiology noting the 100th anniversary of the discovery of Chagas disease in Brazil, written by two Fogarty grantees and a colleague, calls for tighter links between research and public health practices.

The researchers, Dr. Ricardo Gurtler and Dr. Uriel Kitron, along with co-author Lileia Diotaiuti also note the relationship between political conditions and efforts to re-establish effective control of the disease.

It was identified in 1909 by Brazilian doctor Carlos Ribeiro Justiniano das Chagas, remains primarily a disease confined to South and Central America and spread by blood-sucking bugs known as Panstrongylus megistus, which hide in thatched roofs, walls and bedding of poorly constructed houses.

After cycles of success and failure to control Chagas--the authors call it "a poverty-related and poverty-promoting disease"--the burden of disease in Latin America is up to 2.7 times that of malaria, schistosomiasis, leishmaniasis and leprosy combined.

The commentary notes that existing insecticides, diagnostics and drugs are "grossly misused or applied in suboptimal ways...within the frame of less effective or misguided strategies." In addition, "Recurrent instability at political, social and economic levels pose major threats to disease control and elimination programs in the regions most affected by Chagas disease."

Beyond better public health management, the authors conclude that broad social participation and school-based health promotion are essential for sustained Chagas disease management.

To achieve long-term sustainability of disease management programs, they suggest, the tight links between research and disease control exemplified by the discovery of Chagas disease must be re-established and strengthened to eradicate it.

Chagas disease: 100 years since discovery and lessons for the future. Ricardo E Gurtler, Lileia Diotaiuti and Uriel Kitron. International Journal of Epidemiology. 2008 37(4):698-701; doi:10.1093/ije/dyn134