Eliminating Chagas disease: challenges and a roadmap

BMJ 2009; 338 doi: (Published 14 April 2009) Cite this as: BMJ 2009;338:b1283
  1. Richard Reithinger, honorary lecturer1,
  2. Rick L Tarleton, distinguished research professor2,
  3. Julio A Urbina, emeritus investigator3,
  4. Uriel Kitron, professor4,
  5. Ricardo E Gürtler, associate professor5
  1. 1Disease Control and Vector Biology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. 2Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA
  3. 3Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela
  4. 4Department of Environmental Studies, Emory University, Atlanta, USA
  5. 5Department of Ecology, Genetics and Evolution, Universidad de Buenos Aires, Buenos Aires, Argentina
  1. Correspondence to: R Reithinger rreithinger{at}
  • Accepted 8 December 2008

Millions of people in Central and Southern America are affected by Chagas disease. Richard Reithinger and colleagues explain the difficulties of elimination and suggest a strategy

In 2007, the World Health Organization announced a renewed strategy to eliminate Chagas disease in the Americas by 2010.1 The intention was “to answer key questions about the treatment and control of Chagas disease, and to coordinate global efforts towards the prevention of transmission through a new Global Network for Chagas Elimination.”1 The announcement was welcome because it put the spotlight on Chagas disease, which has been overshadowed by other priorities, such as HIV and malaria, in recent years. However, two years later, WHO has yet to produce a clear strategy for elimination and we are unaware of any new operational activities to eliminate the disease. Too many challenges remain.

Scale of the problem

Chagas disease is both a disease of poverty and, like other neglected tropical diseases, poverty promoting.2 An estimated 10-20 million people live with the condition and it is responsible for a burden of 670 000 disability adjusted life years,3 making it the most important parasitic disease in the Americas.

The disease is caused by the protozoan parasite Trypanosoma cruzi,4 which is transmitted through the faeces of blood feeding triatomine bugs; trypomastigotes in the faeces contaminate the wound or enter through mucosal surfaces.5 It can also be transmitted by blood transfusions, organ donations, through the placenta, or by eating contaminated food. Most people do not know that they have become infected with T cruzi because the acute symptoms tend to be unspecific or benign (fever, swollen lymph glands, inflammation at the biting site or a swollen eye, and, rarely, severe myocarditis or meningoencephalitis). In mammals, T. cruzi must invade host cells in order to replicate. It ultimately destroys these …

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