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Let us not forget Chagas disease

I lived for over 16 years in Bolivia where Chagas was, and currently still is, a serious life-threatening disease. It is one of the first things people warn you about when you go camping in the countryside. I was checked several times for the disease and met people who were suffering from its side effects.

Chagas is primarily found in Central and South America. Globally, it is estimated that about 6 to 7 million people are infected with the disease. It is a parasitic disease with the highest burden in the western hemisphere, but despite this, Chagas is often forgotten. It is caused by the protozoan parasite Trypanosoma cruzi and mostly transmitted by a bite of the triatomine bug. Although transmission also occurs through consumption of infected foods, blood-to-blood, and mother-to-child. Infection can initially be asymptomatic for more than 50% of cases. Those with symptoms show skin lesions, swellings, fever, headaches, and swollen eyelids, among others. After the initial acute stage, the disease can be ‘dormant’ for quite a while. However, without treatment, ten to thirty years later the infected persons can face serious cardiac disorders, digestive or neurological conditions, and even death. Chagas can be treated if detected at an early stage through blood analysis, but as many people are asymptomatic or ignore symptoms, this is challenging. It is nonetheless a better solution than attempting to identify Chagas disease at a later, chronic stage which is often clouded by comorbidities and thus is more complex.

Bolivia is among the countries with the highest burden of Chagas disease. The Lancet reported that in 2019, Chagas was associated with over 90.9 DALYs per 100,000 persons in Bolivia. According to World Health Organization, 755 people died of Chagas in 2020, equivalent to 1% of all deaths in the country, the highest death rate in the world. It is thought this is due to Bolivia being a particularly attractive habitat for triatomine bugs. This is because the houses are built from adobe and wood and the temperature and humidity levels create an environment within which the bug can happily live and reproduce.

The most effective way to manage Chagas in a population is to prevent infection by the triatomine bug. This can be done by improving household cleanliness, disposing of used construction materials, and implementing extra sanitary hygiene measures or sleeping under bed-nets. Buying homes that are constructed using modern building techniques is the most effective way to reduce exposure to Chagas, but families and people at risk are often not able to afford these. Solutions like spraying with insecticides are cheaper but only work for a brief period and are toxic, possibly causing other health concerns among humans and animals. Chagas disease symptoms can be experienced in men and women between the ages of 20 and 70 years, therefore the impact on society is large. The economic burden on families due to high health care costs or premature deaths can be dramatic but is also unknown due to underreporting. As most countries in Latin America do not have universal health coverage, medical costs are often paid out-of-pocket by the families, or not at all.

Let’s not forget diseases like Chagas and keep taking steps to better understand and treat people exposed. Instead of short-term solutions, long-term investments into communities most affected are likely more worthwhile, but require governments, NGOs, and researchers to work together to address this neglected disease.

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