Every hour a baby is born with Chagas somewhere in the world, adding to some 9,000 per year. In Argentina, the country with the largest number of people infected by Trypanosoma cruzi, the number is around 1.400 per year or close to 4 per day. One every 6 hours.
These figures cannot be justified, especially considering that effective diagnostic methods and treatment are available today. In order to reduce those figures to zero over the next decade, Mundo Sano Foundation yesterday launched a campaign focusing on women and newborns.
Not A Single Baby with Chagas, as the initiative has been named, aims to attain the objective that by 2030 all babies born with the disease may receive treatment and be cured, and also, that all childbearing age females may have access to diagnosis and treatment.
“The campaign seeks to eliminate congenital Chagas as a public health issue -explains Marcelo Abril, CEO of the Foundation which has been working on neglected tropical diseases for 25 years now. The campaign has two phases: the first one consists in ensuring diagnosis and treatment to all children born with the infection and to pregnant or childbearing age women. If we succeed in reaching out to all women we will eliminate congenital Chagas. That is our first great objective because there we have a golden opportunity, which are pregnancy controls. Of course there is work to do before they get pregnant. And for this reason, we want to expand Chagas detection: this should not be only in the hands of infectious disease specialists but also under charge of pediatricians, gynecologists….”
During the presentation, attended by Mirta Roses, former director of The Health Organization, former Health Ministers Ginés González García and Juan Manzur, Leandro and Pedro Cahn, executive director and scientist, respectively, of Fundación Huésped, and actress Carla Peterson, among others, Luis Pescetti, writer and musician, underscored the perception that this initiative is inspired in a democratic principle: “May not your origin determine your fate.” He stated.
According to a WHO 2015 epidemiological bulletin, American Trypanosomiasis affects 1,505,235 people in Argentina, followed by Brazil and Mexico, two countries with considerably larger populations but with 1,156,821 and 876,458 affected individuals, respectively. Then ranks Bolivia (the country with the highest prevalence in the world) with 607,186 cases, and Colombia, with 45.7% of people infected in the Andean region. These figures are arguable because only acute cases are reported, which occurs when kissing bugs sting and symptoms appear; but not the rest of cases, so that if a patient was not diagnosed at the time of getting the disease, they will never appear as a Chagas case in the health system unless complications arise. On the other hand, a number of cases go unrecorded. And although there exists a national Chagas program since 1962, the awful truth is that the number of patients has not decreased, as should be the case.
A disease with no borders
To make matters worse, the disease, that until not long ago was confined to the American continent, at present recognizes no borders. There are Chagas cases in Japan, in Australia, in Italy, in Switzerland… and conenose bugs in Texas, Arizona, New Orleans.
“Unlike what happens in other countries -Abril emphasizes- in our territory we have areas that can be called endemic zones and then we have urban cases where there is no recent records of vector transmission (through the insect). From a certain point of view, Chagas attention should be managed in the same fashion regardless of whether you are in Comodoro Rivadavia (southern Argentina) or in Barcelona (Spain).”
Thanks to the progress made in vector and transfusion control, one of the most frequent transmission patterns at present is now the vertical or congenital path, i.e. that occurring between a mother infected with the parasite and the gestating baby.
“When a childbearing age woman is found to be infected by Trypanosoma, she is immediately administered benznidazol or nifurtimox during 60 days -Abril explains. We have evidence that this treatment prevents vertical transmission. There are works published. If she is already pregnant, treatment cannot be administered during pregnancy, but then the newborn is tested for diagnosis and, if positive, both of them will receive treatment. For the baby, the sooner the treatment over their first year, the better.”
“The objective of the campaign is that by 2030, not a single baby may be born with Chagas; which is tantamount to have all childbearing age females diagnosed and treated,” says Silvia Gold, president, Mundo Sano Foundation. We have presented a ‘Commitment’ and invited various organizations and personalities to join in so that the reality of this disease can be changed. “Now we are at a new stage, as diagnosis and treatment tools are available and scientific consensuses have been reached, added to clinical guides endorsed by the WHO, which demonstrate that the treatment is working, particularly in children, young people and childbearing age females.”
Today 8 million people in the world live with Chagas, out of which 1.2 million are childbearing age females. In our country, it is estimated that seven million people are at risk.
Abril concludes: “The mother-child entity is the entrance door to their whole family’s healthy status. They are the beginning to any success. Chagas has to be included in primary health care. An adult with Chagas is a child never treated.”