Dr Pedro Albajar Viñas presentación realizada en el Congreso Europeo de Medicina Tropical y Salud Internacional, en Barcelona ...

1. 7th European Congress on Tropical Medicine & International Health
Barcelona, 3 - 6 October 2011
Néstor Favré-Mossier 2007. Silence
Chagas disease in Europe. Are we doing enough?
What has been done after the Verona meeting?
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2. Chagas disease taken into account in new areas
Framework achievements
New strategic approach & innovation
Murcia, October 20th 2009
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Lisbon, February 26th 2010

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5. - Congenital transmission was described in a child born in 1975 in
Romania (Pehrson PO, Wahlgren M, Bengtsson E. Asymptomatic congenital
Chagas' disease in a 5-year-old child. Scand J Infect Dis 1981; 13(4): 307-8)
- In 1982 was published the case of an adopted Latin American child
by a Swedish family with probable congenital Chagas disease (Pehrson,
PO, Wahlgren M, Bengtsson E. Intracranial calcifications probably due to
congenital Chagas' disease. Am J Trop Med Hyg 1982; 31(3): 449-451)
- In Spain was reported the first European case of laboratory accident in
1983 (Alvar J. 1983. Un caso agudo de enfermedad de Chagas causado por
una inoculación accidental de laboratorio. Laboratorio 76(456): 645-648)
- Transfusional transmission case after bone marrow transplant in
1992 (Villalba R, Fornés G, Alvarez MA, Román J, Rubio V, Fernández M,
García JM, Viñals M, Torres A. Acute Chagas' disease in a recipient of a bone
marrow transplant in Spain: case report. Clin Infect Dis 1992;14(2): 594-5)
- Congenital Chagas disease case in 2001, initially confused with
congenital leishmaniasis (Flores-Chávez M, Faez Y, Olalla JM, Cruz I,
Gárate T, Rodríguez M, Blanc P, Cañavate C. Fatal congenital Chagas'
disease in a non-endemic area: a case report. Cases J 2008; 1(1): 302)
- In 1988 was published the case of acute Chagas disease in a French
woman who travelled to Colombia (Brisseau JM, Cebron JP, Petit T,
Mariolet M, Cuilliere P, Godin J, Grolleau JY. Chagas' myocarditis imported
into France. Lancet 1988; 1 (8593): 1046)
- In 1996 was described the case of Chagasic cardiomyopathy in a
Bolivian patient in Switzerland (Sztajzel et al. Chagas' disease may also
be encountered in Europe. European Heart Journal 1996; 17, 1289-1291)
- In 1997 a survey was conducted in Berlin, Germany, among Latin
American migrants, showing 2% of infection prevalence (Frank M,
Hegenscheid B, Janitschke K, Weinke T. Prevalence and epidemiological
significance of Trypanosoma cruzi infection among Latin American
immigrants in Berlin, Germany. Infection 1997; 25(6): 355-8)
- In 1997, in Italy was published the first case of an Italian traveller to
an endemic country with acute Chagas disease (Crovato F, Rebora A.
Chagas' disease: a potential plague for Europe. Dermatology 1997; 195:
184-5)
-…
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6. WHO Informal Consultation on
Chagas Disease Control and
Prevention in Europe (Jointly
organized by WHO
Headquarters and WHO
Regional Office for Europe),
Geneva, Switzerland
17 & 18 December 2009
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7. Epidemiological information update - Europe
Distribution of cases of T. cruzi infection in Europe by country,
and reported transmission among the European population
(data reported to WHO as of Dec 2009)
Chagas disease taken into account in new areas
Framework achievements
New strategic approach & innovation
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8. "It is clear that improvements
in the lives of the poor
have been unacceptably slow,
and some hard-won gains
are being eroded by
the climate, food & economic crises"
But the report also cites big gains
in cutting the rate of extreme poverty,
getting children into primary schools,
addressing AIDS, malaria and
child health, and a good chance
to reach the target for access
to clean drinking water
UN Secretary-General Ban Ki-moon
Millennium Development Goals Report 2010, issued on 23 June 2010
• More than 1 billion people –
1/6 of the world's population
– suffer from one o more NTD.
Primarily poor populations
living in tropical and
subtropical climates.
• Infections are attribuitable to unsafe water, poor housing
conditions and poor sanitation.
• Children are most vulnerable to infections of most NTD.
• NTD kill an estimated 534,000 people worldwide every year.
Their impact on worker productivity adds up to billions of dollars lost
annually and maintains low-income countries in poverty.
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10. - …all transmission routes have to be tackled
- to integrate the care of patients with acute and
chronic clinical forms of Chagas disease into primary
health services…
- Increasing number of cases of Chagas disease in
countries where the disease is not endemic… New
Initiative for prevention and control of Chagas disease in
non-endemic regions
- Mobilization of national and international, public and
private financial and human resources… promote
intersectorial efforts and collaboration, and facilitate
networking between organization and partners…
- Reporting in the next 65 WHA (2 years period).
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11. WHO is currently focusing on 17 NTDs:
1. Buruli ulcer disease (Mycobacterium ulcerans infection)
2. Chagas disease (American trypanosomiasis)
3. Cysticercosis
4. Dengue
5. Dracunculiasis (guinea-worm disease)
6. Echinococcosis
7. Endemic treponematoses
8. Foodborne trematode infections
9. Human African trypanosomiasis (sleeping sickness)
10. Leishmaniasis
11. Leprosy (Hansen disease)
12. Lymphatic filariasis (elephantiasis)
13. Onchocerciasis (river blindness)
14. Rabies
15. Schistosomiasis (bilharziasis)
16. Trachoma
17. Soil-transmitted helminthiases
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13. Funda
ción d
e Enfer
m
- FUN os de Chag
DECH as
VIDA por la vida
ASSOCIAÇÃO DOS PORTADORES DE DOENÇA DE CHAGAS
E INSUFICIÊNCIA CARDÍACA – RECIFE – PERNAMBUCO - BRASIL
New key actors…
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15. Euro Surveill. 2011;16(37):pii=19968
Euro Surveill. 2011;16(37):pii=19968
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16. Euro Surveill. 2011;16(37):pii=19968
Chagas disease taken into account in new areas
Framework achievements
New strategic approach & innovation
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17. WHO Programme on Control of Chagas disease
Reduction of
Chagas disease
burden
Stop transmission: Patient care:
blood transfusion, diagnosis & treatment
organ transplantation, of vertical transmission,
… acute and chronic
cases
The two-pillar strategy
30 June & 1st July 2010 - Meeting of the STAG on NTD
New strategic approach & innovation
World surveillance
- Open transmission routes
- Where the patients are to take care of them
Primary Health Care versus specialists
(chagologists, cardiologists)
Information, Education & Communication tools
Access to screening & diagnosis
Access to parasitological and non-parasitological treatment
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18. Update of the world map
WHO NTD Report 2010
…main health determinants of the Latin American communities
in a specific area (diversity and barriers such as their immigrant
condition and socio-cultural-economic characteristics) is crucial
to design and implement comprehensive health-care strategies
for the care of people with Chagas disease.
Specific innovative approaches are needed to make possible
the meeting between the health system and the T. cruzi infected
patients, such as:
- Interdisciplinary approach;
- Community approach;
- Expert Patient Programme.
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19. Guidelines on the Management of Chagas disease
patients at Primary Health Care level
IEC, distance education…
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20. WHO International
Biological Reference Preparations
for Chagas Disease Diagnostic Tests
• Provides a tool for comparison of
results between different assays
(biological measurement)
• Supports regulatory authorities and manufacturers:
harmonization of international regulations; establishment of
quality and safety regulations…
• Facilitates the development of diagnostic and therapeutic
products
Transmission through
blood transfusion or
organ, tissue & cell transplantation
• Implementation of screening of the target population
• Questionnaire taking into account the different country
epidemiological profiles with their different history of
transmission control
• Implications of a systematic screening in blood banks and
organ, tissue and cell transplantation
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21. About the disease and its parasitological treatment
Diversity of parasites (Trypanosoma cruzi I, II, III, IV, V, VI)
Variety of clinical manifestations (South America versus Central
& North America, Andean countries versus Central Brazil…)
Silent & silenced chronic disease (>50% of acute and chronic
cases are asymptomatic or olygosymptomatic) of the poorest
populations (rural, periurban and migrant populations…)
One of the highest burden of disease among NTDs in the
Americas, in Europe…
<20% of infected are diagnosed and treated
>55,585 persons per year would require etiological treatment, but
around 6,500 people are annually treated by benznidazol and 1,500
people are annually treated by nifurtimox (2nd-line treatment).
Treatment
• Parasitological and non-parasitological treatment.
• Treatment to stop/delay clinical evolution of Chagas disease.
• Access to specific treatments and protocols for their rational use.
• Tolerance to specific treatments, surveillance with early
detection of side-effects and their rapid management/treatment.
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22. WHO Programme for International Drug Monitoring
Full and Associate Member States
Pharmacovigilance
WHO Safety of medicines & Pharmacovigilance programme
Quality and Safety: Medicines / Essential Medicines & Pharmaceutical Policies
Innovative approach
in the schools
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23. Collaboration / partnership…
• Working together with PAHO, EURO and
WPRO teams
• Partnership/interaction with governments
• WHO Technical Groups
• Collaboration with universities, scientific
institutions
• Partnership with private companies, foundations,
NGOs…
• Listening to patient associations
"We must not fail the billions who look
to the international community
to fulfill the promise of the
Millennium Declaration
for a better world…"
UN Secretary-General, Ban Ki-moon
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24. Moltes gràcies
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