Current epidemiological trends for Chagas disease in Latin America and future challenges in epidemiology, surveillance and health policy
Current epidemiological trends for Chagas disease in Latin America and future challenges in epidemiology, surveillance and health policy
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DOI：
10.1590/s0074-02762009000900005
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发表时间：
2009-07-01
期刊：
影响因子：
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通讯作者：
Silveira, Antonio Carlos
中科院分区：
文献类型：
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作者：
Moncayo, Álvaro;Silveira, Antonio Carlos
查加斯病以卡洛斯·查加斯的名字命名，他在1909年首次描述了这种疾病，只存在于美洲大陆。它是由一种寄生虫引起的，克氏锥虫，通过吸血锥虫和输血传播给人类。恰加斯病有两个连续的阶段：急性和慢性。急性期持续6 - 8周。在进入慢性期几年后，20-35%的受感染个体（取决于地理区域）将发展心脏、食道和结肠中的自主神经系统以及周围神经系统的不可逆损害。1980年代，由于在以前没有准确资料的国家进行了具有人口代表性的横断面研究，关于南美锥虫病流行率和分布情况的数据质量有所提高。1979年，一个专家小组在巴西利亚开会，制定了标准方案，在全国范围内对人类T。Cruzi感染和锥蝽室内侵染。由于在南锥体国家开展了一项协调一致的多国方案，1997年在乌拉圭、1999年在智利和2006年在巴西阻断了通过病媒和输血传播恰加斯病的情况;因此，新的锥虫病感染病例的发生率有所下降。南美大陆的克鲁齐已经减少了70%。安第斯国家和中美洲也发起了类似的多国倡议，据报告，在按照世界卫生大会1998年决议的要求实现阻断南美锥虫病传播的目标方面取得了迅速进展。对巴西病媒控制方案投资的成本效益分析表明，在预防方面每花费1美元，在医疗保健和残疾方面可节省17美元，这表明该方案是一项回报率很高的保健投资。拉丁美洲许多著名的研究机构是世界实验室网络的关键组成部分，这些实验室开展基础和应用研究，支持国家南美锥虫病控制方案的规划和评价。本文综述了拉丁美洲南美锥虫病目前的流行病学趋势以及在流行病学、监测和卫生政策方面的未来挑战。
Chagas disease, named after Carlos Chagas, who first described it in 1909, exists only on the American Continent. It is caused by a parasite, Trypanosoma cruzi, which is transmitted to humans by blood-sucking triatomine bugs and via blood transfusion. Chagas disease has two successive phases: acute and chronic. The acute phase lasts six-eight weeks. Several years after entering the chronic phase, 20-35% of infected individuals, depending on the geographical area, will develop irreversible lesions of the autonomous nervous system in the heart, oesophagus and colon, and of the peripheral nervous system. Data on the prevalence and distribution of Chagas disease improved in quality during the 1980s as a result of the demographically representative cross-sectional studies in countries where accurate information was not previously available. A group of experts met in Brasilia in 1979 and devised standard protocols to carry out countrywide prevalence studies on human T. cruzi infection and triatomine house infestation. Thanks to a coordinated multi-country programme in the Southern Cone countries, the transmission of Chagas disease by vectors and via blood transfusion was interrupted in Uruguay in 1997, in Chile in 1999 and in Brazil in 2006; thus, the incidence of new infections by T. cruzi across the South American continent has decreased by 70%. Similar multi-country initiatives have been launched in the Andean countries and in Central America and rapid progress has been reported towards the goal of interrupting the transmission of Chagas disease, as requested by a 1998 Resolution of the World Health Assembly. The cost-benefit analysis of investment in the vector control programme in Brazil indicates that there are savings of US$17 in medical care and disabilities for each dollar spent on prevention, showing that the programme is a health investment with very high return. Many well-known research institutions in Latin America were key elements of a worldwide network of laboratories that carried out basic and applied research supporting the planning and evaluation of national Chagas disease control programmes. The present article reviews the current epidemiological trends for Chagas disease in Latin America and the future challenges in terms of epidemiology, surveillance and health policy.