The impact of Chagas disease control in Latin America: a review
The impact of Chagas disease control in Latin America: a review
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DOI：
10.1590/s0074-02762002000500002
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发表时间：
2002-07-01
期刊：
影响因子：
--
通讯作者：
Schofield, CJ
中科院分区：
文献类型：
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作者：
Dias, JCP;Silveira, AC;Schofield, CJ
恰加斯病于 1909 年被发现，逐渐被证明在整个拉丁美洲广泛传播，影响了数百万农村人口，对发病率和死亡率产生了很大影响。由于没有可用于大规模公共卫生干预措施的疫苗或具体治疗方法，主要控制策略依赖于预防传播，主要是通过消灭国内昆虫媒介和通过输血控制传播。病媒控制活动始于 20 世纪 40 年代，最初通过住房改善，然后在巴西（Bambui 研究中心）成功进行田间试验后通过喷洒杀虫剂，很快在圣保罗、阿根廷、委内瑞拉和智利复制了类似的结果。但国家控制计划直到 20 世纪 70 年代后才开始实施，当时技术问题已被克服，恰加斯病的严重社会影响的科学论证被用来鼓励支持全国运动的政治决心（主要是在巴西）。同样，拉丁美洲对受感染献血者的大规模筛查直到 20 世纪 80 年代艾滋病出现后才开始。到上世纪末，人们清楚地认识到，对邻近流行地区的持续控制可能会导致消灭最严重的家养病媒种群，特别是致病锥蝽和长红锥蝽，以及其他广泛传播的物种，如巴西锥蝽、臭锥蝽和二甲蝽，进而导致大量减少。阻断疾病向农村人口的传播。恰加斯病控制的社会影响现在可以通过急性病例的消失和年轻群体中新感染的消失以及控制地区死亡率和发病率的逐步降低来证明。从经济角度来看，干预措施（喷洒杀虫剂、血库血清学）与减少恰加斯病（在医疗和社会护理以及提高生产力方面）之间的成本效益关系非常积极。有效控制恰加斯病现在被认为是一个可实现的目标，主要取决于维持政治意愿，因此主要的制约因素涉及公共卫生服务的分散化和对恰加斯病的逐渐政治冷漠相关的问题。与之相平衡的是政治和技术合作战略，例如 1991 年发起的“南锥体倡议”。这一由泛美卫生组织协调的国际方法非常成功，已经在乌拉圭、智利以及巴西和阿根廷的大部分地区消除了恰加斯病的传播。南锥体倡议还帮助刺激了该地区其他国家（巴拉圭、玻利维亚、秘鲁）的控制运动，这些运动也取得了有效的成效，并取得了切实的区域成功。这种国际活动模式已被证明是可行和有效的，自 1997 年以来在安第斯地区和中美洲制定了类似的举措。目前，墨西哥和亚马逊地区仍然是下一个主要挑战。随着所有流行国家业务计划的整合，未来的重点将是流行病学监测和对已感染者的护理。从政治角度来看，迄今为止，拉丁美洲对恰加斯病的控制可以被视为国际科学合作的胜利，但需要持续的政治承诺才能取得持续的成功。
Discovered in 1909, Chagas disease was progressively shown to be widespread throughout Latin America, affecting millions of rural people with a high impact on morbidity and mortality. With no vaccine or specific treatment available for large-scale public health interventions, the main control strategy relies on prevention of transmission, principally by eliminating the domestic insect vectors and control of transmission by blood tran fusion. Vector control activities began in the 1940s, initially by means of housing improvement and then through insecticide spraying following successful field trials in Brazil (Bambui Research Centre), with similar results soon reproduced in Sao Paulo, Argentina, Venezuela and Chile. But national control programmes only began to be implemented after the 1970s, when technical questions were overcome and the scientific demonstration of the high social impact of Chagas disease was used to encourage political determination in favour of national campaigns (mainly in Brazil). Similarly, large-scale screening of infected blood donors in Latin America only began in the 1980s following the emergence of AIDS.By the end of the last century it became clear that continuous control in contiguous endemic areas could lead to the elimination of the most highly domestic vector populations - especially Triatoma infestans and Rhodnius prolixus - as well as substantial reductions of other widespread species such as T. brasiliensis, T. sordida, and T. dimidiata, leading in turn to interruption of disease transmission to rural people. The social impact of Chagas disease control can now be readily demonstrated by the disappearance of acute cases and of new infections in younger age groups, as well as progressive reductions of mortality and morbidity rates in controlled areas. In economic terms, the cost-benefit relationship between intervention (insecticide spraying, serology in blood banks) and the reduction of Chagas disease (in terms of medical and social care and improved productivity) is highly positively. Effective control of Chagas disease is now seen as an attainable goal that depends primarily on maintaining political will, so that the major constraints involve problems associated with the decentralisation of public health services and the progressive political disinterest in Chagas disease. Counterbalancing this are the political and technical cooperation strategies such as the "Southern Cone Initiative" launched in 1991. This international approach, coordinated by PAHO, has been highly successful, already reaching elimination of Chagas disease transmission in Uruguay, Chile, and large parts of Brazil and Argentina. The Southern Cone Initiative also helped to stimulate control campaigns in other countries of the region (Paraguay, Bolivia, Peru) which have also reached effective, with tangible regional successes. This model of international activity has been shown to be feasible and effective, with similar initiatives developed since 1997 in the Andean Region and in Central America. At present, Mexico and the Amazon Region remain as the next major challenges. With consolidation of operational programmes in all endemic countries, the future focus will be on epidemiological surveillance and care of those people already infected. In political terms, the control of Chagas disease in Latin America can be considered, so far, as a victory for international scientific cooperation, but will require continuing political commitment for sustained success.