This year, one hundred years since the discovery of Chagas disease, the medical humanitarian organization Médecins Sans Frontières (MSF) is launching its campaign, “Chagas: It’s time to break the silence,” including the special web site www.chagas-break-the-silence.com (English and Spanish). MSF calls on endemic countries to end neglect of Chagas sufferers and support diagnosis and treatment for affected people, rather than focusing solely on vector control. MSF also calls for further research and development efforts into new drugs, rapid diagnosis tests to use in remote settings and better cure tests for one of the world’s most neglected diseases.

Every year, Chagas kills 14,000 people and it is estimated that 10 to 15 million people are infected. The disease is endemic in several Latin American countries but worldwide migration means that more and more cases are being reported in the U.S., Europe, Australia and Japan. Chagas is a potential killer, but so far governments have focused on prevention and vector control rather than treatment of patients. Integrating Chagas care into primary healthcare facilities would improve patient access to treatment.   

Chagas disease is caused by the Trypanosoma cruzi parasite. In most Latin American countries, the disease is transmitted by the vector know as the “kissing bug,” although transmission is also possible from mother to child, through blood transfusions, organ transplants and contaminated food. Chagas patients may be asymptomatic for years, but during the chronic phase of the disease one third develop serious health problems (mainly heart and intestinal complications) that can lead to death. “One of the main problems we have is that for years patients have no symptoms so they do not know they are sick and receive no treatment. Active case detection is essential to find and treat infected people,” explains Nines Lima, an MSF doctor working on Chagas.   

The sooner the disease is detected, the more effective the treatment. The only two existing drugs – benznidazole and nifurtimox – were developed more than 35 years ago through research not specifically focusing on Chagas. Although these medicines are very effective in newborn and breastfeeding children, only about 60 to 70 per cent of adolescents and adults are successfully treated. The older the patients are, the greater the likelihood they will experience side effects from the drugs. “Doctors do not treat children, let alone adults, for fear of side effects. We are showing that these effects are manageable in both cases. Leaving patients untreated is no longer ethical,” said Tom Ellman, doctor and MSF head of mission in Bolivia. 

However there is still an urgent need for better drugs for treatment of Chagas. The disease is mainly poverty related, and therefore Chagas has been absent from political agendas and research and development for years. A recent study by Global Funding for Innovation for Neglected Diseases revealed that in 2007 only $ 11.5 million was spent on research and development for Chagas. 

Research and development must be boosted in order to develop new rapid diagnosis tests, better medicines and new cure tests to address this disease more effectively. “The lack of commercial incentives has pushed Chagas into oblivion. New ways to boost research and development and better tools to care for patients need to be found,” said Gemma Ortiz, head of the MSF Chagas campaign.  

MSF has been working in projects fighting Chagas disease since 1999. Currently, the organization is working in three districts on the outskirts of Cochabamba, in Bolivia, the country registering the highest Chagas prevalence worldwide. Activities are carried out in collaboration with the Bolivian Ministry of Health and integrated to five primary healthcare centres, where children and adults up to 50 years of age are diagnosed and treated. Using the same approach, the organization is currently setting up a new project in the rural zone of Cochabamba region, where it is working to involve the communities in all aspects of the strategy (prevention, diagnosis and treatment), in an area where the vector is much more prevalent. 

At the end of 2008, MSF had tested over 60,000 people for Chagas, treating 3,100 patients, of whom 2,800 successfully completed their treatment. This shows that, even though the current means are not ideal, diagnosing and treating Chagas in limited resource settings and remote areas is feasible. 

For more information on Chagas disease and the enormous gap between the number of Chagas sufferers and those who receive treatment, go to: www.chagas-break-the-silence.com. Visitors can participate in the MSF campaign and “break the silence” by sending information about this silent disease to their friends.

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