The Challenges of Chagas Disease— Grim Outlook or Glimmer of Hope?

Through its impact on worker productivity, premature disability, and death, Chagas disease accounts for 670,000 disability-adjusted life years per annum [1]. This makes it the most important parasitic disease of the Americas. It is both a disease of poverty (Figures 1 and and2)2) and, like other neglected tropical diseases, also "poverty promoting" [2]. Traditionally confined to Latin America, Chagas disease is becoming an important health issue in the United States and Europe. First, due to the continuous influx of immigrants from disease-endemic countries in Latin America, a proportion of whom are infected with Trypanosoma cruzi, an increasing number of infected subjects are seen in clinical practice, whether, for example, through routine screening of US blood and organ banks [3] or physicians' offices in Europe [4]. The appearance of T. cruzi in US blood banks led to the implementation of the first Food and Drug Administration–approved diagnostic blood screening test for Chagas disease earlier this year [5]. Second, an increasing number of autochthonous Chagas disease cases have been reported in the US [6,7], which may mirror the increased reporting of T. cruzi infection in domestic animals and wildlife. Recognizing that Chagas disease can no longer be considered an "exotic" disease in the US, the American Society of Tropical Medicine and Hygiene held a clinical course in Chagas disease prior to its 2007 annual meeting (http://www.astmh.org/meetings/premeeting.cfm#clinical). Figure 1 Chagas Disease Is Closely Linked to Poverty and Socioeconomic Development, and Poor Housing In Particular Figure 2 Interior of House Showing the Type of Wall Construction Often Found in Households in Many Endemic Areas Despite estimates of up to 15 million existing cases and 50,000–200,000 new infections per year, funding for research, prevention, and control has been limited, and therapeutic options remain unsatisfactory. Consequently, several editorials and perspectives have recently drawn attention to Chagas disease and T. cruzi [8–10]. While these papers highlighted the impact of this disease on public health in the Americas, and rightly pointed out that major achievements have been made in its control, they failed to emphasize several key challenges that are currently undermining these achievements and that must be urgently addressed in order to move to the next stage: ensuring the long-term and sustainable control of this devastating disease.