Chagas disease: Venezuelan Tropical Diseases specialists, Dr. Oscar Noya and Javier Alberto Roa Sayago talk about the situation in Táchira

What happened in the state can be seen as an endemic outbreak and not as an epidemic Oral transmission is not an epidemiological threat


In Venezuela, several common use medications are scarce, but, in this specific case, all medications needed to treat the infected were provided

Puerto Nuevo city, in Libertador, South of Táchira state, about 100 kilometers from Rio Arauca, in the Colombian border, registered in April an outbreak of acute Chagas disease. The disease was confirmed in at least five deceased patients and in some of the 40 symptomatic patients who were transferred to San Cristóbal Central Hospital.

In the site, a small city with about 1300 inhabitants, people struggle with lack of adequate infrastructure and there, poverty is a reality. Some villagers have enough income to buy water bottles for daily consumption, but most drink water from fountains, and many times, without boiling it first. Besides this, the community also suffers with very precarious electric power supply services. According to reports, some houses have cement waterways to divert sewage water.

Interviewed by the Brazilian Society of Tropical Medicines press advisory, two renowned Venezuelan physicians, Dr. Oscar Noya, from the Tropical Medicine Institute at Venezuela Central University, and tropical diseases specialist Dr. Javier Alberto Roa Sayago, who is also a member at the Venezuelan Society of Infectology, Táchira Chapter, talked about the situation.

Infectious diseases researcher Dr. Oscar Noya observes the numbers are real, but he says the study is not finished yet. The number of dead is correct, but it will still take a few days before we can accurately determine how many people were affected, so it is important that we wait for the confirmation results of this important Oral Chagas Disease outbreak by Dr. Noel Calderon, Táchira State Chief of Epidemiology, he says. Still according to the specialist, transmission of OCD can happen anywhere in the country, even in places distant from where the food infected with Trypanosoma cruzi is prepared. In this case, there are strong signs of insalubrity, but we still cannot point to any food or drink as an infection source. In Venezuela, like the rest of Latin America, it is common to have homemade or artisanal juices, which can be contaminated by the kissing bugs feces or even the entire bug during preparation, he says.

Infectious diseases physician and tropical diseases specialist, Dr. Javier Sayago, says that in the ‘8 de fevereiro’ neighborhood, in Puerto Nuevo, Táchira state, for two years authorities have been alerted about sewage water being released in clean water, and currently, in almost the entire 200-meter range where cases prevailed, there are pig farms, cheese factories and slaughterhouses dumping waste in the sewage systems, which will then mix to drinking water. This created unhealthy conditions, which added to the presence of rodent and triatomines breeding sites will contaminate food (fruits), and build the infection way for the presented cases, he explains while adding that this is a Chagas Disease prevalence area.

The outbreak rises amidst a crisis, with medication shortages, even preventing Venezuelans to seek treatment. Dr. Oscar Noya admits the shortages of several common use medications (antihypertensive, insulin, antiarrhythmic, antibiotics, etc.) and other specific medications for diseases exclusively treated by the Health Ministry (malaria, Chagas, etc.). However, in this specific case, it was possible to acquire all medication needed to treat the infected people. We do not know how large are the medication supplies in the Environmental Health offices from the Health Ministry in Táchira State, he acknowledges while adding that, based on prior experiences, treatment will probably be held with benznidazole. Dr. Javier Sayago agrees to his colleagues statement and emphasizes that fortunately the sanitary authorities’ opportune intervention with the epidemiological siege was able to break the transmission chain, with proper control. About the treatment, our worse scenario would have been the deaths of people with Trypanosoma identified in blood tests, however, authorities responded with medication supply, he adds.

Asked about spraying in households presumed to host the Trypanosoma cruzi parasite, as well as residual waters, both experts agreed the measure is enough, given they meet the World Health Organizations normative. For Dr. Oscar Noya, the most important is to educate the population in order to prevent these outbreaks, especially regarding food preparation and storage, use of mosquito nets in doors and windows, cleaning breaches in walls to avoid the vectors presence, pasteurizing homemade juices and broths, besides keeping animals far from the households, among others. Dr. Javier Sayago adds that the country always undertakes prevention measures, considering the prevalence areas and large number of people in risk situations. In this case, it was actually an endemic outbreak, there was no need to register as an epidemic, nor to alert the Country, since it never left the area where it started and proper actions were put in practice, he says.

Considering the constant flow of Venezuelans migrating to Colombia, the possibility of the disease reaching this country was considered. However, both tropical diseases specialists ruled out this possibility. We do not foresee this possibility, since for now it is a very localized fact, and again, we have cut the epidemiological chain in time, says Dr. Javier Sayago. Dr. Oscar Noya emphasizes that Chagas Disease is present in all Latin American countries where the disease is transmitted, but only now it has been reported in Brazil, Venezuela, Colombia, French Guyana and Bolivia. I believe it is important for the Colombian government to start their safety protocols for other diseases, as measles, diphtheria, TBC, etc. Colombia has registered important outbreaks as I said, from which, certainly some started in Venezuela, since some patients crossed the border seeking treatment, he says.

Finally, infectious diseases physician Javier Sayago says the situation could be more alarming. According to him, over six million Venezuelans are at risk of Chagas diseases because Venezuela is an endemic area. To him, it is necessary to provide more treatments in the area, even for patients who have had the disease for a long time and will be treated for 30 to 40 years, since after this period, they may have heart manifestations and treatment will no longer be possible.