Brazil leads through Fiocruz national and Latin American strategic research initiatives to tackle congenital Chagas disease transmission

By Alberto Novaes Ramos Jr. Associate Professor at the Faculty of Medicine – Federal University of Ceará

World Chagas disease day

April 14 was instituted in May 2019 by the World Health Organization (WHO) during the 72nd World Health Assembly of that year as the “World Chagas disease Day”. This is a very special date, as a true collective achievement to increase the visibility of this disease, especially to all people affected by it.

This is a relevant date that reinforces the importance of science in the service of health and life in order to provide answers to the paths that ensure access to diagnosis and treatment for all those in need. The Brazilian Society of Tropical Medicine – SBMT has supported this initiative since its inception and has already marked this important achievement during the 2019 Medtrop-Parasito Congress in view of the high and persistent burden of disease morbidity and mortality.

The SBMT would like to register again the outstanding performance of many of our researchers in the country, with the dedication of their lives to decipher and reveal the issues surrounding Chagas disease. We respectfully remember here our emeritus researchers Dr José Rodrigues Coura, from the Oswaldo Cruz Institute, and Dr Zilton de Araujo Andrade. On their memories, remember here researchers and health professionals around the world who are steadfast in this work to overcome Chagas disease as a public health problem worldwide.

This date represents the day that Carlos Justiniano Ribeiro Chagas – a Brazilian researcher at the Oswaldo Cruz Foundation – first diagnosed a human case of the disease. The girl Berenice Soares de Moura had access, at the age of two, to the diagnosis by Carlos Chagas. She lived in the backlands of Minas Gerais for many decades, became a woman, mother and grandmother, without developing any signs or symptoms of the disease, and died at 72 years of age from a neurological cause that was not related to the disease.

Unfortunately, many women in the past and the present have not had and still don´t have the opportunity to diagnose the disease, not even the prenatal screening of their daughters and sons, as well as the generations of women who followed them. Since the discovery of the disease, many advances have been made for control, but major flaws still persist, particularly so that all people in need have access to diagnosis and treatment, maintaining congenital transmission as a possibility. This serious neglect is associated with the social character of the disease, as it mainly affects people in conditions of poverty and social vulnerability.

Since the discovery, many advances have been made for control, but major flaws still persist, particularly so that all people in need have access to the diagnosis and treatment of this disease. Unfortunately for every 100 people with the disease, only 10 (or less) had access to the diagnosis. Access to treatment for the disease is even worse: out of every 100 people with the disease who need treatment, only one (1) has access. This serious neglect is associated with the social character of the disease, as it mainly affects people in conditions of poverty and social vulnerability, requiring the development of strategic research.

The launch of the projects

In 2021 the theme of the second World Day is “ATTENTION to affected people, in its integral and universal sense” again amid the pandemic caused by the new coronavirus (COVID-19). Among the central objectives of the 2021-2030 roadmap of the World Health Organization for the control of Chagas disease are the efforts aimed at eliminating congenital transmission, considered an increasingly relevant route of transmission, without forgetting transmission by transfusion, vector and blood/organ transplants.

In response to this critical public health problem, two important projects are being launched on April 14 2021 led by the Oswaldo Cruz Foundation.

1- Still in 2019, the Pilot Project: Access to the detection and treatment of Chagas disease within the scope of primary health care in Brazil – IntegraChagas-Brasil was beginning to be outlined. Coordinated by the Oswaldo Cruz Foundation in Rio de Janeiro in partnership with the Federal University of Ceará, it is a strategic research project of the Ministry of Health, articulated with the Secretariat of Health Surveillance and the Secretariat of Primary Health Care. Also included as partners in this research network: Ministry of Health (SVS and SAPS), Fiocruz units (IOC, ENSP, ICICT, Bio-Manguinhos, Farmanguinhos, INCQS, Fiocruz Minas Gerais and Bahia), social movements (Casa de Chagas, RioChagas, Achaba da Bahia and the Caçula de Goiás, which is being constituted today with the support of the project!), Municipal health departments (Espinosa, Porteirinha, São Desidério, Iguaracy and São Luis de Montes Belos), state health secretariats (BA, GO, MG and PE), partner universities (UFBA, UFG, UFBA, UPE, UFF with LABA Ciências and UFRJ), in addition to non-governmental institutions DNDi, Doctors without Borders and NHR Brazil.

The main defined objective is “to expand access to the detection and treatment of Chagas disease within the scope of primary health care in Brazil”. The study will be developed in the states of Goiás, Bahia, Pernambuco and Minas Gerais and was designed from the construction of a strong partnership with states, regional health and municipalities. In these institutional spaces, the participation of managers, health professionals, teachers, researchers and representatives of social movements is considered fundamental for the success of this project.

As one of the important results of this important project, it is expected to develop intervention models capable of expanding access to diagnosis and treatment in primary health care, with great potential to be replicated in other places in Brazil on a larger scale.

2- Even in the face of the serious health challenge imposed by COVID-19, the launch of the project Aim to  eliminate congenital transmission of Chagas disease in Latin America, the CUIDA Chagas project, was also undertaken. Today, the signing of the contract for its execution is symbolically marked, a cause for great joy and which takes us back to the countrys historical responsibilities, particularly by Fiocruz, when it was launched for the whole of society.

The project aims to act through integrated actions aimed at reproductive, maternal, neonatal and child health, focused on primary health care, expanding access to the detection, diagnosis and treatment of women of childbearing age, their sons and daughters, including contacts households living in conditions of epidemiological risk for the disease in Bolivia, Brazil, Colombia and Paraguay. It is an unprecedented project in these countries, with the proposal of implementing integrated and systematized actions for surveillance and control of congenital transmission, making it possible to estimate the burden of this condition as precisely as possible, opening a more effective way for the implementation of sustainable and effective control actions.

Led by Fiocruz, this Consortium has investment guaranteed by the partnership between UNITAID and the Brazilian Ministry of Health. The partnership includes the Ministries of Health of Bolivia, Colombia and Paraguay for believing in the leadership of Fiocruz and for the partnership in the construction of this project. In addition, the highly relevant role of the members that comprise the Chagas Consortium (Instituto Nacional de Laboratórios de Salud INLASA, in Bolivia; National Institute of Health, in Colombia; Servicio Nacional de Erradicación del Paludismo, SENEPA, in Paraguay, and the international non-governmental organization The Foundation for Innovative New Diagnostics, FIND, based in Geneva).

These projects will bring great and important response possibilities that will provide benefits to people affected by Chagas disease in all endemic areas not only in Brazil, but also in all of Latin America. Towards a world without children with Chagas disease!

SBMT supports these two projects from the beginning, having granted visibility within Medtrop for debates and technical meetings for construction and development.

Launch Channels

World Chagas Disease Day: Fiocruz will coordinate Unitaid project on the disease

The Chagas Consortium, led by the Oswaldo Cruz Foundation (Fiocruz), through the Foundation to support Fiocruz (Fiotec), will sign on April 14 in the midst of the World Chagas Disease Day celebrations, an agreement with Unitaid for the project aimed at eliminating the congenital transmission of Chagas disease in endemic countries in Latin America. The event will be broadcast on Fiocruzs YouTube channel (https://www.youtube.com/watch?v=kBpCnUq3EHk), starting at 9am.

More details at: https://agencia.fiocruz.br/fiocruz-coordena-projeto-da-unitaid-em-doenca-de-chagas

Video: Nísia Trindade Lima, president-in-office of Fiocruz, tells how the history of the Foundation is linked to Chagas disease https://we.tl/t-2AAz17QwS2

Video: Mauricio Cysne, Director of External Relations at Unitaid, comments on the partnership with Fiocruz https://we.tl/t-CD5VPKvsav

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Recalling other important mobilizations of Fiocruz for April 14 2021:

Minas Gerais, April 12, 13, 15 16, 2021 – 9:00-10:00h: Fiocruz Virtual Event for the World Day of Chagas Disease. Fiocruz Minas YouTube Channel https://www.youtube.com/channel/UCFkRY6TRo4F3acz45Rv68Wg

Piauí, April 14, 2021 – 14:00-18:00h: International Day of Chagas Disease – Chagas Disease in Piauí: a view of science, education and society. Event website: https://www.even3.corn.br/dcpiaui