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Chagas disease bcn - who

Jose Da Silva
Jose Da Silva

Dr Pedro Albajar Vi単as presentaci坦n realizada en el Congreso Europeo de Medicina Tropical y Salud Internacional, en Barcelona ...

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7th European Congress on Tropical Medicine & International Health Barcelona, 3 - 6 October 2011 N辿stor Favr辿-Mossier 2007. Silence Chagas disease in Europe. Are we doing enough? What has been done after the Verona meeting? 1
Chagas disease taken into account in new areas Framework achievements New strategic approach & innovation Murcia, October 20th 2009 2
3 Lisbon, February 26th 2010
4
- Congenital transmission was described in a child born in 1975 in Romania (Pehrson PO, Wahlgren M, Bengtsson E. Asymptomatic congenital Chagas' disease in a 5-year-old child. Scand J Infect Dis 1981; 13(4): 307-8) - In 1982 was published the case of an adopted Latin American child by a Swedish family with probable congenital Chagas disease (Pehrson, PO, Wahlgren M, Bengtsson E. Intracranial calcifications probably due to congenital Chagas' disease. Am J Trop Med Hyg 1982; 31(3): 449-451) - In Spain was reported the first European case of laboratory accident in 1983 (Alvar J. 1983. Un caso agudo de enfermedad de Chagas causado por una inoculaci坦n accidental de laboratorio. Laboratorio 76(456): 645-648) - Transfusional transmission case after bone marrow transplant in 1992 (Villalba R, Forn辿s G, Alvarez MA, Rom叩n J, Rubio V, Fern叩ndez M, Garc鱈a JM, Vi単als M, Torres A. Acute Chagas' disease in a recipient of a bone marrow transplant in Spain: case report. Clin Infect Dis 1992;14(2): 594-5) - Congenital Chagas disease case in 2001, initially confused with congenital leishmaniasis (Flores-Ch叩vez M, Faez Y, Olalla JM, Cruz I, G叩rate T, Rodr鱈guez M, Blanc P, Ca単avate C. Fatal congenital Chagas' disease in a non-endemic area: a case report. Cases J 2008; 1(1): 302) - In 1988 was published the case of acute Chagas disease in a French woman who travelled to Colombia (Brisseau JM, Cebron JP, Petit T, Mariolet M, Cuilliere P, Godin J, Grolleau JY. Chagas' myocarditis imported into France. Lancet 1988; 1 (8593): 1046) - In 1996 was described the case of Chagasic cardiomyopathy in a Bolivian patient in Switzerland (Sztajzel et al. Chagas' disease may also be encountered in Europe. European Heart Journal 1996; 17, 1289-1291) - In 1997 a survey was conducted in Berlin, Germany, among Latin American migrants, showing 2% of infection prevalence (Frank M, Hegenscheid B, Janitschke K, Weinke T. Prevalence and epidemiological significance of Trypanosoma cruzi infection among Latin American immigrants in Berlin, Germany. Infection 1997; 25(6): 355-8) - In 1997, in Italy was published the first case of an Italian traveller to an endemic country with acute Chagas disease (Crovato F, Rebora A. Chagas' disease: a potential plague for Europe. Dermatology 1997; 195: 184-5) - 5
WHO Informal Consultation on Chagas Disease Control and Prevention in Europe (Jointly organized by WHO Headquarters and WHO Regional Office for Europe), Geneva, Switzerland 17 & 18 December 2009 6
Epidemiological information update - Europe Distribution of cases of T. cruzi infection in Europe by country, and reported transmission among the European population (data reported to WHO as of Dec 2009) Chagas disease taken into account in new areas Framework achievements New strategic approach & innovation 7
"It is clear that improvements in the lives of the poor have been unacceptably slow, and some hard-won gains are being eroded by the climate, food & economic crises" But the report also cites big gains in cutting the rate of extreme poverty, getting children into primary schools, addressing AIDS, malaria and child health, and a good chance to reach the target for access to clean drinking water UN Secretary-General Ban Ki-moon Millennium Development Goals Report 2010, issued on 23 June 2010 More than 1 billion people 1/6 of the world's population suffer from one o more NTD. Primarily poor populations living in tropical and subtropical climates. Infections are attribuitable to unsafe water, poor housing conditions and poor sanitation. Children are most vulnerable to infections of most NTD. NTD kill an estimated 534,000 people worldwide every year. Their impact on worker productivity adds up to billions of dollars lost annually and maintains low-income countries in poverty. 8
9
- all transmission routes have to be tackled - to integrate the care of patients with acute and chronic clinical forms of Chagas disease into primary health services - Increasing number of cases of Chagas disease in countries where the disease is not endemic New Initiative for prevention and control of Chagas disease in non-endemic regions - Mobilization of national and international, public and private financial and human resources promote intersectorial efforts and collaboration, and facilitate networking between organization and partners - Reporting in the next 65 WHA (2 years period). 10
WHO is currently focusing on 17 NTDs: 1. Buruli ulcer disease (Mycobacterium ulcerans infection) 2. Chagas disease (American trypanosomiasis) 3. Cysticercosis 4. Dengue 5. Dracunculiasis (guinea-worm disease) 6. Echinococcosis 7. Endemic treponematoses 8. Foodborne trematode infections 9. Human African trypanosomiasis (sleeping sickness) 10. Leishmaniasis 11. Leprosy (Hansen disease) 12. Lymphatic filariasis (elephantiasis) 13. Onchocerciasis (river blindness) 14. Rabies 15. Schistosomiasis (bilharziasis) 16. Trachoma 17. Soil-transmitted helminthiases 11
12
Funda ci坦n d e Enfer m - FUN os de Chag DECH as VIDA por la vida ASSOCIAO DOS PORTADORES DE DOENA DE CHAGAS E INSUFICINCIA CARDACA RECIFE PERNAMBUCO - BRASIL New key actors 13
14
Euro Surveill. 2011;16(37):pii=19968 Euro Surveill. 2011;16(37):pii=19968 15
Euro Surveill. 2011;16(37):pii=19968 Chagas disease taken into account in new areas Framework achievements New strategic approach & innovation 16
WHO Programme on Control of Chagas disease Reduction of Chagas disease burden Stop transmission: Patient care: blood transfusion, diagnosis & treatment organ transplantation, of vertical transmission, acute and chronic cases The two-pillar strategy 30 June & 1st July 2010 - Meeting of the STAG on NTD New strategic approach & innovation World surveillance - Open transmission routes - Where the patients are to take care of them Primary Health Care versus specialists (chagologists, cardiologists) Information, Education & Communication tools Access to screening & diagnosis Access to parasitological and non-parasitological treatment 17
Update of the world map WHO NTD Report 2010 main health determinants of the Latin American communities in a specific area (diversity and barriers such as their immigrant condition and socio-cultural-economic characteristics) is crucial to design and implement comprehensive health-care strategies for the care of people with Chagas disease. Specific innovative approaches are needed to make possible the meeting between the health system and the T. cruzi infected patients, such as: - Interdisciplinary approach; - Community approach; - Expert Patient Programme. 18
Guidelines on the Management of Chagas disease patients at Primary Health Care level IEC, distance education 19
WHO International Biological Reference Preparations for Chagas Disease Diagnostic Tests Provides a tool for comparison of results between different assays (biological measurement) Supports regulatory authorities and manufacturers: harmonization of international regulations; establishment of quality and safety regulations Facilitates the development of diagnostic and therapeutic products Transmission through blood transfusion or organ, tissue & cell transplantation Implementation of screening of the target population Questionnaire taking into account the different country epidemiological profiles with their different history of transmission control Implications of a systematic screening in blood banks and organ, tissue and cell transplantation 20
About the disease and its parasitological treatment Diversity of parasites (Trypanosoma cruzi I, II, III, IV, V, VI) Variety of clinical manifestations (South America versus Central & North America, Andean countries versus Central Brazil) Silent & silenced chronic disease (>50% of acute and chronic cases are asymptomatic or olygosymptomatic) of the poorest populations (rural, periurban and migrant populations) One of the highest burden of disease among NTDs in the Americas, in Europe <20% of infected are diagnosed and treated >55,585 persons per year would require etiological treatment, but around 6,500 people are annually treated by benznidazol and 1,500 people are annually treated by nifurtimox (2nd-line treatment). Treatment Parasitological and non-parasitological treatment. Treatment to stop/delay clinical evolution of Chagas disease. Access to specific treatments and protocols for their rational use. Tolerance to specific treatments, surveillance with early detection of side-effects and their rapid management/treatment. 21
WHO Programme for International Drug Monitoring Full and Associate Member States Pharmacovigilance WHO Safety of medicines & Pharmacovigilance programme Quality and Safety: Medicines / Essential Medicines & Pharmaceutical Policies Innovative approach in the schools 22
Collaboration / partnership Working together with PAHO, EURO and WPRO teams Partnership/interaction with governments WHO Technical Groups Collaboration with universities, scientific institutions Partnership with private companies, foundations, NGOs Listening to patient associations "We must not fail the billions who look to the international community to fulfill the promise of the Millennium Declaration for a better world" UN Secretary-General, Ban Ki-moon 23
Moltes grcies 24

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Chagas disease bcn - who

  • 1. 7th European Congress on Tropical Medicine & International Health Barcelona, 3 - 6 October 2011 N辿stor Favr辿-Mossier 2007. Silence Chagas disease in Europe. Are we doing enough? What has been done after the Verona meeting? 1
  • 2. Chagas disease taken into account in new areas Framework achievements New strategic approach & innovation Murcia, October 20th 2009 2
  • 4. 4
  • 5. - Congenital transmission was described in a child born in 1975 in Romania (Pehrson PO, Wahlgren M, Bengtsson E. Asymptomatic congenital Chagas' disease in a 5-year-old child. Scand J Infect Dis 1981; 13(4): 307-8) - In 1982 was published the case of an adopted Latin American child by a Swedish family with probable congenital Chagas disease (Pehrson, PO, Wahlgren M, Bengtsson E. Intracranial calcifications probably due to congenital Chagas' disease. Am J Trop Med Hyg 1982; 31(3): 449-451) - In Spain was reported the first European case of laboratory accident in 1983 (Alvar J. 1983. Un caso agudo de enfermedad de Chagas causado por una inoculaci坦n accidental de laboratorio. Laboratorio 76(456): 645-648) - Transfusional transmission case after bone marrow transplant in 1992 (Villalba R, Forn辿s G, Alvarez MA, Rom叩n J, Rubio V, Fern叩ndez M, Garc鱈a JM, Vi単als M, Torres A. Acute Chagas' disease in a recipient of a bone marrow transplant in Spain: case report. Clin Infect Dis 1992;14(2): 594-5) - Congenital Chagas disease case in 2001, initially confused with congenital leishmaniasis (Flores-Ch叩vez M, Faez Y, Olalla JM, Cruz I, G叩rate T, Rodr鱈guez M, Blanc P, Ca単avate C. Fatal congenital Chagas' disease in a non-endemic area: a case report. Cases J 2008; 1(1): 302) - In 1988 was published the case of acute Chagas disease in a French woman who travelled to Colombia (Brisseau JM, Cebron JP, Petit T, Mariolet M, Cuilliere P, Godin J, Grolleau JY. Chagas' myocarditis imported into France. Lancet 1988; 1 (8593): 1046) - In 1996 was described the case of Chagasic cardiomyopathy in a Bolivian patient in Switzerland (Sztajzel et al. Chagas' disease may also be encountered in Europe. European Heart Journal 1996; 17, 1289-1291) - In 1997 a survey was conducted in Berlin, Germany, among Latin American migrants, showing 2% of infection prevalence (Frank M, Hegenscheid B, Janitschke K, Weinke T. Prevalence and epidemiological significance of Trypanosoma cruzi infection among Latin American immigrants in Berlin, Germany. Infection 1997; 25(6): 355-8) - In 1997, in Italy was published the first case of an Italian traveller to an endemic country with acute Chagas disease (Crovato F, Rebora A. Chagas' disease: a potential plague for Europe. Dermatology 1997; 195: 184-5) - 5
  • 6. WHO Informal Consultation on Chagas Disease Control and Prevention in Europe (Jointly organized by WHO Headquarters and WHO Regional Office for Europe), Geneva, Switzerland 17 & 18 December 2009 6
  • 7. Epidemiological information update - Europe Distribution of cases of T. cruzi infection in Europe by country, and reported transmission among the European population (data reported to WHO as of Dec 2009) Chagas disease taken into account in new areas Framework achievements New strategic approach & innovation 7
  • 8. "It is clear that improvements in the lives of the poor have been unacceptably slow, and some hard-won gains are being eroded by the climate, food & economic crises" But the report also cites big gains in cutting the rate of extreme poverty, getting children into primary schools, addressing AIDS, malaria and child health, and a good chance to reach the target for access to clean drinking water UN Secretary-General Ban Ki-moon Millennium Development Goals Report 2010, issued on 23 June 2010 More than 1 billion people 1/6 of the world's population suffer from one o more NTD. Primarily poor populations living in tropical and subtropical climates. Infections are attribuitable to unsafe water, poor housing conditions and poor sanitation. Children are most vulnerable to infections of most NTD. NTD kill an estimated 534,000 people worldwide every year. Their impact on worker productivity adds up to billions of dollars lost annually and maintains low-income countries in poverty. 8
  • 9. 9
  • 10. - all transmission routes have to be tackled - to integrate the care of patients with acute and chronic clinical forms of Chagas disease into primary health services - Increasing number of cases of Chagas disease in countries where the disease is not endemic New Initiative for prevention and control of Chagas disease in non-endemic regions - Mobilization of national and international, public and private financial and human resources promote intersectorial efforts and collaboration, and facilitate networking between organization and partners - Reporting in the next 65 WHA (2 years period). 10
  • 11. WHO is currently focusing on 17 NTDs: 1. Buruli ulcer disease (Mycobacterium ulcerans infection) 2. Chagas disease (American trypanosomiasis) 3. Cysticercosis 4. Dengue 5. Dracunculiasis (guinea-worm disease) 6. Echinococcosis 7. Endemic treponematoses 8. Foodborne trematode infections 9. Human African trypanosomiasis (sleeping sickness) 10. Leishmaniasis 11. Leprosy (Hansen disease) 12. Lymphatic filariasis (elephantiasis) 13. Onchocerciasis (river blindness) 14. Rabies 15. Schistosomiasis (bilharziasis) 16. Trachoma 17. Soil-transmitted helminthiases 11
  • 12. 12
  • 13. Funda ci坦n d e Enfer m - FUN os de Chag DECH as VIDA por la vida ASSOCIAO DOS PORTADORES DE DOENA DE CHAGAS E INSUFICINCIA CARDACA RECIFE PERNAMBUCO - BRASIL New key actors 13
  • 14. 14
  • 15. Euro Surveill. 2011;16(37):pii=19968 Euro Surveill. 2011;16(37):pii=19968 15
  • 16. Euro Surveill. 2011;16(37):pii=19968 Chagas disease taken into account in new areas Framework achievements New strategic approach & innovation 16
  • 17. WHO Programme on Control of Chagas disease Reduction of Chagas disease burden Stop transmission: Patient care: blood transfusion, diagnosis & treatment organ transplantation, of vertical transmission, acute and chronic cases The two-pillar strategy 30 June & 1st July 2010 - Meeting of the STAG on NTD New strategic approach & innovation World surveillance - Open transmission routes - Where the patients are to take care of them Primary Health Care versus specialists (chagologists, cardiologists) Information, Education & Communication tools Access to screening & diagnosis Access to parasitological and non-parasitological treatment 17
  • 18. Update of the world map WHO NTD Report 2010 main health determinants of the Latin American communities in a specific area (diversity and barriers such as their immigrant condition and socio-cultural-economic characteristics) is crucial to design and implement comprehensive health-care strategies for the care of people with Chagas disease. Specific innovative approaches are needed to make possible the meeting between the health system and the T. cruzi infected patients, such as: - Interdisciplinary approach; - Community approach; - Expert Patient Programme. 18
  • 19. Guidelines on the Management of Chagas disease patients at Primary Health Care level IEC, distance education 19
  • 20. WHO International Biological Reference Preparations for Chagas Disease Diagnostic Tests Provides a tool for comparison of results between different assays (biological measurement) Supports regulatory authorities and manufacturers: harmonization of international regulations; establishment of quality and safety regulations Facilitates the development of diagnostic and therapeutic products Transmission through blood transfusion or organ, tissue & cell transplantation Implementation of screening of the target population Questionnaire taking into account the different country epidemiological profiles with their different history of transmission control Implications of a systematic screening in blood banks and organ, tissue and cell transplantation 20
  • 21. About the disease and its parasitological treatment Diversity of parasites (Trypanosoma cruzi I, II, III, IV, V, VI) Variety of clinical manifestations (South America versus Central & North America, Andean countries versus Central Brazil) Silent & silenced chronic disease (>50% of acute and chronic cases are asymptomatic or olygosymptomatic) of the poorest populations (rural, periurban and migrant populations) One of the highest burden of disease among NTDs in the Americas, in Europe <20% of infected are diagnosed and treated >55,585 persons per year would require etiological treatment, but around 6,500 people are annually treated by benznidazol and 1,500 people are annually treated by nifurtimox (2nd-line treatment). Treatment Parasitological and non-parasitological treatment. Treatment to stop/delay clinical evolution of Chagas disease. Access to specific treatments and protocols for their rational use. Tolerance to specific treatments, surveillance with early detection of side-effects and their rapid management/treatment. 21
  • 22. WHO Programme for International Drug Monitoring Full and Associate Member States Pharmacovigilance WHO Safety of medicines & Pharmacovigilance programme Quality and Safety: Medicines / Essential Medicines & Pharmaceutical Policies Innovative approach in the schools 22
  • 23. Collaboration / partnership Working together with PAHO, EURO and WPRO teams Partnership/interaction with governments WHO Technical Groups Collaboration with universities, scientific institutions Partnership with private companies, foundations, NGOs Listening to patient associations "We must not fail the billions who look to the international community to fulfill the promise of the Millennium Declaration for a better world" UN Secretary-General, Ban Ki-moon 23