Antonio Fuchs and Juana Portugal (INI/Fiocruz)
The Chagas Consortium of the Oswaldo Cruz Foundation (Fiocruz) has been selected in the first phase of the Unitaid call that aims to eliminate congenital transmisson of Chagas disease in endemic countries in Latin America. The goal of the initiative is to raise awareness on the disease and provide the much-necessary new diagnostic tools and therapeutic strategies, focusing on the reduction of mother-to-baby transmission, considered one of the main infection routes of the disease all over the world. Coordinated by the Evandro Chagas National Infectiology Institute (INI/Fiocruz), the Chagas Consortium - towards the elimination of congenital transmission of Chagas disease, boasts partnerships with other units of the Foundation, with Brazilian universities (UFC, UFF, UFRJ, UFBA, UFMG), in addition to the Ministry of Health and NGOs, such as the Drugs for Neglected Diseases initiative (DNDi) and Latin America Foundation for Innovative New Diagnostics (FIND). With activities scheduled to take place in Bolivia, Brazil, Colombia and Paraguay, the consortium will be working for four years, focusing its actions on two axis: the first involves a research of implementation in target municipalities in the four participating countries, designed to improve access and demand for existing services focused on Chagas disease; the second aims to develop diagnostic tools and innovative treatments to fight the disease.
“We are living very difficult times right now with the Covid-19 Pandemic, but it is crucial that we do not forget the other diseases, especially the ones that are endemic in our countries and affect the poorest and most marginalized populations. We cannot allow diagnosis to be delayed and treatments to be interrupted as it is happening in many countries. This call shows an increased global attention and country commitment to fight Chagas disease and help bring better science to the neglected populations.”, highlighted Fiocruz president, Nísia Trindade Lima. “We are certain this project will be very successful, and hopefully we will be able to scale up our good practice to other endemic countries in Latin America”.
For the principal investigator of the Chagas Consortium and researcher of the Laboratory of Clinical Research on Chagas Disease of INI/Fiocruz, Andréa Silvestre, Chagas diseases has been going through a historical moment all over the world, as new investments are coming in, the result of the dissemination of public calls by funding agencies. “We believe that with our clinical trial and with the development of new diagnostic tools, it will be possible to reach the final goal of the project proposed by Unitaid, which is to eliminate congenital transmission of this disease that is so prevalent in Latin America”, she emphasized.
To develop the activities proposed, the consortium will be carrying out a study on the knowledge, attitudes, practices and perceptions of people with Chagas diseases, their communities and health professionals, to understand the different dimensions of vulnerability in the areas where the project will be implemented. In addition, an international, randomized and multicentric clinical trial involving 1200 patients, 300 of each country, will have the goal of supporting changes to the guidelines of national policies and to the treatment administered. It is expected that this clinical trial will find a new therapeutic regime that is as effective as the standard treatment (the drug currently use to treat Chagas disease is benznidazole), but safer for the patients. In addition, the group will also be assessing new diagnostic tools for chronic and congenital Chagas disease.
Coordinated by the Evandro Chagas National Infectiology Institute (INI), the Chagas Consortium at Fiocruz brings together researchers of the Sergio Arouca National School of Public Health (Ensp), of the Oswaldo Cruz Institute (IOC), the Institute of Scientific and Technological Communication in Health (Icict), Casa de Oswaldo Cruz Institute (COC), Immunobiological Technology Institute (Biomanguinhos), the Institute of Drug Technology (Farmanguinhos), the National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), the Gonçalo Moniz Institute (Fiocruz Bahia), the René Rachou Institute (Fiocruz Minas), and of the Carlos Chagas Institute (Fiocruz Paraná). As international partners, it boasts the Instituto Nacional de Laboratorios de Salud (National Institute of Health Laboratories - Inlasa), of Bolivia, the Instituto Nacional de Salud (National Health Institute - INS) of Colombia, and the Servicio Nacional de Erradicación del Paludismo - Senepa (National Service for Malaria Erradication), of Paraguay, in addition to the Drugs for Neglected Diseases initiative (DNDi) and Latin America Foundation for Innovative New Diagnostics (FIND).
Unitaid is a global health initiative that works through several partnerships in the search for innovations to prevent, diagnose and treat important diseases in a more accessible, effective and rapid manner, in countries with low and medium income. Its emphasis is on tuberculosis, malaria, and HIV/Aids, among others, thus providing better access to healthcare services to the populations that need them the most. The initiative has innovated and launched, for the first time, a public call focused on Chagas disease and Latin America.
Chagas disease is an infectious fever disease caused by protozoa Trypanosoma cruzi, whose vectors are the triatominea, insects also known as kissing bugs. From the clinical perspective, the disease presents two different phases (acute and chronic) and is endemic in 21 countries of the Americas. It affects about six million people, with an annual incidence of 30,000 new cases in the region, resulting in an average of 14 thousand deaths per year and 8 thousand newborn infected during pregnancy. It is estimated that about 70 million people live in exposure areas and are at risk of contracting the disease.
According to estimates, in Brazil at least one million people have been infected by T. cruzi at some point in their lives. In 10 years (from 2008 to 2017), 46,568 deaths were recorded as having Chagas as their basic cause, of which 4,543 occurred in 2017 only.
According to the Ministry of Health, in 2019 there were 380 cases of acute Chagas disease in Brazil, of which 92% occurred in the northern region, mainly in the state of Pará (290 cases). The incidence of the acute disease was 0.18 cases per 100,000 inhabitants.