World Health Assembly recognizes World Chagas Disease Day

On the eve of the 119th anniversary of Fiocruz, on May 25, the institution had a further reason to celebrate. On May 24, a resolution that designated April 14 as World Chagas Disease Day was approved. The announcement took place during the 72nd World Health Assembly (WHA), an annual gathering that brings together ministers of health from the 194 member states of the World Health Organization (WHO) and representatives of key world health institutions to discuss themes such as health emergencies and climate change. The president of Fiocruz, Nísia Trindade Lima, was in the entourage representing Brazil. The decision was be formalized on May 28, during the final plenary session of the Assembly.

"We need to break the silence about patients and make a commitment to prevention and treatment. Carlos Chagas called the disease that was named after him the 'disease of Brazil', a country that forgot its hinterlands. Today, more than a neglected disease, it has become a problem of neglected populations. By recognizing the importance of its prevention and treatment, WHO gives an example of the affirmation of the great motto of 2030 Agenda: 'no one left behind'", said Nisia during her speech at the Assembly.

Described in Brazil, 110 years ago, by doctor Carlos Chagas, a researcher at the Oswaldo Cruz Institute (IOC/Fiocruz), the disease is classified by WHO as a neglected tropical disease. Since the pioneering discovery, scientific research on the disease has been developed uninterruptedly at Fiocruz. 

With an estimate of more than eight million people affected worldwide, the mobilization for the visibility of the disease and for the recognition of a world awareness day started with patients and received intense support from the scientific and health community, including Fiocruz. 

The history of this mobilization began in 2009 at the Annual Meeting of Applied Research on Chagas Disease in Uberaba (MG), when the first Meeting of Associations of People of the Americas, Europe and the Pacific Affected by Chagas Disease was held. At the meeting, Simone Kropf, a researcher from the Casa de Oswaldo Cruz (COC/Fiocruz), presented and discussed her research into the history of the disease with representatives of the associations, in a collective reflection on how to relate the knowledge of history to the challenges of the present and the future. The meeting was a milestone for the creation, in 2010, of the International Federation of People with Chagas Disease, who began seeking, together with WHO, worldwide recognition of this important day.

Chosen as World Day, April 14 recalls the date of 1909 in which Carlos Chagas identified, for the first time, the parasite Trypanosoma cruzi, cause of infection, in a patient: Berenice, a 2-year-old girl living in Lassance, Minas Gerais. Published in the scientific journal "Memórias do Instituto Oswaldo Cruz” (Memoirs of the Oswaldo Cruz Institute), the description of the Chagas disease cycle was one of the most emblematic achievements of Brazilian science. In addition to characterizing the agent causing the infection and the set of symptoms, Carlos Chagas identified the transmitting insect: the triatomine, popularly known as the “kissing bug”. (photo: Berenice and her great-grandson / Courtesy to the collection of DAD/COC/Fiocruz: Bernardino Vaz de Melo)

110 years after the discovery, rates estimate that less than 10% of people with Chagas are diagnosed early enough and only 1% receive appropriate treatment. According to WHO, 65 million are at risk of contracting the infection. Like others neglected tropical diseases, it is associated with poverty. Precarious housing conditions favor the infestation of “kissing bugs”, which transmit T. cruzi. Since the disease may be silent in the acute phase, poor access to diagnostic services means that many patients do not receive the appropriate medication soon after the infection, when treatment can eliminate the parasite. In the chronic phase, after decades of infection, about 30% of individuals develop cardiac or digestive problems. These conditions may lead to death, but adequate diagnosis and treatment are able to prolong and significantly increase patients' quality of life.

In Brazil, according to the Ministry of Health, recent studies indicate that there are between 1.9 million and 4.6 million people infected by T. cruzi - the majority being chronic carriers - and Chagas disease is one of the four major causes of death due to infectious and parasitic diseases. In 2006, the country received the international certificate of elimination of Triatoma infestans, the main kind of “kissing bug” responsible for the domestic transmission of the infection. However, there are still residual vector outbreaks and other triatomine species present potential for the colonization of homes, reinforcing the importance of health surveillance and control actions. In addition, the oral transmission of the disease is a concern in the country. From 2008 to 2017, cases of this type were registered in 21 states of the country. Associated with outbreaks, oral infection occurs by the consumption of foods infected by T. cruzi, such as açaí berries or sugarcane juice, in which “kissing bugs” are accidentally crushed during the preparation of juices.

For a long time, Chagas disease was an infection restricted to the Americas, especially to Latin America. However, in the last two decades, the disease has spread to other continents, with cases registered in the United States, Canada and several in Europe, as well as Australia and Japan. Associated mainly with human migrations, the spread of the disease was also recorded in cases of blood transfusion and organ donation, since screening for infection was not performed in some countries. 

Carlos Chagas: the hinterland researcher 

Chagas was educated at the Faculty of Medicine of Rio de Janeiro in 1903, when the fight against yellow fever began by physician Oswaldo Cruz, then director general of public health and responsible for the Manguinhos Institute (which in 1908 became the Oswaldo Cruz Institute). The disease was a serious public health problem in the federal capital, plagued by recurrent epidemics that compromised economic movement in the port of the then federal capital. 

In 1908, Chagas became a researcher at the Oswaldo Cruz Institute, which, in addition to manufacturing vaccines and products to meet sanitary requirements, established a research and teaching center in the field of microbiology and tropical medicine. 

A specialist in malaria, the scientist was sent to Lassance, in the rural area of Minas Gerais, to combat an epidemic of the disease that interrupted works to expand the “Central do Brasil” railroad. When examining a hematophagous insect, popularly known as a “kissing bug”, common in the wattle and daub houses of the poor population in rural Brazil, Carlos Chagas identified a new species of Trypanosoma, which he named Trypanosoma cruzi in honor of Oswaldo Cruz.

On April 14, 1909, when identifying the parasite in the blood of a child of Lassance, he announced the discovery of the new disease, caused by this protozoan and transmitted by the “kissing bug”. This episode, a landmark in the history of Chagas disease, happened 110 years ago.