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Epidemiological impact in the region

The average reduction of incidence in the Southern Cone countries is 94% as shown in Table 4.4. By cutting the transmission of the disease in the countries of the sub-region in this proportion, the incidence of Chagas disease in the whole of Latin America has been reduced by 70%: the number of incident cases was reduced from an estimated

700,000 new cases per year in the whole region in 1983 to less than 200,000 new cases per year in 2000 and to 41,200 in 2006. Also the annual number of deaths dropped

Table 4.4 Changes in epidemiological parameters due to interruption of transmission and decrease of incidence, 1990—2006

Epidemiological

parameters

1990

2000

2006

Annual deaths Annual new cases Prevalence (million) Population at risk (million) Distribution

>45,000

  • 700,000
  • 30
  • 100
  • 18 countries
  • 21,000
  • 200,000
  • 18
  • 40
  • 16 countries
  • 12,500
  • 41,200
  • 15
  • 28
  • 15 countries (transmission interrupted in Uruguay in 1997, Chile in 1999 and Brazil in 2006)

Source: World Health Organization/TDR. Report of the Scientific Working Group on Chagas disease, Buenos Aires, Geneva; 2006. p. 7.

from more that 45,000 to 12,500. The number of endemic countries was 18 in 1983 and in 2006 it was reduced to 15, as shown in Table 4.4.37

The intradomiciliary infestation by T. infestans has been eliminated in Brazil in 2006, in Chile in 1999, and in Uruguay in 1997.

At present, the major challenge is to ensure the sustainability of this program in an epidemiological context with very low T. cruzi infection rates and a political—institutional context of health sector reforms, where the decentralization of operations may result in the risk of the activities losing priority. The new institutional order requires that Chagas disease control be integrated into other services, and programs, and become part of a broader scheme for meeting the health needs of the population. In these circumstances the integrated activities must sustain the significant progress so far achieved in the way of elimination of Chagas disease.

 
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