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Future challenges

In spite of the progress achieved there are a number of future challenges to pursue on the way ahead. They can be divided into three categories: epidemiological, technical, and political.

Epidemiological

Oral transmission

This route of transmission is well established and documented67,68 (Ministerio da Saude/Brasil 200569,70). The most salient characteristic of the oral transmission is the fact that several persons are affected simultaneously pointing to the occurrence of a common source outbreak through contaminated food.

Table 4.5 Coverage of screening of blood for transfusion for T. cruzi (%) and proportion of positive samples in endemic countries, 2005

Country

Coverage of screening for T. cruzi (%)

Positive samples (%)

Southern cone

Argentina

100

2.47

Bolivia

80

8.0

Brazil

100

0.21

Chile

87

0.6

Paraguay

99

3.2

Uruguay

100

0.47

Andean countries

Colombia

100

0.44

Ecuador

100

0.15

Peru

99

0.57

Venezuela

100

0.6

Central America and Mexico

Belice

ND

0.4

Costa Rica

100

0.09

El Salvador

100

2.4

Guatemala

100

0.79

Honduras

100

1.4

Nicaragua

100

0.9

Panama

97.6

1.4

Mexico

100

0.51

ND, no data.

Source: Document OPS/HDM/CD/425-06, Reunion Iniciativa de los Palses de Centroamerica 2006, ReuniOn Iniciativa de los Palses Andinos 2006.

The challenge here is the prevention of the oral transmission via the ingestion of beverages such as the acai juice (Euterpe oleracea, Euterpa catinga) in the Brazilian Amazon region.

In other documented cases of outbreaks of oral transmission the contaminated food was served in family celebrations and in circumstances that were unpredictable. This was the case in the outbreaks of Teotonia, Catole do Rocha and Santa Catarina in Brazil (Nery-Guimaraes et al., 1968,67 Ministerio da Saiide/Brasil 2005) and in Caracas, Venezuela.70

The approach for prevention of these outbreaks is based on surveillance, prevention, and management similar to the control of diseases transmitted by food as recommended by a group of experts convened by the Pan American Health Organization (PAHO) in Brasilia in 2006.71

 
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