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Chagas Disease: A 2014 World Cup Yellow Card

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This post was co-authored by Bernard Pécoul.

As the most expensive World Cup ever is set to begin in Brazil, a "yellow card" warning must be raised about one of Latin America's most serious public health threats: Almost 6 million of the most vulnerable people living in the nine participating Latin American countries today do not receive treatment for their most debilitating neglected tropical disease.

Chagas disease is a leading cause of severe and life-threatening heart disease of the extreme poor in the Americas and gradually is becoming a disease that affects all social classes around the world. It is caused by a microscopic parasite known as a trypanosome that can be transmitted to humans when they are bitten by blood-feeding "kissing bugs" at night. Trypanosomes have the ability to invade human hearts and cause severe cardiac damage.

The disease affects mainly people who live in poverty, mostly because their poor-quality houses allow the "kissing bug" vector to thrive in the cracks and crevices of mud, brick and thatch. Throughout South and Central America it strikes those who live in squalor often not far from nearby areas of great wealth.

World Cup-participating nations such as Argentina, Brazil, Chile and Uruguay have made great strides in eliminating new transmission of Chagas disease through national programs of insecticidal spraying, but it remains a sad fact that most people living with Chagas disease are never tested for their illness, and less than 1 percent of these infected individuals have access to treatment. Instead they are mostly neglected by their medical communities, and allowed to become sick and die. More than 10,000 such people die every year of Chagasic heart disease. Brazil, Argentina and Mexico lead the world in terms of number of cases -- more than one million each -- and deaths.

Beyond its health impact, Chagas disease also causes an estimated $7 billion in global economic losses as infected people become too ill to work and the health care costs accumulate for managing heart disease. It comes as no surprise that a new study conducted in Mexico just determined that it is ultimately less expensive to treat a Chagas disease patient than not to treat.

The two medicines that can be used to treat Chagas disease have unwanted side effects but have the potential to cure a patient if he or she is caught early enough in the course of their disease. The primary drug, benznidazole, is being manufactured locally in Brazil -- in Pernambuco in the northeast of Brazil -- as well as by a second producer in Argentina. The other drug, nifurtimox, is available for free through an agreement between the World Health Organization (WHO) and Bayer, a German pharmaceutical company.

Our Global Chagas Disease Coalition of research and advocacy organizations works to encourage governments of the affected countries to identify and diagnose patients and put them on anti-parasitic therapy, supported by growing evidence of the efficacy of the current treatment for chronic patients, as well as accelerate research and development (R&D) for badly needed new health tools. A recent Coalition experts meeting found that most people living with Chagas disease are unaware of their illness until they develop advanced heart disease and by then it is too late for the medicines to be effective. Thus, much like other forms of heart illness or other chronic diseases such as cancer, early detection and treatment is the key to a successful therapeutic outcome.

Today, three-quarters of the world's Chagas disease patients live in the nine Latin American countries that will be represented in the 2014 FIFA World Cup in Brazil. Another 375,000 patients live in the United States where there is also evidence for Chagas disease transmission among the poor and in Spain, the most affected European country.

In parallel with scaling up screening and treatment of Chagas disease, R&D needs to be boosted to improve currently available diagnostics and to develop better and safer treatments or vaccines, all for improved individual patient care and sustainable, long-term disease control. For decades, scientists in Brazil, Argentina, and elsewhere in Latin America have conducted important, pioneering research on Chagas disease in the areas of diagnostics and treatment, as well as basic research that are now yielding results that could be translated into new drugs, and vaccines.

Ultimately, solving the Chagas disease problem in the Americas will require new public policies and the active participation of an alliance that includes governments, academia, affected communities, patient advocacy groups, the medical community, and the pharmaceutical industry.

The theme of the 2014 FIFA World Cup Brazil is "all in one rhythm." So far that rhythm could leave behind millions of Chagas disease sufferers in the Americas.

Peter Hotez, MD, PhD is Texas Children's Hospital Endowed Chair in Tropical Pediatrics, Dean of the National School of Tropical Medicine at Baylor College of Medicine, and President of the Sabin Vaccine Institute.

Bernard Pécoul , MD, MPH is Executive Director of the Drugs for Neglected Diseases initiative (DNDi).