The evolution of Chagas disease (American trypanosomiasis) control after 90 years since Carlos Chagas discovery.

Chagas disease is one of the most serious parasitic diseases of Latin America, with a social and economic impact far outweighing the combined effects of other parasitic diseases such as malaria, leishmaniasis and schistosomiasis. Serological data indicate well over 16 million people are infected with the causative agent, Trypanosoma cruzi, with a further 100 million people considered at risk (WHO 1991). The World Bank, in 1993, calculated an annual loss due to Chagas disease of 2,740,000 ‘disability-adjusted life years’ (DALYs), representing an economic loss to the endemic countries of Latin America equivalent to over US$6.5 billion per year (WHO 1997, Schofield & Dias 1999). Control of Chagas disease is now given high priority by Latin American governments, partly because of its high economic impact and consequent financial benefits of effective control (eg. Schofield & Dias 1991, Akhavan 1996, Basombrio et al. 1998) but also because of the technical feasibility of control through the interruption of transmission. In 1991 a major regional initiative to eliminate Chagas disease was launched by the governments of Southern Cone countries (Argentina, Bolivia, Brazil, Chile, Paraguay, and Uruguay) (cf. Kingman 1991, Schofield & Dias 1999), which has recently been followed by similar initiatives in Andean Pact countries (Colombia, Ecuador, Peru, and Venezuela) and Central America (El Salvador, Guatemala, Honduras, Nicaragua) (Schofield & Dujardin 1997, WHO 1997).